Podcast 148 – Airway Decisions and Online Etiquette - a podcast by Scott D. Weingart, MD FCCM

If you haven't already, you must watch the Cricothyrotomy Wee

If you want to have any idea what I am talking about...



The Cric Wee

Here is the comment that sparked this podcast



How to Plan Your Airway



* Take Account of the Whole Situation, both Immediate and Delayed Issues

* Pick the Plan the Fails Best



What is a Bad Option IMrHO?



* Anything through the nose without cutting the wires



What are the Good Options



* Cut the Jaw Wires, Prep for Cric, Perform Awake Fiberoptic Nasal Intubation, then sedate/analgese

* Cut the Jaw Wires, Prep for Cric, Perform RSI, then sedate/analgese

* Perform an Awake Cric

* Perform an Awake Trach



How to Cut Jaw Wires (Arch Bars/Wired Jaw)

There will be 2-5 wires connecting the lugs of the arch bars--you need to cut all of them and retrieve the wires. There may also be elastic that needs to be cut. Medical wire-cutters are best, diagonal cutters also work. In a pinch, any heavy scissors will get through these wires. Then grab them with hemostats and pull them out.



from Jones RT et al. JEM



Not many articles in the literature on this topic, but here is one Jones RT et al.



I think it is essential to understand the hardware and how long it takes to cut the wires. So watch this wiring video and then this cutting the wires video.

Do Crics Need to Come Out Right Away?

Probably not



* American Journal of Otolaryngology 2000;121(3):195

* British Journal of Oral and Maxillofacial Surgery 2013;51:779



NAP4

In appropriate circumstances (prophylactic cricothyroidotomy) has numerous advantages, not least the potential to secure and check the ‘rescue airway’ in a calm and unhurried manner, without hypoxia, before an emergency arises      — NAP4 Study



* See this Prior Episode for a Discussion of NAP4



Online Etiquette when Discussing Cases



* Just be nice

* Assume that there were factors you might not understand because you were not there

* Phrase as, "I think if I was in this situation, I would have..."

* If you are going to go nasty, make sure you have the knowledge base to comment (this last one does not pertain to the comment above)



Consent for Filming



* discussed in the podcast



Other Discussions of the Case (For Better or Worse)



* Student Doctor Net

* Reddit



Now on to the Podcast...

Further episodes of EMCrit Podcast

Further podcasts by Scott D. Weingart, MD FCCM

Website of Scott D. Weingart, MD FCCM