Yes, there is an app for that
Online Medical Education on Emergency Department (ED) Critical Care, Trauma, and Resuscitation
We’re still working on the Greater NY Sepsis Initiative. The next step towards making a non-invasive protocol possible is to teach folks how to use ultrasound of the IVC to assess fluid responsiveness. I developed this video to get ED & ICU docs up to speed. If you can do ANY ultrasound exam, you can do this one.
If you want to see the most recent version of the non-invasive protocol:
The invasive protocol that goes with it can be seen here:
Darren Braude, Aiway and EMS master from New Mexico demonstrates the use of a bougie to make the cric procedure MUCH easier. For more great Braude magic, see his site at airway911.com.
This is a video by my friend Seth Manoach, MD. He has been an EM Physician for many years and now is in the midst of a three year critical care fellowship sojourn.
This video demonstrates the fiberoptic stylet-aided cric. In this case he is using a Levitan Scope, but an adult bonfils or any other rigid fiberoptic should work fine.
The airway he is using is the Melker cuffed cric catheter, but I have tried this in trach incisions with 6-0 ET tubes, and 6.0 trach tubes as well.
Here is the article seth put in the literature:
Please note: The sheep in this video was treated with the utmost respect and ethics. It was heavily sedated throughout with tons of thiopental plus ketamine and xylazine.
Here is my video on performing open cricothyrotomy in 3 situations: with a trach set and an assistant, with a trach set when alone, and when you only have a scalpel.
The video for this lecture is up at this link.
Awake intubation can save your butt.
It requires forethought and humility–you must be able to say to yourself, “I am not sure I will be able to successfully intubate this patient.” However, the payoff for this thought process is enormous. You can try an intubation in the ED with very few downsides. If you get it, you look like a star, if you don’t you have not made the situation worse.
Two of my critical care resident specialists, Raghu Seethala and Xun Zhong, volunteered to intubate each other awake. The purpose of this was to let them gain experience, understand what their patients would feel during the procedure, and to prove that awake intubation can be done without complicated nerve block injections or fragile equipment, such as a bronchoscope.
Here is the procedure for ED Awake Intubation–EMCrit Style:
If you can give it early 10-15 min before topicalizing, it will be most effective.
Note: the systemic and pulmonary absorption from this method is quite low. The only place to watch out is spraying the trachea. I would not spray more than 2-3 cc down the ol’ windpipe.
That’s all for this week
For more info on awake ED intubation, you can view a complete lecture here
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Hi, my name is Scott Weingart.
I am an ED Intensivist from New York City. My career goal and the purpose of this blog and podcast is to bring Upstairs Care, Downstairs-–that is to bring ICU level care to the ED, so our patients can receive optimum treatment the moment they roll through the door.
Best Medical Weblog of 2010 from the folks at Medgadget.com