Keychain Emergency Airway Device (Video)

Health professionals who know how to perform cricothyroidotomy to obtain an emergency airway in someone who is obstructing can appreciate a nifty keychain device called LifeStat.

LifeStat can be carried around and immediately utilized to perform emergency cricothyroidotomy in any setting.

Watch a video here to see how it works.

It can be purchase from Shippert Medical for $145 here.

Reference:
Utilization of the LifeStat emergency airway device. Ann Otol Rhinol Laryngol. 2008 Jan;117(1):1-4.

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Best Ballpoint Pen for Emergency Cricothyroidotomy?

I recently blogged about a man who choked to death on an airplane and the impossibility of saving this man's life with a surgical airway like a cricothyroidotomy without a sharp object around inside the plane (ie, knife or scalpel).

I also stated that "Some surgeons would argue a strong, stiff ball-point pen could have been used to perform the cricothyroidotomy, but as someone who has performed a dozen emergency cricothyroidotomies and tracheotomies in the past, even under the best of circumstances with a knife and being on a hospital floor with help around, it is hard. Furthermore, skin and the windpipe is made of tough 'fabric' and trying to punch a ball-point pen through is laughable. Try doing it yourself on a chicken with the skin on."

Well... it got me thinking... Let's assume for argument's sake that it IS possible to perform a cricothyroidotomy by literally punching through with a stiff ball-point pen into the airway. Would it actually work???

Believe it or not, there are two studies (listed below) I was able to find that tried to answer that very question. Contrary to popular belief... even IF a ball-point pen is able to secure an airway, the majority were found to be unsuitable due to inadequate internal diameter with too high an airway resistance for breathing.

In fact, the only TWO pens that might work (from a breathing standpoint) are the:

Baron retractable ballpoint

BIC soft feel Jumbo

I can't even find these items on Amazon.com.

A sports bottle straw apparently works better than a pen.

Reference:
Bystander cricothyroidotomy performed with an improvised airway. Mil Med. 2002 Jan;167(1):76-8.

Airflow efficacy of ballpoint pen tubes: a consideration for use in bystander cricothyrotomy. Emerg Med J. 2010 Apr;27(4):317-20.

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Doctors Don't Always Take Their Advice (ENT Perspective)

Reuters published an interesting story about research that showed doctors don't always recommend treatments to patients that they themselves would pursue if they were sick. In essence, if the doctor was the sick person, they would tend to pursue treatments that carry a higher risk of death but fewer severe side effects whereas patients pursue the exact opposite.

Though the clinical scenarios illustrated in the article/research is not reflective of an ENT practice (colon cancer and bird flu), I do see it quite often in other scenarios... the biggest one being when to perform a tracheostomy... hole placed in the throat for breathing purposes often performed in very sick patients in the ICU.

Trachs are often refused by the patient's family for as long as possible... even weeks until all other avenues have been exhausted before considering a trach.

Although this procedure may sound "scary" and many patients and their families automatically refuse to consider such a procedure, the following (unofficial) survey done on Sermo (online physician community) on February 19, 2008 on physicians nationwide may be illuminating on how worthwhile having this procedure is to recovery.

When US physicians were polled at what point they would consider a tracheostomy on themself or their loved one if prolonged intubation was expected, 50% stated trach should be done within the first 8 days of intubation of which 28% wanted it to be performed within 3-5 days. Only 15% would desire a trach after 12 days or longer intubation.

Read the Reuters story here.


Reference:
Better off not knowing: improving clinical care by limiting physician access to unsolicited diagnostic information. Arch Intern Med. 2011 Mar 28;171(6):487-8.

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U.S. Rep. Gabrielle Gifford Gets a Tracheostomy After 7 Days of Intubation

U.S. Rep. Gabrielle Gifford who is recovering from a gunshot wound to the head 7 days earlier had her breathing tube removed and a tracheostomy tube placed on January 15, 2011.

Many people will wonder why a tracheostomy tube was placed when she's been intubated for only 7 days and even though she has been able to breath on her own since Tuesday. Along with the trach tube, a stomach feeding tube was also placed.

A tracheostomy tube is a small tube placed through an opening in the neck allowing for airway protection, improved ease of breathing, and improved pulmonary care.

It is unusual to keep a patient intubated for greater than 7 days due to risk of tracheal stenosis due to mucosal ulcerations that occur with prolonged intubation. Such ulcerations not only occur in the airway and throat, but also the mouth and lip regions. The exact timing to trach is still controversial however.

However, a tracheostomy tube does appear to speed overall recovery and decrease the number of days of hospitalization.

Though many family members (and patients) may be appalled by the cosmetic appearance of a trach tube, everyone needs to remember a trach tube is TEMPORARY and can be removed without much fuss once the patient regains strength.

Read more about trach here.

Read the Reuters article here.

Watch a video of a trach.



Reference:
Tracheostomy: why, when, and how? Respir Care. 2010 Aug;55(8):1056-68.

Early versus late tracheostomy in patients with acute severe brain injury. J Bras Pneumol. 2010 Feb;36(1):84-91.

Early tracheostomy in intensive care unit: a retrospective study of 506 cases of video-guided Ciaglia Blue Rhino tracheostomies. J Trauma. 2010 Feb;68(2):367-72.

The impact of time to tracheostomy on mechanical ventilation duration, length of stay, and mortality in intensive care unit patients. J Crit Care. 2009 Sep;24(3):435-40. Epub 2009 Jan 17.

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New Video On Performing a Tracheostomy

A new video on performing a surgical tracheostomy has been created by our office and uploaded onto our YouTube channel. Watch the video here or below!

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How a Tracheostomy is Performed Step-by-Step with Pictures

Below is a step-by-step description with pictures of how a tracheostomy is performed. To read more about this procedure as what to expect with swallowing, eating, talking, etc, click here.

	Neck is sterilized with betadine to clean the skin and than draped to prevent any contamination from the environment.
	After the incision, underlying fat is removed.
	Dissection is carried down to the windpipe which is completely exposed in this picture. One can see the faint outlines of 2 1/2 tracheal rings.
	A small window is then created in the windpipe. In this picture, one can see the endotracheal tube inside the windpipe. This tube is slowly removed from the windpipe as the anesthesiologist pulls the tube out from the mouth.
	Once the endotracheal tube is removed, the windpipe and surrounding area is completely suctioned of all secretions and blood.
	The tracheostomy tube is then inserted and secured in place. That's it!

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