So I was at the Blood & Sand conference a few weeks ago in the Bahamas. The highlight of the course was a lecture by Mike Mallin. The lecture is now on EMCrit–I'm sure you'll enjoy it.
Thoughts I had during the Talk & Meta Stuff
- Sympathetics lead to/augment: fight, flight, freeze, or shout
- We need to get Mike on to do a book club on
[easyazon_image align=”none” height=”160″ identifier=”B010EULHB6″ locale=”US” src=”https://emcrit.org/wp-content/uploads/2015/12/51ZjACKHO4L.SL160.jpg” tag=”emcrit-20″ width=”100″][easyazon_link identifier=”0393326152″ locale=”US” tag=”emcrit-20″]Deep Survival by Laurence Gonzales[/easyazon_link] - Since I've started speaking about crics, I've received more than 50 emails from people who heard a lecture or a podcast and it gave them a boost to get the job done. That's why I keep putting up lectures like this one.
More on Surgical Airway
Well we have a wee bit on the EMCrit Surgical Airway Page
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Editor-in-Chief, at EMCrit.org
An ED Intensivist from NY.
Professor
Nassau University Medical Center
No conflicts of interest (coi).
Professor
Nassau University Medical Center
No conflicts of interest (coi).
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Thank you for sharing. Excellent.
Thanks so much. I found this to be another reaffirmation of why I chose or why Emergency Medicine found me. This touches on wholly what it means to be an Emergency Physician and reminds us of how respectful we need to be of physiological processes. Props to the author for displaying such vulnerability to discuss a difficult case and thanks to Emcrit for highlighting emotional intelligence and what it takes to develope resilience under stress. Please more!!
Lucy McKenzie
ED Senior RMO
Prince of Wales Hospital Sydney
Australia
I showed my husband this video (he was a military pilot and was the safety officer for his squadron) and the first words out of his mouth were “van Zanten.” As soon as he said it I knew he’d nailed it. The British ??anesthesiologist?? wondered “what was going through their minds” at about 24:15. I think the Tenerife airport disaster* might be a parallel. I would speculate that the person who was “in charge” didn’t act and no one felt comfortable stepping in and taking over. We quite rightly want to respect our colleagues and few people are arrogant enough… Read more »
absolutely. all of us who have studied crew resource management are aware of these and other cases of hierarchy bias affecting good decisions.
A long time ago, in a children’s hospital, I was working as an orderly. ED Techs had not yet been invented. A nurse from the clinic across the parking lot called to say that Dr. X was running across said parking lot carrying a 5 year old boy who was losing his airway very rapidly (epiglottitis). As Dr. X rushed through the doors he announced that the boy had indeed quit breathing, and the head nurse called a “Code”. The Chief of Anesthesiology, a gentleman in his 60’s, responded along with others. He attempted intubation, and failed. So he attempted… Read more »
Holy crap–that is the saddest story ever! And they fired you and the intern. this is just amazing
Grant, thanks for sharing your experience and sorry to hear of the tragedy.
This is why I commend folks like Scott and Levitan and others who openly publish and share online educational material to improve airway management/education.
I personally know of at least 5 successful cases of surgical airway done by folks who attributed their performance to learning online via Scott or similar authors material .
Scott knows of many others as well.
By sharing our experiences and knowledge, we hope that tragedies like you experienced will never occur again.
Doctor…Thank you for your reply. I most certainly agree that EMCrit and perhaps other social media sites contribute greatly to provider’s knowledge, and comfort level with a wide range of things medical. I carry, in my lower right leg pocket, everything I would need to do a cric. While the occassion has not arisen yet I feel that as soon as I could get past the “decision” point I would be able to perform the procedure quickly and correctly. Why? Because I go through the entire procedure mentally almost every day. I would venture to say that I have done… Read more »
That’s so wrong. At least you knew what to do. It’s awful that just because a person has a status ranking, that they’re the “go to” person. A lot of times no matter how educated we are, our ego gets in the way of correct decisions.
