July Sim + Procedure Lab

7/31/13.  Mark the date, July EM residents/rotators.  Because this is…

Advanced Airway Day.

Where every patient needs an airway placed, and you’re the medical professional to do it.  Battle through artificial blood, emesis, and otherwise difficult anatomy as you practice placing both direct and surgical airways on semi-embalmed cadavers in controlled conditions, so that when the stuff hits the fan in the ED, you know exactly what to do.

For those of you who are new to the fold and want a little prepping advice, I typically find that a stiff, succinct combo of Diet Dew, Pink Floyd, and EMCrit/ Scott Weingart are enough to get me amped and ready to rock.  I’ll share a few links below to get you started.  I particularly like the spiced-up version of Shock Trauma Center’s Difficult/Failed Airway algorithm.


Shock Trauma Center Failed Airway Algorithm
The (sometimes controversial) Cric-Con approach to difficult airways
“Breathe” by Pink Floyd

Journal Club- May 2013: Does pre-hospital advanced airway management lead to worse patient outcomes?

Perhaps one of the most controversial topics in EM and prehospital literature was tackled by residents Tony Mueller and Eric Ernest (with faculty leader Dr Muelleman) a few weeks ago at an evening journal club dinner hosted at Dr Larsen’s house.  In their parsing out of the literature, the two residents debated whether recent evidence truly suggests poorer outcomes for patients who receive advanced airways by EMS prior to hospital arrival.  Many paramedics learn how to intubate unstable patients as part of their training, and are currently able to do so if a patient meets certain criteria.  Much has yet to be determined as why poorer outcomes are being noticed more often in cardiac-arrested patients with EMS-placed airways, although longer time-to-ED and more frequent CPR pauses have been suggested.  

The articles:
#1 Association of prehospital advanced airway management with neurologic outcome and survival in patients with out-of-hospital cardiac arrest. JAMA. 2013 Jan 16;309(3):257-66. doi: 10.1001/jama.2012.187612.

#2  Advanced airway management does not improve outcome of out-of-hospital cardiac arrest. Hanif MA et al. Acad Emerg Med. (2010)

In addition to a great discussion, residents, faculty, families, and pets alike all got to enjoy great food, drinks, swimming, smores, and a bonfire graciously hosted by the Larsen family at their farm west of Omaha.   Here are a few images from the night:

Knowledge bombs

Knowledge bombs

Dr Muelleman

Dr Muelleman

Journal Club

Journal Club