Cite this post as:
Scott Weingart, MD FCCM. Airway Innovation – Drs. George Kovacs and Sam Campbell discuss Aggressive Management. EMCrit Blog. Published on December 3, 2015. Accessed on October 2nd 2023. Available at [https://emcrit.org/emcrit/airway-innovation/ ].
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: December 3, 2015
Date of Most Recent Review: Jan 1, 2022
Termination Date: Jan 1, 2025
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“A little nonsense now and then is relished by the wisest men”. Mr. W. Wonka
I think it was great. If you can’t take a joke, to h*** with you, eh. A-C-T-U-A-L-L-Y though I would like to hear more about what these guys, or others, would do “for real” in the situation described. I’ve often thought that perhaps if I had a patient with “salad” welling-up constantly that perhaps having them on their side, and maybe a bit Trendelenberg might work, although I expect I would end up looking a bit Jackson Pollock”ish” myself when all was said and done. But, I would definitely do the multiple tubes. Not only three or so successful tubes,… Read more »
My thoughts on this. Presumably if patient with lots of fluid in the airway is unable to self protect and clear their airway then head down in such a case should allow everything to drain out. Multiple large bore suctions and scooping out debris to the side should keep the airway clear. Avoid positive pressure breaths if the sats are doing fine as it will otherwise blow aspirate up into the lungs. If the patient is combative then one might have to use something like ketamine to get control. Head down might increase the amount of regurgitation so perhaps only… Read more »
Interesting case here, but well managed indeed. Awake thoracotomy with non-sterile retrograde quadruple tracheal intubation along with ECMO inside of an iron lung is clearly indicated in this case. I am however very surprised to hear of a unit running out of sprinkler lidocaine, that must have been terrifying. This is also a textbook indication for the application of nipple caps (good catch, most MDs forget about these little life savers). The unit I work on has gone as far as stocking entire code carts with only nipple caps, and the results are staggering! My only recommendation would be to… Read more »
Nice discussion, but I’m afraid that you’re missing some essential points. (1) Manual traction on the esophagus is reasonable, but a better way to achieve this is with a Blakemore tube. If this can’t be passed transorally in the standard fashion, then it can be introduced via the thoracotomy incision following a retrocardiac dissection. While performing this dissection, if the patient is hypotensive then REBOA can also be directly deployed into the descending aorta. (2) We have found that tranexamic acid is extremely useful for epistaxis, both topically, systemically, and via the sprinkler system. Our sprinkler system actually contains a… Read more »
Josh, your center is extremely remiss in not including tPA in the sprinkler–because you never know, you never know.
I agree, and would also recommend sprinkler-delivered hydrocortisone. After all, it can’t hurt, and might help. Wouldn’t you want it if your mother were on the table?
we found that we had to remove the pip/tazo from the sprinkler system…too many false positive galactomanin assays were coming up. Infection control went ape poop since we depleted the antifungals in four weeks after implementation.
Scott do you have copper pipes or lead pipes at your shop, we found that the copper pipes for the sprinkler system deactivated the TPA… oh man this was picked up by one of our forth year med students…He happned to study this hydro dynamics as an undergrad…whew we were super lucky.
Janus actually retrofitted titanium pipes as the taste of the sprinkler bourbon in the docor’s lounge was being adversely affected by the copper