At the last SMACC, I yet again taught the surgical airway station of the airway workshop. I was joined with amazing faculty and together we taught 160 people our method of performing cricothyrotomy. We've been doing this for 4 years, but this past session was the first time it really felt just right. In this podcast, I want to go over some of the lessons learned and how they may contribute to your own self-training on surgical airway.
Models
Each participant had their own 3-d printed model. This was absolutely crucial and a big difference from prior sessions.
We have found models to offer a more realistic experience than animal parts1
Who Gets a Cric & Mental Prep
including a discussion of CricCon2
see this prior episode for more on CricCon
Finding the Membrane/Cut Site
Start Low, feel high
Laryngeal Handshake
We teach Rich's choke hold as a backup method2–4
Build the Model
We used the same steps as in my how to practice crics video
Teaching the participants to build their own was hopefully encouragement to get their own model and practice each month.
All they need is:
- the 3D-printed model
- Good gaffers tape
- 4x4s
- Plastic Bags
We had a few of the frova cric trainer holders, which would have been nice to use, but we didn't have enough for everybody, so we left them in the box.
Rapid Cycle Deliberate Practice (RCDP)
I learned about this teaching method from Alia Dharamsi at the amazing ResusTO conference. I also used the a modified version of her delphi-derived steps as a handout taped to each station.
Hear more from Alia
Steps of RCDP5
- Splitting Cases/Procedures into small segments
- Micro-Debrief after each one
- Add progressive challenges
from Taras & Everett
Iterations
- Step-by-Step through the Procedure
- Dominant Side Palpable Anatomy
- Look-Up
- Non-Dominant Side
- Non-Palpable Anatomy / Cut and then spread to air
- Under Stress
I was demonstrating up front with a video camera–this was huge as it allowed real-time correction with a much lower instructor to participant ratio. I could see a mistake, pause the group, and re-demonstrate proper technique for everyone.
We then allowed folks to practice on each-other under close instructor supervision.
Case Discussions
- We finished the 1 hour session by going over 3 case videos of real-life cricothyrotomies.
See All things EMCrit Cric
Now on to the Podcast…
Podcast: Play in new window | Download (Duration: 15:49 — 14.9MB) | Embed
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- 1.Gustafson ML, Hensley B, Dotson M, Broce M, Tager A. Comparison of Manikin Versus Porcine Trachea Models When Teaching Emergent Cricothyroidotomy Among Emergency Medicine Residents. Cico SJ, ed. AEM Education and Training. April 2019:280-285. doi:10.1002/aet2.10333
- 2.Drew T, McCaul C. Laryngeal handshake technique in locating the cricothyroid membrane: a non-randomised comparative study. Br J Anaesth. 2018;121(5):1173-1178.
- 3.Oh H, Ryu H. Neck midline identification with the laryngeal handshake method. Acta Anaesthesiol Scand. 2018;62(10):1486.
- 4.Oh H, Yoon S, Seo M, et al. Utility of the laryngeal handshake method for identifying the cricothyroid membrane. Acta Anaesthesiol Scand. 2018;62(9):1223-1228.
- 5.Taras J, Everett T. Rapid Cycle Deliberate Practice in Medical Education – a Systematic Review. Cureus. 2017;9(4):e1180.
- COVID19 – Awake Pronation (aka the Pig Roast) A guest write-up by David Gordon, MD - April 6, 2020
- EMCrit Wee – Webinar I Gave to Pulm/Crit Care Fellows on Avoiding Intubation and Initial Ventilation of COVID19 Patients - April 4, 2020
- EMCrit 269 – Rationing of Critical Care and Ventilators in COVID19 with Reub Strayer - March 31, 2020
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