Have we been waiting for this!
Courtesy of The Intensive Care Network – here is Dr Brian Burns (Greater Sydney Area HEMS) speaking at SMACC 2013 on prehospital procedures…
Click HERE for the audio (right click to open this in a new tab)
Accompanying slides below:
A recent concept that has been widely discussed on FOAM sites, as well as at the SMACC conference, is The Vortex (pdf)
Who needs an algorithm? Here is The Vortex!
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:
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
Here is a rarity – a video of a real-life surgical cricothyroidotomy in the setting of a failed intubation!
The clip is sourced from Minh Le Cong’s superb prehospitalmed.com; there is also some excellent discussion that follows the video – read it on Minh’s site here…
Auckland HEMS 