Airway Stepping Stones

An ongoing collection …

 

Have suction(s) on and ready and head of bed up As Soon As Possible for all airways: BLS BVM SGA ETT and/or FONA

If there is time, do a formalized checklist

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Front of Neck Access/Surgical Airway Kits

Continue reading “Front of Neck Access/Surgical Airway Kits”

Bloody cric trainer/sim

Collection of resources and ideas for surgical airway front of neck access trainer/simulation. Contact me to chat about it if you wish further details. Follow me on twitter @TBayEDguy and we will direct message to chat.

Ideas

Checklists List

A collection of different checklist options and ideas

http://emcrit.org/podcasts/intubation-checklist-2-0/

 

 

Bimanual Visualized ELM

The following is a great example from Ricardo Urtubia showing how effective laryngeal manipulation can be in exposing the larynx. Note that in this case, once ELM is taken off, the laryngeal view is lost. This may be because the patient was not optimally positioned first with head elevation and ear to sternal notch positioning. Often, as mentioned above, ELM will seat the blade tip optimally within the valleculae to engage the hyoepiglottic ligament and lift the epiglottis indirectly and allow a good view without the need to continue to maintain ELM.

https://vimeo.com/178328945

[Update 2016-08-10] Ricardo further points out his opinion that ELM stabilizes the laryngeal complex to assist tube delivery into the trachea and thus should be maintained by an assistant.

On further thinking, this makes sense to train one’s assistant to practice this and do it routinely especially for those cases where ELM must be maintained for optimal laryngeal exposure and may be helpful for a difficult tube delivery (small spaces, larger ETT, hyperangulated indirect (“video laryngoscopic” or VL) approach etc).

The only downside of maintained ELM is when it is applied blindly (usually under direct laryngoscopy only (DL) circumstances), the exposure may become suboptimal or too much pressure is used and hampers tube delivery. VL/DL combination and trained/briefed assistants can avoid this issue.

 

Cadaver Study Novice Cricothyrotomy via Scalpel-Finger-Hook-Shiley vs. Melker vs. QuickTrach

Perioperative Medicine  |   August 2016

Emergency Cricothyrotomy Performed by Surgical Airway‚Äďnaive Medical Personnel: A Randomized Crossover Study in Cadavers Comparing Three Commonly Used Techniques

Success rates (P = 0.025)

Surgical cricothyrotomy 95%,
QuickTrach 55%
Melker 50%
The majority of failures were due to cannula misplacement (15 of 20).
Few significant complications were found in successful procedures. No cadaver biometric parameters were correlated with success of the procedure.

Mean procedure time in successes (P < 0.001)

Surgical cricothyrotomy¬†94‚ÄȬĪ‚ÄČ35‚ÄČs
QuickTrach II 77‚ÄȬĪ‚ÄČ34 s
Melker 149‚ÄȬĪ‚ÄČ24 s .

http://anesthesiology.pubs.asahq.org/article.aspx?articleid=2528137

Heymans et al, Emerg Cric Naive Cadavers Three Techniques, Periop Med 2016

via and thanks to Mohammed Asiri

po: compact perpetual SALAD

Refinements on SALAD Sim

#CreativeThinking

A po¬†…¬†moves thinking forward …¬†new ideas or solutions …¬†lateral thinking technique …¬†an extraction from …¬†hypothesis, suppose, possible and poetry

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