BCE 71 Cricothyrotomy and the Value of Simulation Training

Emergency Medicine Cases

Dr. Anton Helman

Education, Health & Fitness, Courses, Medicine, Science

4.7 • 602 Ratings

🗓️ 15 May 2018

⏱️ 12 minutes

🔗️ Recording | iTunes | RSS

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Summary

In anticipation of EM Cases Episode 110 Airway Pitfalls Live from EMU 2018 with Scott Weingart, we have Dr. Shira Brown tell her Best Case Ever of a pediatric trauma patient who required a cricothyrotomy. She explains how, despite working in a non-trauma center with limited resources, her team was well prepared because of the robust simulation program specifically designed for practicing emergency physicians that she had developed in her region. We also discuss the advantages and disadvantages of the scalpel-Bougie vs scalpel-finger-Bougie cricothyrotomy techniques and to maintain an optimistic attitude in seemingly futile cases...

Transcript

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0:00.0	Best case ever.
0:01.8	Best case ever.
0:03.1	Yes, this is EMK's Best Case Ever series, Dr.
0:33.9	Shearer Brown, Chief of Emergency Medicine at South Niagara, Emergency Systems,
0:38.9	Assistant Clinical Professor, Faculty of Health Sciences at McMaster University.
0:43.7	Dr. Brown has been practicing emergency medicine full-time for about 10 years
0:47.1	and has a particular interest in airway management, cryothorotomy, and simulation.
0:57.2	Dr. Brown, welcome to EM cases. Thank you, Anton.
1:03.9	Let's hear your best case ever. I understand this happened at Janus General a few years back.
1:12.7	Yeah, so a few years back, I was working in Janus General, which is a mid-sized hospital. And it was just near the end of my shift when I heard a patch that we were receiving a peri-adolescent girl who had jumped five stories and she would be arriving in about two to three
1:18.7	minutes. Our organization had worked a lot on airway management and we pulled our difficult
1:24.2	airway card out immediately knowing that this may represent a case of difficult
1:29.0	airway management. When the patient rolled in, we saw a pretty dramatic sight. It was a fairly
1:36.2	crumpled periolessent child who had obvious extremity fractures and massive facial injuries.
1:43.7	So my colleague went to make a brief attempt at direct laryngoscopy
1:48.0	after giving her some ketamine. She actually arrived quite awake and breathing spontaneously.
1:54.6	And, you know, the entire facial architecture was mobile and, you know, all we could really see was blood. And so my other
2:02.4	colleague and I looked at each other and we were just like, wow, this is it. This is what we've been
2:05.7	preparing for. And we just been in the Sim Lab, you know, a month prior practicing together. So we didn't
2:11.8	really need to talk. I just opened up the fourth drawer in our difficult airway cart and grabbed what we call our stab bag, ripped it open.
2:21.5	And my friend and colleague looked at me and said, it's right there, it's right there, you know, at the chrykothyroid membrane.
2:27.5	So at that point, the patient stopped breathing, and she obviously couldn't be bagged, and her sat started to drop.
	...

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