Cite this post as:
Scott Weingart, MD FCCM. What Trach for Difficult Airway Cart?. EMCrit Blog. Published on October 6, 2011. Accessed on March 28th 2024. Available at [https://emcrit.org/emcrit/what-trach-difficult-airway-cart/ ].
Financial Disclosures:
Dr. Scott Weingart, Course Director, reports no relevant financial relationships with ineligible companies.
This episode’s speaker(s), (listed above), report no relevant financial relationships with ineligible companies.
CME Review
Original Release: October 6, 2011
Date of Most Recent Review: Jan 1, 2022
Termination Date: Jan 1, 2025
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Hi Scott In the RFDS QLD section, we carry the Melker 5mm cuffed seldinger kit You can use it seldinger style or with open cric technique .It also fits perfectly over our Frova bougie A senior resident on our retrieval service had to deal with an upper airway obstruction case secondary to angioedema just a few days ago. He found the patient hypoxic on air but alert with gross face and neck swelling. Decided to first do no harm and scoop and run from the country hospital back to the tertiary base hospital. Patient coded during loading onto aircraft. CICV.… Read more »
Tough case.
Awake Cricothyrotomy set-up; one try at awake bonfil or fiberoptic; if that attempt fails awake cric is what I would have done. Of course, I have no idea what the pt looked like or the true feel for the situation.
yeah that was my initial suggestion too. I spoke to a couple of anaesthetists about it,one who does retrieval work as well, and they totally disagreed with an awake surgical airway attempt. Their arguement was do what you are best at, assuming you do more RSI than awake surgical airways! The strategy they suggest is that in airway obstruction cases who are deteriorating ( this patient had a SaO2 of 90% on 15 L/min at time of leaving hospital for airport), with limited resources and staff, you gotta do something earlier rather than later when the obstruction is worse to… Read more »
Agree with all of that for most ED / anesthesia folks. For people who have specialized in difficult airway; you have more options as you have more things that you are best at. I would fault nobody for attempting RSI in this case and then putting in an LMA to see if you can get even a cc or two of oxygen in while you move to the neck and perform immediate cric whether it be needle or knife.
Hi Scott and Minh Great podcast. I’ve been invited to work with stocking our difficult airway trolley and wanted to clarify your recommendation of the 6mm Portex tracheostomy tube. The tube you recommend is not a percutaneous tracheostomy set but a simple tracheostomy tube, yes? If so, do you combine it with a scalpal/bougie kit you’ve made up yourself or do use utilise a commercially available all-in-one perc tracheostomy kit for your emergency cricothyrotomies. I’m trying to choose the best kit to store on the difficult airway trolleys throughout the hospital and wanted to get your thoughts on any simple,… Read more »