Podcasts about cricothyroidotomy

Theme: Retrieval Medicine. Participants: Dr Ruby Hsu, Dr Ruth Parsell, Dr Pramod Chandru, Shannon Townsend, Yelise Foon, Shreyas Iyer and Samoda Wilegoda Mudalige.Discussion 1:Benoit, J., Stolz, U., McMullan, J., & Wang, H. (2021). Duration of exposure to a prehospital advanced airway and neurological outcome for out-of-hospital cardiac arrest: A retrospective cohort study. Resuscitation, 160, 59-65. https://doi.org/10.1016/j.resuscitation.2021.01.009.Presenter - Yelise Foon - ED senior resident medical officer. Summary: This study was a retrospective cohort study that looked at adult, non-traumatic OOHCA patients with an advanced airway (supraglottic or endotracheal). The timing of airway placement (intra-arrest versus post-ROSC) and patient outcomes (with respect to the cerebral performance category, or CPC) were analyzed.  They observed a higher CPC in the group that had the advanced airway placed post-ROSC (i.e. 21.7% in post-arrest group versus 7.5% in intra-arrest group). They concluded that the timing of the airway placement was not associated with poor neurological outcomes.  Discussion 2:Aziz, S., Foster, E., Lockey, D., & Christian, M. (2021). Emergency scalpel cricothyroidotomy use in a prehospital trauma service: a 20-year review. Emergency Medicine Journal, 38(5), 349-354. https://doi.org/10.1136/emermed-2020-210305.Presenter - Shannon Townsend, ED advanced trainee at Orange Health Service.Summary & Take-Home Points: This was a retrospective observational study conducted from 2000 to 2019 using clinical records and aimed to (1) ascertain the rate of scalpel cricothyroidotomy and (2) understand indications for and factors associated with this procedure. They observed that the main indication for scalpel cricothyroidotomy was as a rescue airway (for failed laryngoscopy due to a large volume of blood in the airway). They noted high levels of procedural success, but the overall mortality in patients receiving this procedure was high (due to a number of factors).  The rate of scalpel cricothyroidotomy has decreased over the years due to factors such as the introduction of supraglottic airways and longer-acting muscle relaxants (rocuronium versus suxamethonium).  It is important to remember that, if we optimize our intubation conditions (e.g. improving patient position, carefully choosing drugs and equipment according to patient's clinical situation), we are likely to increase our first pass success with laryngoscopy.  It is important to (1) recognize the indications for scalpel cricothyroidotomy, (2) be familiar with the procedure itself, (3) overcome the mental barriers against performing it, and (4) perform it confidently and competently. Discussion 3:Sperry, J., Guyette, F., Brown, J., Yazer, M., Triulzi, D., & Early-Young, B. et al. (2018). Prehospital Plasma during Air Medical Transport in Trauma Patients at Risk for Hemorrhagic Shock. New England Journal Of Medicine, 379(4), 315-326. https://doi.org/10.1056/nejmoa1802345.Presenter - Dr Ruth Parsell. Summary: In this pragmatic, multi-center, cluster-randomized, phase 3 superiority trial, the efficacy of administering thawed plasma to patients at risk of haemorrhagic shock was studied.  The comparative arm was standard-care resuscitation (with crystalloid fluids). The primary outcome was mortality at the 30-day mark.  They concluded that administration of thawed plasma to patients at risk of haemorrhagic shock resulted in (1) lower 30-day mortality and (2) lower median prothrombin-time ratio.  Interlude Segment 1:Presenter - Dr Ruth Parsell. Interlude Segment 2:Presenter - Dr Ruby Hsu.Credits:The discussions were mediated by retrieval specialists and ED consultants, Dr Ruby Hsu and Dr Ruth Parsell and ED consultant Dr Pramod Chandru. This episode was produced by the ­­­­Emergency Medicine Training Network 5 with the assistance of Dr Kavita Varshney, Deepa Dasgupta, Cynthia De Macedo Franco, and Paul Scott.Music/Sound Effects Beach Volley by Scandinavianz | https://soundcloud.com/scandinavianz, Music promoted by https://www.free-stock-music.comCreative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US.  Hands High by LiQWYD | https://www.liqwydmusic.com, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US.  Lose My Mind by ASHUTOSH | https://soundcloud.com/grandakt, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US.  Medical Examination by MaxKoMusic | https://maxkomusic.com/, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution-ShareAlike 3.0 Unported, https://creativecommons.org/licenses/by-sa/3.0/deed.en_US.  Nightswim by Scandinavianz | https://soundcloud.com/scandinavianz, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. Sol by Scandinavianz | https://soundcloud.com/scandinavianz, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US.  Sound effects from https://www.free-stock-music.com. Sunrise by Roa Music | https://soundcloud.com/roa_music1031, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US. The Leap by Sapajou | https://soundcloud.com/sapajoubeats, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US.  Thinking Of You by Ron Gelinas Chillout Lounge | https://soundcloud.com/atmospheric-music-portal, Music promoted by https://www.free-stock-music.com, Creative Commons Attribution 3.0 Unported License, https://creativecommons.org/licenses/by/3.0/deed.en_US.  ~Thank you for listening!Please send us an email to let us know what you thought.You can contact us at westmeadedjournalclub@gmail.com.You can also follow us on Facebook, Instagram, and Twitter!See you next time,Caroline, Kit, Pramod, Samoda, and Shreyas.

