Because minutes matter

July 25th, 2017

Tyler Hedman, MD, won’t soon forget his most challenging intubation, a trauma patient stomped in the head by a bull. The patient’s face was crushed, mangled so badly and bleeding so much that the path to an airway was not immediately clear.

Drs. Tyler Hedman and Keegan Bradley practice

Drs. Tyler Hedman and Keegan Bradley practice intubation during the Difficult Airway Course, advanced training for residents.

Now a third-year resident, Hedman has had lots of practice. While 35 intubations are required for graduation, the average Emergency Medicine resident at JPS has done 50 by the end of the first year. And that’s what it takes to get good at it, says program director Jo Anna Leuck, MD. “Practice, practice, practice. You can’t get that from books or Power Points.”

Hedman has also had the benefit of advanced training in a simulation environment, which JPS provides for residents to advance their skills in a low-risk environment without the pressure of a patient’s imminent demise. Emergency Medicine Residency faculty members teach the Difficult Airway Course for residents in Emergency Medicine, Family Medicine and Surgery. More than 75 residents completed the course last week, practicing on interactive robotic mannequins and reviewing case studies with attending physician instructors.

Dr. Ryan Stroder demonstrates

Dr. Ryan Stroder demonstrates the use of fiber optics in placement of a breathing tube.

Intubation is the placement of a breathing tube down the windpipe of a sedated patient. As well as knowledge of the procedure itself, doctors must be able to anticipate who will need intubation and when, requiring keen assessment skills. Doctors must decide which drugs to use to prepare the patient, accounting for the side-effects of each option. Some sedatives are likely to cause a drop in blood pressure — not good for the patient who has lost a lot of blood. Finally they must decide which equipment to use, and get the patient in proper position, all in a matter of minutes.

When a patient isn’t getting enough oxygen, “it’s not enough to know what to do,” said instructor Veer Vithalani, MD. “You have to know what to do, but then you have to know what you’re going to do if that doesn’t work, and then what to do if that doesn’t work.”

The Difficult Airway Course “allows you to cement your foundation,” said Hedman, and get hands on training with newer tools such as advanced fiber optic cameras. “You have to know when to use them, and how to use them appropriately.”

Hospitals are not required to provide simulation training for residents. “This is a JPS investment in our residents and in our patients,” said Leuck


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