Speed vs Risk

RE: Speed vs Risk

Anthony Todd — Thu, 18 Jan 2018 20:01:38 GMT

Touche!

RE: Speed vs Risk

Martin Atkinson — Thu, 18 Jan 2018 17:03:11 GMT

Erm...she's not there which why I'm doing it single handed?!

RE: Speed vs Risk

Anthony Todd — Thu, 18 Jan 2018 15:44:01 GMT

Wot's the obligatory nurse doing meantime?

Apart from saying "that's amazing!"

RE: Speed vs Risk

Martin Atkinson — Thu, 18 Jan 2018 15:19:57 GMT

[quote user="Robin Grimmer"]

The original question was about how to intubate cats single handed.

[/quote]Presuming cat is anaesthetised with triple/quad combo as I take it we're on our own: place gag in mouth; hold up head with non-dominant hand and use thumb and forefinger of dominant hand to pull tongue forward; secure tongue with forefinger of non-dominant hand; spay lidocaine on larynx; wait 30 secs repeat with tube now in dominant hand; slide tip over epiglottis and Bob's your uncle it's in the trachea.

If you can't do this its not my fault you are not ambidextrous or have poor fine motor skills.

RE: Speed vs Risk

Rob Loxley — Thu, 18 Jan 2018 15:06:26 GMT

[quote user="Anthony Todd"]For a compulsory time delay, why not spray the larynx, clip-up the cat, then tube??[/quote]

Having to re-position the cat?

RE: Speed vs Risk

Robin Grimmer — Thu, 18 Jan 2018 14:55:33 GMT

The original question was about how to intubate cats single handed.

RE: Speed vs Risk

Martin Atkinson — Thu, 18 Jan 2018 14:50:54 GMT

Another who can't understand why anyone has difficulty tubing a cat it seems pretty easy to me. And just for the record I tubed two rabbits this morning with a 2.5 mm uncuffed tube, one 2 kg the other 1.5, again easy with the right technique down to <1 kg.

RE: Speed vs Risk

Julie Innes — Thu, 18 Jan 2018 14:41:53 GMT

[quote user="Edward Jones"]

When I've used intubeze on myself it works pretty much instantly.

[/quote]

Just wondering why?! (I'm assuming we're not now into "it's so easy I've intubated myself, whilst unconcious" territory...)

RE: Speed vs Risk

Julian Earl — Thu, 18 Jan 2018 13:31:12 GMT

Sorry if my choice of language was misleading. I think that Intubeaze does have some immediate effect but waiting is evidently better. Once anaesthetized the larynx does open making tubing relatively easy even for someone inexperienced..

The clipping first idea makes sense. Good advice in any event.

RE: Speed vs Risk

Anthony Todd — Thu, 18 Jan 2018 12:39:55 GMT

[quote user="Evelyn Barbour-Hill"]Because it takes longer than 30 seconds to clip up?[/quote]

What? A C/S?? Spray, clip up, tube, prep. Just a thought....

And the spray will still be effective, probably even more effective??

RE: Speed vs Risk

Evelyn Barbour-Hill — Thu, 18 Jan 2018 12:17:14 GMT

[quote user="Anthony Todd"]For a compulsory time delay, why not spray the larynx, clip-up the cat, then tube??[/quote]

Because it takes longer than 30 seconds to clip up?

RE: Speed vs Risk

Edward Jones — Thu, 18 Jan 2018 12:13:11 GMT

When I've used intubeze on myself it works pretty much instantly.

RE: Speed vs Risk

Anthony Todd — Thu, 18 Jan 2018 11:36:12 GMT

[quote user="Kate Richardson"]You have to wait 30-6o seconds before passing the tube. That's why most people struggle, they don't wait long enough.[/quote]

Spot on I think!

For a compulsory time delay, why not spray the larynx, clip-up the cat, then tube??

RE: Speed vs Risk

Kate Richardson — Thu, 18 Jan 2018 11:32:12 GMT

1 accurate spray of Intubeaze is generally all that is needed. Care with words like soaking or dousing the larynz- it is possible to overdose cats quite easily with lignocaine. Especially if you are using it for other nerve blocks during the procedure eg dentals.

You have to wait 30-6o seconds before passing the tube. That's why most people struggle, they don't wait long enough.

RE: Speed vs Risk

Anthony Todd — Thu, 18 Jan 2018 11:27:09 GMT

Thanks; would have helped 20 years ago....

So "spray and count to ten" is one key [most I've seen don't even wait at all!]

How many squirts of intubeze??

RE: Speed vs Risk

Julian Earl — Thu, 18 Jan 2018 10:19:40 GMT

[quote user="Anthony Todd"]And then you say "soak the region" WTF does that mean? and how to you decide "when the larynx relaxes and opens spontaneously" and does that happen in "30 seconds". which prep; some just use a squirt of lignocaine??[/quote]

By soak, I mean douse the area. It is not an objective measure but one can usually see the film from the spray on the larynx or pharynx. I decide it opens spontaneously because one can see it happen! It occurs five to 10 seconds after the spray and often it is then so open that a tube fits through very easily or comfortably indeed. If it is too soon, then the larynx closes on the tube as reflex when touched. Waiting those few seconds more avoids that. Brand? Intubeaze.

RE: Speed vs Risk

Anthony Todd — Wed, 17 Jan 2018 16:08:11 GMT

[quote user="Julian Earl"]Where to spray?[/quote]

Well I've seen the tongue, the hard palate, the back of the throat etc but there'll be trick or a tip; there always is!