In this follow-up episode to our discussion with Dr. Scott Weingart of EMCrit, we review the indications for performing a resuscitative thoracotomy, together with the potential application of a circulation first resuscitation strategy, and some intricacies regarding performing a surgical cricothyroidotomy.

Knife. Finger. Tube. Sounds simple enough. And you read correctly....a bougie is both unnecessary and superfluous! In this episode I share you some tricks of the trade for performing a cric successfully, together with post-surgical airway considerations including hemorrhage control and the decision to convert to a formal tracheostomy.

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How to use the cric models and optimal surgical airway technique.

Surgical Cricothyroidotomy (Bougie Assisted) A surgical cricothyroidotomy is indicated by the 2017 NYS EMS collaborative protocols to be performed by paramedics when the patient cannot be adequately ventilated and oxygenated by any other method. In these “can’t intubate, can’t oxygenate” (CICO) situations, a rapid, effective surgical cricothyroidotomy may be lifesaving.  This module depicts a simple and effective technique for emergent field surgical cricothyroidotomy utilizing equipment commonly found on the ambulance. Cast in Alphabetical Order: Michael T. Benenati, BS, AAS, EMT-P Tyler F. Cominsky, NRP Seth Goldstein, BA, AS, AEMT-P/CIC Susie Surprenant, BBA, BS, NRP David Violante, MPH, MPA, AEMT-P Faizan H. Arshad, MD @emscritcare Christopher J. Fullagar, MD, EMT-P, FACEP @87MD1

This week we discuss facial trauma and the disasters it can cause to your airway management. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_79_0_Final_Cut.m4a Download 2 Comments Tags: Airway, Cricothyroidotomy, RSI, Trauma Show Notes Take Home Points In a patient with significant head and neck trauma, EACH step of the airway management can be more difficulty. BVM may be hard, LMA may be hard, RSI may be hard, so don't be afraid to ask for help early. Decide whether the patient has an actual obstruction of their airway. If they are obstructed above the larynx, don't bother with your usual airway maneuvers, go directly to the surgical airway. When you do attempt RSI, have double suction and multiple airway techniques set up. This is the time to have your friend standing at your side, scalpel in hand and ready to move directly down the difficult airway algorithm if trouble arises. Finally, consider keeping the patient awake and preserving their own respiratory drive as it may give you more time to secure the airway. Read more LITFL: Facial Trauma LITFL:

