Scenario involving a patient with severe asthma deteriorating to respiratory arrest requiring intubation/ventilation
Author Archives: Scott Orman
Scenario: Diving Emergency
Scenario involving a rapid ascent resulting in probable CAGE and tension pneumothorax. Medical care including possible RSI and stretcher winch of ventilated patient
Please provide feedback on this scenario below
The Vortex
A recent concept that has been widely discussed on FOAM sites, as well as at the SMACC conference, is The Vortex (pdf)
The Vortex is a simple cognitive aid that can be used in the setting of an unanticipated difficult airway. Conceived by Nicholas Chrimes (Melbourne anaesthetist) and Peter Fritz (Melbourne emergency physician), it aims to simply concepts, move away from complex algorithims, and be applicable in multiple settings.
Key to the concept is that the key goal in an unexpected difficult airway situation is alveolar oxygen delivery. Techniques to deliver oxygen (LMA, ETT, face mask) are regarded as equivalent, as any of these, if successful, will move a desaturating patient out of the Vortex into the ‘green zone’ where oxygenation is adequate for a ‘time out’ and alternative planning to occur. At the centre of the vortex is a surgical airway.
Resources regarding The Vortex:
Discussion page and podcast from Minh Le Cong, with an interview of the creators of The Vortex
Presentation by Nicholas Chrimes:
The Vortex in action:
In-flight surgical airway!
Fast-forward to 40 minutes – soldier with severe maxillofacial trauma has scalpel-finger-tube cricothyroidotomy performed under IM ketamine in the back of a Blackhawk
