So my friend, Darren Braude and one of his co-attendings had a horrible airway case, which they presented on EM:RAP. I wanted to comment on the case, because there is so much great teaching fodder. If you have access to EM:RAP, go listen to this portion on the July episode first. I say it in the show, but let me be very clear here as well–the folks involved did an incredible job. These comments are solely Monday-morning quarterbacking.
I introduce two concepts in this wee:
Prepassing the bougie in the mouth and CricCon
Prepassing the bougie
I am fed up with having to look away from the cords on difficult airways, so I’ve taken to putting the bougie in the mouth at the level of the right molars before lifting to expose the glottis. A partner can do the same for you. Listen to the audio to get the full idea.
CricCon Readiness Level
Similar to the DefCon, the prior measure of US military alertness level, CricCon is what level of readiness you have to perform a cricothyrotomy. Hopefully this image explains it all:
All airways should be level 5. Predicted difficult airways should always be at least a 4. In a “forced-to-act” situation you should be a 3. If the first attempt fails, I would move to a 2.
Update: Cricon2 has been released, check it out
Draw your vision of the EMCrit mascot and win a copy of Mike Winters’ Emergency Department Resuscitation of the Critically Ill