Wednesday Wrap-Up: 4/18/12

Special thanks to the SIM team and all those who participated in our Sim Throwdown/ Rumble/ Battle Royale.

Congratulations to Drs. Aherne, Kendall and Grock for winning our first Sim Competition!

Take home points from the simulation cases:

1) When you see a difficult airway, LOAD THE BOAT early! Get ENT, Surgery, and Anesthesia on board as soon as possible. As much as we love procedures, it’s best to avoid having to deal with a crash airway, if you can.

2) Know what you have available (aka always have plan B ready to go)– LMAs can save you! Remember, as long as you can ventilate the patient, you have time to get to a definitive airway. Call for a Cric tray set up early if you think you’re going to have to go there.

In between seeing our fellow colleagues battle it out during simulation cases, we got great lectures from Drs. Adeleke, Scheer, and Lau.

Kevin discussed the management of anaphylaxis and advanced airway management. Of the many things, he talked about, an important part is don’t be afraid of using epinephrine. You can give it IV or as an injection – just make sure you know the dosages. It can save lives! Also, consider intubating these patients early before the laryngeal swelling makes it impossible to intubate them. Dr. Tan gave a great step by step way to perform an awake intubation on these patients.

Diane briefly went over ludwig’s angina and emphasized the importance of knowing how to perform a Cricothyroidotomy and the different ways of performing the procedure. While Crics are not a common procedure, it is definitely a life saving one that you need to know how to do.

Wendy reminded us all how to do a needle cric with jet insufflation with a 14 gauge IV, a 3cc syringe and the cap off of a size 6 ETT. She also discussed the difference between bacterial tracheitis, epiglotitis, and croup, in addition to the signs and symptoms of peritonsillar abscess and retropharyngeal abscess. We see wheezing and sore throats all the time in peds, do you always have all of these things on your differential? If it comes down to having to do some sort of airway management for these children, do you know where to find all of the necessary materials for your procedures? What medication options are available in our Peds ED Pyxis for sedation if you need to intubate these patients, and in what doses?

If you’re interested in learning more of these advance airway management techniques, make sure you contact Dr. Papanaganou about attending the Advanced Airway Management Course taught at IMSAL in the Bronx. (By the way, you get 4 hours of asynchronous learning credit for going!)