And then you say "soak the region" WTF does that mean? and how to you decide "when the larynx relaxes and opens spontaneously" and does that happen in "30 seconds". which prep; some just use a squirt of lignocaine??

So in the first reply I've got queries, but perhaps modvets will have sussed it completely.....

PS, I've just realised some of us are left-handed, some right......

RE: Speed vs Risk

Julian Earl — Wed, 17 Jan 2018 15:53:51 GMT

[quote user="Anthony Todd"]

Should be able to do it with a phone camera/video! Evelyn????????

We'll need a narrative too, like the time between local spray and attempt, to say nothing of where to spray!

I'll bet lots of us [or you's] say "Ah, yeah, now I get it". Too late for me and others I reckon

[/quote]

A goodidea Anthony but I'm confused. Where to spray?" Is there a choice? I can see the point about the time-interval but doesn't one just aim the aerosol at the epiglottis and larynx, soak the region wait thirty seconds, or until the larynx relaxes and opens spontaneously after about 30 seconds? , That is what I used to do. Worked for me, always!

RE: Speed vs Risk

Anthony Todd — Wed, 17 Jan 2018 14:36:27 GMT

[quote user="Julian Earl"]Tubing cats is probably one of them.[/quote]

I hope someone makes the video soon. I've seen lots of good vets struggling! [including me]

Should be able to do it with a phone camera/video! Evelyn????????

We'll need a narrative too, like the time between local spray and attempt, to say nothing of where to spray!

I'll bet lots of us [or you's] say "Ah, yeah, now I get it". Too late for me and others I reckon.

RE: Speed vs Risk

Bob Russell — Wed, 17 Jan 2018 09:20:02 GMT

The lack of 'useful' research outside the universities is not nigh on criminal. It is a shame but completely understandable when you consider how little funding is available.

Human medicine has an almost unlimited budget based on potential profits. Veterinary medicine is on a shoe-string and perhaps we should be congratulating ourselves on how good a job we manage under 'impoverished' conditions.

RE: Speed vs Risk

Julian Earl — Tue, 16 Jan 2018 23:06:49 GMT

[quote user="David Mills"]I thought everyone could solo tube? Hardly rocket science.[/quote]

Blimey I agree completely with David! I would suggest that over the years I've seen a lot of examples of mountains being made from molehills when things should not be that complicated. Tubing cats is probably one of them.

RE: Speed vs Risk

Michael Woodhouse — Sat, 23 Dec 2017 23:14:40 GMT

[quote user="David Mills"]Universities want people fresh out, internship then residency. They don't care a damn for general practice experience. Go and apply if you don't believe me [/quote]

I know some surgical specialists who've never spent a day working in general practice. A number of people applied for internships straight from college.

RE: Speed vs Risk

David Mills — Sat, 23 Dec 2017 22:37:38 GMT

[quote user="Chris Milligan"]how many years stacking shelves is enough?[/quote]

Is this how you see general practice? Enlightening 98% of the profession are shelf stackers

[quote user="Chris Milligan"]how many weeks of spays do you need to do before you have an appreciation of how to do them?[/quote]

Oh, darling, many, many years I'm afraid.

The issue with specialists in the vet profession is this. To be a consultant in the human surgical world you need at least 10k of hours practical experience. Most specialists in the etc world have dipped their toe for a couple of years then observed for a couple of years.

I've no idea how old you are. But do you think after 2 years you have a true appreciation of general practice?? God help you if so. Show some humility, old fruit.

[quote user="Chris Milligan"]to be admitted to a residency program in most of the university hospitals you need at least 2 years in general practice (usually more) +/- internship and, depending on the specialism, have 1 or 2 peer-reviewed publications. Most Cambridge residents for instance have been in practice for 3+ years before getting admitted to the SCTS program[/quote]

Le sigh.

Universities want people fresh out, internship then residency. They don't care a damn for general practice experience. Go and apply if you don't believe me [quote user="Chris Milligan"]Evidence based medicine means it's a work in progress.[/quote]

?!?

[quote user="Chris Milligan"]ok you're going to have to explain these two sentences to me[/quote]

I'm sure you'll figure it out.

All anaesthetised animals are in a critical state Lord save us.

RE: Speed vs Risk

Chris Milligan — Sat, 23 Dec 2017 20:25:10 GMT

[quote user="David Mills"]Here's a little task. Go and see how much evidence there is for comminuted humoral fractures in cats. You'll be amazed.[/quote]

I'm sorry, I forgot to put the usual disclaimer in my comments that the sum of all human knowledge hasn't been elucidated yet. Evidence based medicine means it's a work in progress. I'll tell you what will amaze people - how little useful research is done outside of a university setting in this profession, which compared to the human field is nigh-on criminal.

[quote user="David Mills"]God bless America. what a ludicrous statement.[/quote]

ok you're going to have to explain these two sentences to me

RE: Speed vs Risk

Chris Milligan — Sat, 23 Dec 2017 20:21:49 GMT

[quote user="David Mills"]"after a couple of years in general practice" etc etc[/quote]

how many years stacking shelves is enough? how many weeks of spays do you need to do before you have an appreciation of how to do them?

to be admitted to a residency program in most of the university hospitals you need at least 2 years in general practice (usually more) +/- internship and, depending on the specialism, have 1 or 2 peer-reviewed publications. Most Cambridge residents for instance have been in practice for 3+ years before getting admitted to the SCTS program