Dear dr.Weingart. This lecture really is amazing as the topic is amazing and not talked about enough. You mention you use meditation, mostly focusing on breath which is also a part of mindfulness meditation which is quite popular now. Also you say you have no literature or evidence, but as i was writing my residency research i found tons of it. There are proven effects, mostly using fMRI in the brain that shows structural changes in regular “meditators”. A nice start is this article by German researcher Britta Hölzl: http://www.emory.edu/ECCS/education/Holzel.pdf A big name is also Peter Fonagy and the beginner… Read more »
Nice job Mike. You are a great educator and doctor. Your residents and patients are very lucky. Seems as though with all the excitement and stress you forgot that you actually did use the ultrasound on the patient. Managing the truly emergent airway is the crown jewel of emergency medicine. It is the act that upmost defines our specialty. It is the act that defines if one is a great EM doc. In that moment you are the Hero or the Goat. You are the Hero!! Well Done!!
Great talk Mike and thanks for posting Scott. At 32:20-ish you say that people should never be allowed to fail in simulation. I’d be interest in any evidence to support this. I’m sure aviators would disagree – surely one of purposes of simulation is to allow failure in a safe environment so that consequences can be learned? In our training at Sydney HEMS we place some emphasis on guided error training(1,2), as this seems to be memorable and useful for the trainees. In any other domain in which mastery is sought, failure is a key part of learning. Simulation allows… Read more »
Cliff, Great points. I think my comments on that mental rehearsal slide in reference to simulation were a bit of a mis-step. While you are much more experienced in simulation than me, and I defer to your expertise, I would agree that cognitive error in a simulation setting is a great way to learn. At that point in the talk I was referring more to mental rehearsal, and how you should always envision success in your mental rehearsal exercises.(1) Although, I think the same would be true for technical aspects of simulation (not to include cognitive processes). One thing I… Read more »
Thanks Mike – great point and interesting reference. I’m going to be mindful of that next time I brief a team pre-simulation. Like you say, hopefully we all already do that but that article crystallises the importance of selling the learning experience.
Great talk. Thanks. One part you brought up peripherally really got me thinking about a (very) recent close call I just had. I’m a PCCM fellow. This morning I was literally on the 29th hour of a 30hr call. I had fallen asleep at about 4am and then got paged to a Rapid Response at 5:15am for hypotension on the surg onc floor. These happen not infrequently, and often they are resolved by waking the patient up, getting a second (now higher) bp and then explaining to the somewhat worried patient what all the fuss was about. So to be… Read more »
What an excellent podcast – should be required material for anyone in EM. I work as a paramedic in Denver, and given a highly variable pace to any shift, find myself fluctuating from white to red (hopefully never black) frequently. My last shift featured a particularly unpleasant call…a 150 kg+ gentleman, peri-arrest in his basement from a lower GI bleed. In true EMS fashion, he was a difficult airway who had recently eaten. We were dispatched as a nonemergent diabetic problem, so I went in with a first-in kit and a monitor…no suction, no extrication devices. I goosed my first… Read more »
thanks for sharing that story, Tyler
Thanks so much for this podcast. I work as a paediatric anesthesiologist in Canada and keeping calm during crises is a work in progress. Meditation and yoga definitely help me.
Mike, I know this was not the point of your podcast, but the airway nerd in me NEEDS to know what was causing your patient’s airway to look like that. Cancer? Infection? Anaphylaxis? Weird systemic thing?
Thanks,
Kathy
Phenomenal talk! I’ve listened to it three times already just to take as much of it in as possible. I must echo Dr DeKoven’s question: did you find out what the pathological process in the airway was?
Epiglottitis perhaps?
Many thanks for the upload.
-K (Canadian Anesthesia resident)
Kathy, Kristen,
Yes it was epiglottis.
Excellent discussion of both Cric decisions and the stress of the situation. Much better than just a naked discussion of stress reaction/coping.