This week we discuss facial trauma and the disasters it can cause to your airway management. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_79_0_Final_Cut.m4a Download 2 Comments Tags: Airway, Cricothyroidotomy, RSI, Trauma Show Notes Take Home Points In a patient with significant head and neck trauma, EACH step of the airway management can be more difficulty. BVM may be hard, LMA may be hard, RSI may be hard, so don’t be afraid to ask for help early. Decide whether the patient has an actual obstruction of their airway. If they are obstructed above the larynx, don’t bother with your usual airway maneuvers, go directly to the surgical airway. When you do attempt RSI, have double suction and multiple airway techniques set up. This is the time to have your friend standing at your side, scalpel in hand and ready to move directly down the difficult airway algorithm if trouble arises. Finally, consider keeping the patient awake and preserving their own respiratory drive as it may give you more time to secure the airway. Read more LITFL: Facial Trauma LITFL:

Bouncing Back from the Beach – Cutting to Air to secure an Emergency Surgical Airway Summary by: Thomas Dolven To handle airways means being prepared to handle them all the way. You need to be prepared for a cannot intubate cannot oxygenate CICO scenario. The common, final end point of airway management in a is the emergency surgical airway, the cricothyroidotomy. So how to prepare?Often, it is not being taught right. This is a rare procedure under high stress and time sensitive. And most importantly, it is a bloody procedure that will be blind. You cannot use your eyes. So it needs a simple technique without fine motor skills, and it must be tactile. Your finger is the perfect tool for this task, and will guide you through it. The video of my personal real world experience is backed by available empirical evidence and lab training. There will never be an RCT, this is the best evidence we will have. So read NAPP4 and the case series article on the scalpel-finger-tube technique. Read these available articles, train, and remember these two key points:1) There will be blood. But that’s OK, because.2) Your finger can see.

This week we discuss some of the dangers of blood transfusions and pearls from our procedure workshops. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Core_EM_Podcast_12_Final.m4a Download Leave a Comment Tags: Blood Transfusions, Cricothyroidotomy, Lateral Canthotomy, Tube Thoracostomy Show Notes Cricothyrotomy Resources EMCrit: EMCrit Wee – Mind Blowing Cricothyrotomy Video ACEP Now: Tips and Tricks for Performing Cricothyrotomy Tube Thoracostomy University of Maryland EM: Tube Thoracostomy Lateral Canthotomy Resources Rowh AD et al. Lateral canthotomy and cantholysis: emergency management of orbital compartment syndrome. J Emerg Med 2015. 48(3):325-330. PMID: 25524455 Larry Mellick: Emergency Lateral Canthotomy and Cantholysis

This week we discuss some of the dangers of blood transfusions and pearls from our procedure workshops. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Core_EM_Podcast_12_Final.m4a Download Leave a Comment Tags: Blood Transfusions, Cricothyroidotomy, Lateral Canthotomy, Tube Thoracostomy Show Notes Cricothyrotomy Resources EMCrit: EMCrit Wee – Mind Blowing Cricothyrotomy Video ACEP Now: Tips and Tricks for Performing Cricothyrotomy Tube Thoracostomy University of Maryland EM: Tube Thoracostomy Lateral Canthotomy Resources Rowh AD et al. Lateral canthotomy and cantholysis: emergency management of orbital compartment syndrome. J Emerg Med 2015. 48(3):325-330. PMID: 25524455 Larry Mellick: Emergency Lateral Canthotomy and Cantholysis

This week we discuss some of the dangers of blood transfusions and pearls from our procedure workshops. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Core_EM_Podcast_12_Final.m4a Download Leave a Comment Tags: Blood Transfusions, Cricothyroidotomy, Lateral Canthotomy, Tube Thoracostomy Show Notes Cricothyrotomy Resources EMCrit: EMCrit Wee – Mind Blowing Cricothyrotomy Video ACEP Now: Tips and Tricks for Performing Cricothyrotomy Tube Thoracostomy University of Maryland EM: Tube Thoracostomy Lateral Canthotomy Resources Rowh AD et al. Lateral canthotomy and cantholysis: emergency management of orbital compartment syndrome. J Emerg Med 2015. 48(3):325-330. PMID: 25524455 Larry Mellick: Emergency Lateral Canthotomy and Cantholysis

Matthew Mac Partlin talks about emergency airways access. Make sure you listen or watch this on www.intensivecarenetwork.com before Matthew's workshop on cricothyroidotomy at BCC Cairns!