More than You Ever Wanted to Know About Extra Glottic Devices

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More than You Ever Wanted to Know About Extra Glottic Devices

Our good friend Jim DuCanto visited us earlier this year. We spent several days sharing knowledge and perspectives.

Part of our time together was spent recording this podcast. It has been simmering and is finally available for listening. Within, we briefly go through the history of the extra-glottic device (EGD) in general, and then, we talk about the Laryngeal Mask Airway (LMA) and its “descendants” in great detail.

Jim really had a tremendous wealth of knowledge to share…

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"Video Laryngoscopy" Needs to Die

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"Video Laryngoscopy" Needs to Die

Let the record show, this is not a debate for or against the use of video cameras on laryngoscopes. It’s not really a debate at all. It’s a plea. An honest plea…

The “DL vs. VL” debate has been had. It will continue to be had as our research evolves and our tools evolve (and we will participate). But, I beg of us as a community to pause and collectively consider a point of order: our discussion and debate, and worse our education of novice critical care providers, and even worse our research, is becoming marred by the fact that we aren’t all speaking the same language. We often throw around terms without RIGOROUS attention to detail.

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EMS Scope of Practice

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EMS Scope of Practice

Recently, I had the pleasure of sitting down with Dr. Dustin Calhoun, EMS faculty member within the Department of Emergency Medicine at the University of Cincinnati.

Dustin had been responsible for an EMS fellow didactic session covering EMS scopes of practice and EMS licensure. While on the surface these topics may seem a bit “boring,” I found our examination of the complexities quite interesting. In fact, I found the session so useful that I asked Dustin to record this podcast with me (and I’m a former EMT!).

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Ebola Preparations: The Greater Cincinnati Area EMS Provider Perspective

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Ebola Preparations: The Greater Cincinnati Area EMS Provider Perspective

As we are all coming to realize, there is a tremendous amount of information to digest when it comes to preparations for potential Ebola cases...

I sat down with Dr. Don Locasto and Dr. Dustin Calhoun to discuss their work with the PHEMAC committee. PHEMAC stands for "Public Health EMS Medical Directors Advisory Council." They exist specifically to deal with situations like this within our region.

PHEMAC recently released an update to all regional EMS providers. The goal of the update was to distill down all of the information out there into a useable form for our local teams. The text is available below.

Our discussion summarizes these initial recommendations, as well as makes suggestions for staying up-to-date as more recommendations are released. You can listen to the podcast here, or by subscribing to us through iTunes.

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Suction Assisted Laryngoscopy and Airway Decontamination with Jim DuCanto, MD

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Suction Assisted Laryngoscopy and Airway Decontamination with Jim DuCanto, MD

Recently, one of our FOAMed friends came to visit the University of Cincinnati. Jim Ducanto is well known for his innovations and general wealth of airway management knowledge. One wonderful thing that Jim shared with us during his visit was an airway mannequin that he “modified” to be able to puke…yes…puke. Not sort of puke…but REALLY PUKE!! Here is what Jim has to say regarding the motivation for building the device as well as lessons we learned while doing it’s “beta-test”.

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Liquid Plasma aka "Never Frozen Plasma"

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Liquid Plasma aka "Never Frozen Plasma"

I recently had the pleasure of sitting down with my co-EMS fellow, Dr. Ryan Gerecht, to discuss his experience with the implementation of a new blood product on our HEMS service: Liquid Plasma. Ryan was responsible for this implementation while serving as a Resident Assistant Medical Director during his last year of EM training at UC (2013-2014).

Here is what Ryan has to say…

In the Emergency Department, ICU, or operating room what do you resuscitate the hemodynamically unstable, bleeding trauma patient with? What about the patient with a massive GI bleed or ruptured AAA? How do you manage the patient with an intracerebral hemorrhage on Coumadin? (assuming you don’t have PCC’s readily available)

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Logistics are Critical

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Logistics are Critical

Not much gets me as fired-up anymore as trying to optimize them. While I like to think that it’s because they are integral to our mission and are the ultimate weapon in our quest to go from “good to best”, it’s really just my borderline OCPD (just kidding…sort of).

Long story short, I spend a lot of time thinking about clinical and operational logistics in HEMS – it’s become my thing. My goal with this post is to share some of that thinking with others who might want to build off of our ideas in hopes that those colleagues (i.e. you) will share their ideas that they are really excited about with us at some point.

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LMA FOI - You Mean You Can Intubate through that Thing?

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LMA FOI - You Mean You Can Intubate through that Thing?

Emergency airway management is being revolutionized. Think about it…those of us who are in training now are being exposed to some very different core skills. The big culprit is the recent advent of video laryngoscopy – not much argument there.

With that said, I will argue that almost as significant as the advent of video laryngoscopy from a general “airway management revolution” perspective is the philosophical change of many pre-hospital providers in that it is becoming the norm for extra-glottic devices to be placed primarily, or at least considerably more often than in the past.

It is likely that the rate of field placement of extra-glottic devices will become more common. Thus, we will probably see many more patients present to the ED in whom EMS has placed an extra-glottic. As we recognize the power of extra-glottic devices, I think that even the most advanced airway managers will use extra-glottic devices with more frequency to facilitate rescue oxygenation and ventilation.

This begs the obvious question: should we remove these devices after they are in and working?

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Needle Cricothyrotomy

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Needle Cricothyrotomy

Circumstances rarely are such where we must perform a surgical airway emergently. When we do, it is always for the same indication: you have a patient that you can’t intubate AND can’t oxygenate. In most cases where a surgical airway is required, a traditional open or Seldinger technique is preferred.

In children, however, these approaches are contraindicated (most authors describe age less than 10 or so as the cut-off). Thus, the needle cricothyrotomy is a procedure that we must be prepared to perform as emergency providers as this can be done in pediatric patients.

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