Category: Airway

The last episode of the ETM Podcast (available here) with Bruce Paix generated a lot of comments on the blog and activity on Twitter.  Scott Weingart (from EMCrit) very politely asked for some air-time to make a few additional comments on the topic of surgical airways and we were more than happy to oblige.

Andrew managed to get Scott on the line for what I’m sure you’ll agree is a great addition to, or extension of the podcast with Bruce in which he and Andrew discuss the novice vs expert approach to this procedure with some great pearls on mindset and training, the rationale for his approach to cricothyroidotomy (which differs from Bruce’s), the utility of the bougie and a bunch of other practical tips.  Scott also tells us how he would approach a surgical airway in a paediatric patient.

These two episodes combined are an outstanding  #FOAMed resource and are perhaps one of the most comprehensive overviews of the hands-on, practical approach to emergency surgical airways available anywhere.

It’s also timely as since the last episode was posted, ANZCA has clarified their position in response to the Royal College of Anaesthetists UK statement on the subject of CICO and surgical airways, which you can read here.

Huge thanks again to Bruce Paix for his interview, huge thanks to Scott Weingart and of course thanks to Andrew Perry for recording these two excellent episodes.

Andrew and Bruce are back, taking a deep-dive into the neck to discuss a procedure that can strike fear into even the most experienced trauma practitioner and one which has created much debate regarding the “best” method (i.e. needle vs knife).  (Go to audio)

Bruce is the co-author of a seminal paper on this topic:

Emergency surgical cricothyroidotomy: 24 successful cases leading to a simple ‘scalpel-finger-tube’ method. Paix BR, Griggs WM Emerg Med Australas. 2012 Feb;24(1):23-30  (Full text available here – thanks EMCrit)

To date, between them, Bruce and Bill have performed 26 surgical airways.  In this episode you will hear Bruce describe in detail his first-hand, real-world, extensive experience with this procedure and his rationale for supporting the simple “scalpel-finger-tube” technique over the many other methods that have been described.  Andrew was also recently indoctrinated into the “cric-club” and provides some immensely valuable insights for those of us who are yet to do this procedure “in anger”.

This is a timely episode, with the Royal College of Anaesthetists (ROCA) UK only days ago publishing the findings of a working group of anaesthetists and ear, nose and throat surgeons that recommend the scalpel-bougie-tube technique as the preferred technique for front of neck access (FONA) in a can’t intubate, can’t oxygenate (CICO) situation.  (Bruce discusses the pros and cons of using a bougie in the podcast!)

Surgical intervention during a Can’t Intubate Can’t Oxygenate (CICO) event: Emergency Front-of-neck Airway (FONA)? (Full text free)

A description of the rationale for this paper from ROCA can be read here:

Anaesthetists and surgeons reach agreement on front of neck emergency techniques in life-threatening ‘CICO’ situations

Enjoy the podcast and please leave a comment below (we’re sure this topic will generate some robust debate!)

This is an interview I did back in March at the SMACC Conference in Sydney which had to go on the back-burner while we got the course up and running. Peter Fritz, an Emergency Physician from Melbourne (and his Anaesthetist mate Nicholas Chrimes) have created something that will likely go down in history as a revolutionary advance in airway management.

It is the Vortex cognitive aid for the management of the unanticipated difficult airway. Many of you will already be familiar with this concept, for those that aren’t I strongly suggest you get over to their website, (www.vortexapproach.com) download the free e-book, watch the videos, and start using the Vortex for your ED RSI intubations.  I’m positive that lives will be saved with this tool, and I was lucky enough to catch up with Peter at SMACC and chat to him about the Vortex.

Here’s Pete taking the interview very seriously…