Resus Now

This is part 1/3 in our subclavian central line series.  First we discuss the blind approach and see this excellent video on the procedure. 


https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&ved=2ahUKEwiWi9bi16HuAhXBQc0KHfqwCY4QFjAMegQIAxAC&url=https%3A%2F%2Fjomi.com%2Farticle%2F290.14%2FBlind-Technique-for-Subclavian-Central-Line-Placement&usg=AOvVaw1GYu3SgBKI4_a-SQGWlz_p

https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&ved=2ahUKEwiWi9bi16HuAhXBQc0KHfqwCY4QFjANegQIHhAC&url=https%3A%2F%2Fwww.youtube.com%2Fwatch%3Fv%3DRDtgzNWmYBw&usg=AOvVaw29uSjDYjpH_bJ1e-o4ia3e

The retrograde intubation! An oldy but goody and a nice trick to keep in your back pocket.
1. Prep the neck
2. Identify the anatomy and your Cricothyroid membrane
3. Introduce your needle with syringe attached through cricothyroid membrane in a cranial (cephalad) direction. Withdraw plunger and confirm position with whisp of air in syringe (can have saline in syringe to look for bubbles).
4. Pass wire through needle until operator at the head retrieves it with forceps. Continue passing the wire until most is exiting the oral cavity.
5. Clamp wire at the front of the neck with needle holder.
6. 2 operators work to stabilize wire and pass the tube until resistance is met.  Then, unclamp wire and pass tube/pull wire from up top, simultaneously.
7. Inflate cuff, confirm placement.  See video below:

This video utilizes a cook catheter over the wire but the technique is essentially the same, enjoy:

https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&ved=2ahUKEwjao8S40qHuAhXPHM0KHXdeDpUQFjAGegQIAhAC&url=https%3A%2F%2Fwww.youtube.com%2Fwatch%3Fv%3D4fw0UezAkzk&usg=AOvVaw2ykYSvBB-pQE8ywlDu_bLc


Enjoy these articles about retrograde intubation:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3016593/

https://journals.lww.com/johnajournal/fulltext/2019/05000/the_retrograde_tracheal_intubation_technique_for.3.aspx

Part 4 of 4! Things we talk about:
1. Reinforce safety, never have your finger in the same hole as a scalpel.
2. Extend your incision from sternal notch to hyoid bone (in the midline) if anatomy is not palpable.
3. Be wary of previous front of the neck surgical scars!
4. The wired jaw airway emergency. See below
5. Nasotracheal intubation and fiberoptic  techniques. 

Check out this reference on steps and pictures of cutting the vertical fixation wires:
http://sjrhem.ca/wiredjaw/

Article on nasotracheal intubation:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4518776/

Fiberoptic scope techniques by Rich Levitan of SMACC:
https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=video&cd=&ved=2ahUKEwj7oI3qz6HuAhUMH80KHZzVDOMQtwIwB3oECAgQAg&url=https%3A%2F%2Fwww.youtube.com%2Fwatch%3Fv%3DgOYDlc2Jq8E&usg=AOvVaw1wWzfsaBSIaMUbE09pHQ6p

This is part 3 of 4 in the surgical airway series.  We discuss pitfalls including entering a false passage with the bougie.  Watch the below video from EMCrit, George Kovacs, as I referenced in the podcast demonstrates that “hold up” is possible in a false passage.  All credit goes to Dr. Weingart, Dr. Kovacs and all the brilliant airway gurus for continuing to teach and perfect these techniques. Enjoy

https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=video&cd=&cad=rja&uact=8&ved=2ahUKEwiAzYaXy6HuAhVIVs0KHQyDCv0QtwIwAHoECAAQAg&url=https%3A%2F%2Fwww.youtube.com%2Fwatch%3Fv%3DV0Miq86nYZM&usg=AOvVaw0FyDnCYGlcNboz74djX4kv

This is part 2 of 4 in a our surgical airway series.  Below are some good videos on the proper approach and technique.  Credit goes to Scott Weingart, my RLA professor and the host of EMCrit podcast as this technique was adopted from his teaching.

https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&ved=2ahUKEwjm0fHdxqHuAhXVK80KHWG2AosQwqsBMAB6BAgOEAM&url=https%3A%2F%2Fwww.youtube.com%2Fwatch%3Fv%3DQ0RVlgwC9rs&usg=https://www.google.com/url?

sa=t&rct=j&q=&esrc=s&source=web&cd=&ved=2ahUKEwjm0fHdxqHuAhXVK80KHWG2AosQwqsBMAF6BAgOEAY&url=https%3A%2F%2Fwww.youtube.com%2Fwatch%3Fv%3DWnTBm5f_ihQ&usg=https://www.google.com/url?

sa=i&url=https%3A%2F%2Femcrit.org%2Femcrit%2Freal-surgical-

This is part 1 of 4 in a our surgical airway series.  Below are some good videos on the proper approach and technique.  Credit goes to Scott Weingart, my RLA professor and the host of EMCrit podcast as this technique was adopted from his teaching.

https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&ved=2ahUKEwjm0fHdxqHuAhXVK80KHWG2AosQwqsBMAB6BAgOEAM&url=https%3A%2F%2Fwww.youtube.com%2Fwatch%3Fv%3DQ0RVlgwC9rs&usg=https://www.google.com/url?

sa=t&rct=j&q=&esrc=s&source=web&cd=&ved=2ahUKEwjm0fHdxqHuAhXVK80KHWG2AosQwqsBMAF6BAgOEAY&url=https%3A%2F%2Fwww.youtube.com%2Fwatch%3Fv%3DWnTBm5f_ihQ&usg=https://www.google.com/url?

sa=i&url=https%3A%2F%2Femcrit.org%2Femcrit%2Freal-surgical-