Emergency airway study day
BMJ 2012; 345 doi: https://doi.org/10.1136/bmj.e6051 (Published 02 October 2012) Cite this as: BMJ 2012;345:e6051
- Ananth Vijendren, core trainee year 1, ear, nose, and throat medicine
- shivan5{at}yahoo.com
A “difficult airway” is defined as a clinical situation in which a trained medical practitioner has problems using a face mask on a patient and performing endotracheal ventilation.1 Its incidence during routine anaesthesia has been estimated at 3-18%, with higher figures reported in emergencies.2 Failure to recognise and intervene appropriately in a case of a patient with a difficult airway can have catastrophic repercussions. The Difficult Airway Society has therefore produced guidelines and algorithms that include recommending the creation of a surgical airway in such situations.3 However, this procedure lies outside the comfort zone of most trainees, being performed infrequently even by experienced clinicians.
In addition, postoperative airway management requires subspecialised knowledge and skills that doctors from other specialties who are providing cross cover out of hours—such as general surgery or plastic surgery—may not possess. In recognition of this, Whipps Cross University Hospital has designed a course on how to handle emergency airways and the associated care.
Who is it for?
The emergency airway study day is aimed at all medical professionals who regularly deal with airway management: doctors (foundation and specialty trainees), nurses, and allied health professionals who work in anaesthetics; emergency medicine; or ear, nose, and throat medicine.
Why did you do it?
As a core surgical trainee in ear, nose, and throat medicine, I found it a challenge when asked to review patients with complications relating to their tracheostomies or laryngeal tubes (for example, tubes that had been blocked or dislodged or were bleeding from the stoma site). Because I was first on call for ear, nose, and throat medicine out of hours, with the registrars usually off site, I was keen to be taught formally how to create surgical airways should the need arise and should help not be available on time.
Where is it held?
The one day course is run twice a year at the Medical Education Centre at Whipps Cross University Hospital, east London. The faculty members were consultants in ear, nose, and throat medicine, head and neck surgeons, consultant anaesthetists, and ear, nose, and throat registrars. The number of candidates is limited to 24 to ensure a faculty to delegate ratio of 1:2.
What did it involve?
The morning session comprised a series of lectures on anatomy and physiology of the airway, differences between adult and paediatric airways, emergency scenarios, and a theoretical approach to performing cricothyroidectomy and tracheostomy. A talk on the non-technical skills needed during emergencies highlighted the importance of leadership qualities and communication in such situations.
After lunch we were divided into groups of three and rotated around practical stations: performing elective and emergency tracheostomies, needle and surgical cricothyroidectomies, stoma care, and different tracheostomy tubes. After these were two simulated situations in a clinical skills laboratory, with constructive debriefing after each scenario. The day ended with general feedback, and all candidates were awarded a certificate of course completion. No formal assessments were done.
How much does it cost?
The course costs £200, which includes a pocket guidebook to ear, nose, and throat medicine written by the course organiser, a booklet of all the lectures, and lunch.
Was it worth it?
Besides being immensely entertaining, the mixture of short didactic lectures and practical sessions consolidated a large amount of knowledge in a short time. I left the course feeling confident in my newly acquired surgical skills and my ability to manage patients with tracheostomies. I would recommend this course to anyone who deals with tracheostomy patients regularly.
Top tips
It is best to do the course at the beginning of a placement in ear, nose, and throat medicine; intensive care; anaesthetics; or emergency medicine.
Background reading on the anatomy of the airway would be beneficial.
Candidates who had done the advanced trauma life support and care of the critically ill surgical patient courses followed this course better; however, attending these courses is not a prerequisite.
Further information
Further information about the course is at www.wxmec.org.uk/courses/index.html.
Footnotes
Competing interests: None declared.