Did a code at a nursing home last week. Patient, last seen allegedly an hour earlier, found apneic and pulseless in bed. She was asystole with cool, cyanotic skin. No shock advised on the first responders’ defibrillator. I intubated her, did a round of epi down the tube, then got an IV and did 25 minutes of ACLS, including 25 grams of Dextrose because her sugar was less than 20, but got nothing back, and so I presumed her. It wasn’t until I came back to the base and was writing up the presumption that I recognized the medical history as someone who I had transported a few days earlier for a broken knee. Dead people really have nothing in their faces because I had not a clue that I had actually been talking to this person so recently.
When I did the tube, I didn’t initially see the chords, but with my right hand, I applied crick pressure for myself, using my fingers like the fingers on a flute to find the right spot — a modification of a technique I learned in a half-day airway class at the JEMS conference in Phillidelphia three years ago. The idea is that the intubator has much better control of the manipulation than a third party. When I pressed down with my middle finger tip the chords dropped right down into view. I said to my partner. “See where I am pressing with my finger. Put your fingertip right there.” She put it right in the right spot, and I easily slipped the tube in. The technique doesn’t always work so well, but it has helped me out a number of times.
The half-day airway class I took in Philidelphia was taught by Richard M. Levitan, M.D. He is the guy behind the airway cam videos and book. It was a great course. I went to his web site recently and see he offers a two day class with everyone getting their own cadaver for the second day. It’s pricey, but I’m thinking about doing it at some point. Anything to help improve my airway skills.
A couple years ago, I also took a two day class taught locally called D.A.M.S. (Difficult Airway Management in the Streets) that was also excellent. That was taught by Daniel and David Tauber. The class culminated in an airway tunnel where we had to crawl under tables in a dark room illuminated only by light sticks from one airway station to the next — each station (there were 10 of them) involved a different airway scenario (basic ET, nasal, broken equipment, pedi, combitube, awkward positining requiring “icepick” technique, etc.)
I have also heard of an airway class called SLAM(Street Level Airway Management) that I would love to take someday.
You can never know too much about the airway.