Today I had my first interview for band 5 newly qualified theatre practitioner. To say I was nervous is understating considerably. First interview and the imagined added pressure of many of my cohort already having jobs lined up. I am greeted in the theatre department by a very apolagectic team leader for how late they were running and led into the room. I am trying to remember what happened but it was just a complete blur. My mind was racing with CQC statistics, Francis Report knowledge, trust policies, emergency procedures,etc aaaaaaarrrggghhhh interview prep.
Of course they asked me nothing on any of these things and I came away feeling annoyed that I had to be prompted on one question, this would surely go against me. I have settled with myself that it is invaluable experience for when I interview in the trust I’m training in even if nothing comes of it.
I arrived home an hour later
In my inbox was an email
Thank you for attending for interview today, the interview went very well and we are delighted to be able to give you a conditional offer of a Band 5 Theatre practitioner post in our Emergency Theatre. The HR department will be in contact with you in due course and support you through the remainder of the process.
This just got very, very real.
Bring it on.
![anaestheticroom:
Cricoid pressure, commonly called the Sellick maneuver,1 has many uses in emergency airway management. Although simple to perform, the Sellick maneuver requires explanation:
Locate the cricoid cartilage, larynx, trachea, and the hyoid bone by palpation so that pressure is applied to the right structure. Hold the cricoid cartilage between the thumb and the middle finger. Place the index finger on the cricoid cartilage. Push the cricoid cartilage backward against the spine. Push with about 9 pounds of pressure (40 Newtons). Use common sense. If the patient is at risk for a cervical spine fracture, use less pressure.
The primary purpose of this pressure is to collapse the esophagus between the cricoid cartilage and the spine. This prevents regurgitation of gastric contents. a It is not intended to prevent vomiting. Patients who vomit have active gag reflexes. If you are applying cricoid pressure and the patient vomits, let go and let the patient cough out the vomitus. Log roll the patient to ease this process and to suck out the vomitus with a suction tip.
During orotracheal intubation, the person who performs cricoid pressure must maintain this pressure from the onset of the procedure until the ET tube has been inserted and tested for correct placement (esophageal intubation detector [EID], CO2 detection, breath sounds, etc.) and the cuff of the ET tube has been inflated.
One can press too hard. If the intubator is having difficulty getting the endotracheal tube introducer (ETI) or the ET tube into the trachea, you may be obstructing the larynx with too much pressure. Ease up the pressure momentarily and let the tube in.
If the intubator is having difficulty visualizing the larynx, move the cricoid cartilage from side to side. If the intubator is looking at the esophagus, it will not move.
If the intubator inserts the laryngoscope blade too deeply, you will feel the larynx being lifted by the blade. If this occurs, inform him or her. As the blade backs out, you will feel the larynx fall back when it reaches its correct position.
If the intubator uses an ETI, you will feel the tip of it run over the tracheal rings. This feels like a washboard sensation. If you feel this effect, it is positive confirmation of correct placement of the ETI. Inform the intubator.
Another important use for cricoid pressure is to prevent filling of the esophagus and stomach with air during use of a bag-valve-mask.
Got to get some more cricoid pressure experience in](http://25.media.tumblr.com/0cd54f87358dcaa796414b90f326efe3/tumblr_mj3m3cqjvK1qc7n4go1_500.jpg)
