Emergency cricothyroidotomy over the phone – a case study
Ever had to talk someone through doing a surgical airway over the phone? No?
How would you do it? This is probably the single best test of your ability and knowledge of this life saving technique. Well, read this coroners report from Western Australia, in which a young woman suffered an anaphylaxis from nut allergy and presented in life threatening condition to a remote nurse.
This nurse had to perform a surgical airway , with a doctor on the end of the phone, instructing her. Read how things went and the outcome. You might even read about a young Dr Casey Parker in the report ( he was not the doctor on the end of the phone though…intrigued?). THERE IS EVEN ATTEMPTED USE OF A BALLPOINT PEN..if you read carefully the report…what foresight, Andy!?
Here is the coroners report
CORONIAL INQUEST FINDING INTO ANAPHYLAXIS DEATH AT CORAL BAY ,2007.
Think about it. Would you be ready if put to the same situation? A call from a remote nurse with a patient in a life threatening anaphylaxis and impending complete upper airway obstruction despite adrenaline.
From death we learn.
Minh
Challenging case and sobering – respect to the solo nurse dealing with this case on her own and to the GP providing phone backup
Lots of things coming out of the Coroners – obviously the difficulty of access to EpiPens under PBS criteria and the fact that patient education takes considerable time
I dunno about the rest of you, but for us docs in the bush I find it hard to remember critical doses of drugs and emergency protocols – both because I’m not managing these emergencies everyday (unlike my city specialist colleagues in ED/ICU) and because I am taskloaded
I’m a big believer in keeping a simple flip chart of protocols and common emergency drugs and infusions in the ED…
…but of course they may not be by the phone if I am called by a nurse.
So – simple things
- hands free phones and videolinks, espec with retrieval specialists
- easy access to protocols/checklists – iPhone/iPad would seem to lend itself to this
Know, adapt, modify the environment to suit you…
Interesting to review and case. amazingly detailed.
Really brings up the need to know cold the doses of emergency meds like Epi…especially in the different forms we can give it.
IV vs IM. Also the different concentrations. Good to review with the interns how to make and epi drip with 1:1000 vs 1:10,000.