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4 intubations last night with the residents. One was s/p throat cancer treatment and anatomical landmarks via DL/VL were, eh, not good.
Proceeded with an approach that may be helpful to those of you responsible for managing airways.
Retrograde intubation, a thread:
Proceeded with an approach that may be helpful to those of you responsible for managing airways.
Retrograde intubation, a thread:
In deference to all good airway setups, have a checklist and a plan complete with backup plans. Let your team know your plan.
Last night, the resident and I both attempted DL without success. VL confirmed we weren't mistakenly not identifying landmarks. One word: mushy.
Last night, the resident and I both attempted DL without success. VL confirmed we weren't mistakenly not identifying landmarks. One word: mushy.
So, we prepped the neck, but not for a cric.
The patient was ox/venting well, so we had some time.
Using a central line kit, I filled a syringe with 1 mL of NS and attached the finder needle. I inserted the needle through the cricothyroid membrane in a cephalad direction.
The patient was ox/venting well, so we had some time.
Using a central line kit, I filled a syringe with 1 mL of NS and attached the finder needle. I inserted the needle through the cricothyroid membrane in a cephalad direction.
When air was aspirated, I then threaded the wire in via Seldinger, and my partner fished it out of the oropharynx. We advanced the wire enough that a 6.5 ETT was able to be loaded over the wire, and clamped a needle driver over the end.
Then, we pulled the tube and wire down until we met resistance, at which point the needle driver was released, the wire was pulled through the neck, and the ETT was then subsequently seated. We did this with the glidescope in place to help visualize the process.
So, in this patient, it was, I believe an appropriate approach to secure the airway in somebody who had difficult landmarks secondary to prior malignancy. We were not rushed, and it was an ideal scenario in my mind to use this maneuver.
tl:dr retrograde intubation steps:
1) Prep neck
2) Needle cric membrane and thread wire into mouth
3) Put tube over wire and clamp end of tube at top
4) Pull wire+tube down until resistance is met
5) Release clamp, pull wire
6) Push tube to appropriate depth
7) Confirm placement
1) Prep neck
2) Needle cric membrane and thread wire into mouth
3) Put tube over wire and clamp end of tube at top
4) Pull wire+tube down until resistance is met
5) Release clamp, pull wire
6) Push tube to appropriate depth
7) Confirm placement
Hopefully this is educational. We stand on the shoulders of giants in this discipline, and I owe my successes to the docs who taught me. @umassEMresident
This completes the required educational component of my tweets. Back to dumb shit soon.
This completes the required educational component of my tweets. Back to dumb shit soon.
