Episode 19: Surgical Airway

The West Midlands surgical skills course offers cadaveric training for PHEM and EM practitioners on rare life saving procedures. Click here to go straight to their page.

Anatomy

The Guidelines

Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults. C. Frerk et al. Difficult Airway Society: Intubation guidelines working group. British Journal of Anaesthesia, 115 (6): 827–848 (2015) doi:10.1093/bja/aev371

For more information, have a look at the Difficult Airway Society website.

AAGBI Safer Prehospital Anaesthesia

Click here for the 2017 guidelines

The Kit

Know what your service carries, practice with that equipment, then you will be familiar with the kit you are using in the heat of the moment.

Minimal kit: scalpel, bougie, tube

Tracheal dilators and tracheal hook

The Technique

For a demonstration of the DAS recommended technique for surgical front of neck access, have a look at this video, recorded by colleagues over at openairway.org:

Just a Routine operation

The video we mention in the podcast produced by Martin Bromiley after the death of his wife, Elaine, in a can’t intubate can’t oxygenate scenario is available here:

https://www.youtube.com/watch?v=JzlvgtPIof4

And have a look at the website for more of Martin’s work with the Clinical Human Factors group.

Other fantastic #FOAM resources regarding airway management are available:

From Nicholas Chrimes  at http://vortexapproach.org

From the fabulous people over at Life in the Fast Lane including a video demo from Scott Weingart from EMCrit: https://lifeinthefastlane.com/ccc/surgical-cricothyroidotomy/

References

This is Tim’s recent publication we mention in the ‘cast!: Nutbeam, T., Clarke, R., Luff, T., Enki, D. and Gay, D. (2017), The height of the cricothyroid membrane on computed tomography scans in trauma patients. Anaesthesia. doi:10.1111/anae.13905

Buonopane, C. E., Pasta, V., Sottile, D., Del Vecchio, L., Maturo, A., Merola, R., et al. (2014). Cricothyrotomy performed with the Melker set or the QuickTrach kit: procedure times, learning curves and operators’ preference. Il Giornale Di Chirurgia, 35(7-8), 165–170.