Full credit for this goes to Dr James DuCanto, airway geek and innovator from Milwaukee, USA. It’s been my great privilege (and crazy pleasure) to facilitate with Jim at smacc airway workshops in Chicago and Dublin, using the SALAD sim (suction assisted laryngoscopic airway decontamination). This is a great setup to teach techniques to manage…
Posts tagged ‘james-ducanto’
— Anesthesiology News (@anesthesianews) September 30, 2015
— Mike Abernethy (@FLTDOC1) August 16, 2015
— Thomas D (@thomas1973) June 26, 2015
— James DuCanto (@jducanto) July 9, 2015
The following is an excerpt from feedback that Jim provided me after SMACC Chicago. He kindly gave permission to share his thoughts with you all.
It was a transformative experience. I was walking around that conference with my head spinning, so great was the energy of these people and their passion. It was like an out-of-body experience—I have not ever felt anything like that. To have colleagues in EMS and Emergency Medicine happy to meet me and talk about airway management like that was a bit overwhelming— But it all works out when you learn that what makes it all better is when you finally wake up and take a positive, leadership role in your interactions with colleagues and staff. Simply don’t allow room for negativity. We can do this at work, and we can also do this in life.
Giving the Ted-style lecture was intimidating at first, but I simply had to be honest with myself—I was asked to provide the talk because of the knowledge, innovation, passion and willingness to teach that I have shown through PHARM and EMCRIT. I belonged there, and I was going to do the best job possible.
I centered myself with my breathing, and took stock of where I was: The Arie Crown Theater, a major venue for theatrical performances in Chicago. I had been there once as a youth to see a play—I never thought I would be there on stage. I breathed into my heart and my center, and envisioned that my father, a prominent Chicago lawyer, now passed on 2 and a half years, was sitting in the audience. At worst, I could give the lecture to his visiting spirit.
Rich introduced me in a respectful, affectionate manner, in effect, declaring to me and the crowd how much respect and warmness he had for me—it was a perfect introduction. I sought to start the lecture on a lighthearted note, using the opening notes of “Stairway to Heaven” to give the history of “stuff” kind of a Renaissance Faire feel. Then I scrolled the iPhone over to the guitar solo that song is known for to describe the modern day…. Anyway, that was fun.
I gave the lecture as if I was speaking to my best and most interested students, and also my best friends. I know I blew people’s minds with some of the videos. Maybe what they walked away with was that there is no reason to get excited, even though the patient is dying. I am sure that video will give many the confidence to face the hopeless with a lot more dignity, and a bit more courage. What I did not say at the end of my lecture (which I did state at the end of Rich’s course), was that sometimes you are going to be called on to help people die. When that time comes, you will know it—my instructions are for everyone to pull together and work as a team and kill the patient together (I know that’s a bit crass, but that gets the point across—you attend the patient to the end (not committing a heinous act).
Giving that workshop was fun! I’ve given boat loads of workshops, and this one was good because of the students! Our planning and implementation were great, but if the students don’t connect, put out the effort, ask questions and take chances, the seminar would otherwise be flat and boring. I knew Tim Leuwenberg would be absolutely lit on fire by running the SALAD sim—he was a natural, and it gives him (as well as all of us) the ability to re-define the simulations moving forward in a manner that challenges and stimulates us intellectually as well as professionally.
When I returned back to my lab to put everything away and wash the SALAD mannequin, I had this odd feeling that I didn’t really belong in private practice—I belonged where the young and vibrant students and attendings are. It took a few days for this feeling of remorse, as it were, to wear down, but it gave me the opportunity to look at myself at where I am, and potentially where I may go. The truth is..I am in the perfect place right here, right now. I have employment, the administration of the hospital has given a colossal simulation space in the office building (was formerly their sleep lab, now decommissioned) and they are looking to me to help run simulation for their physician staff. I am also Quality Officer of the hospital at present (until the end of the year).
The colleagues I met in person had a huge impact on me. Reuben Strayer, has bonded with me on a mutual interest in ketamine-driven sedation for airway management. Andy Sloas and I are the newest BFF’s on intubation through SGA’s. Sam Ghali share interests on all sorts of stuff. Chris Carroll is building tongue mannequins, somewhat with my input. I’m helping the college student, Mitch Page, build mannequins. The saga of the SALAD simulation continues with Mike Abernathy and Mike Steurwald at UW Madison.
Overall, I hope to continue to collaborate and participate with you and Yen and the whole of the FOAM movement. I have a few concepts that need vetting, like:
1. If an CICV situation exists, would mechanical chest compressions potentially open the airway to allow endoscopy from above if VL and video stylet endoscopy is used (like a rigid bronch through epiglottitis)? Allow you to follow the bubbles?
2. Can a technique involving using a rigid suction catheter to deliver a bougie be useful, as bougies are too difficult to rely upon with hyper curved VL’s? Use the suction catheter to deliver the bougie. And the suction catheter can decontaminate or deliver oxygen.
Thanks Mihn! The saga continues!
Movie captures the important lessons of a simulation session based upon using a rigid suction catheter (Yankauer and other variant) to decontaminate the airway of a modified Laerdal Difficult Airway Simulator mannequin. The technique described in this simulation is known as the “SALAD” technique–Suction Assisted Laryngoscopy Airway Decontamination.
The central tenant of the SALAD technique is to make the rigid suction catheter the “tent-pole” of airway management–the suction catheter is utilized in all phases of laryngoscopy to facilitate the quick and proper placement of the laryngoscope blade on the first pass attempt, in lieu of older methods such as opening the patient’s mouth with a scissor-type gesture of the right forefinger and thumb. The result is speed and efficiency coupled with the ability to decontaminate the airway during routine and emergency airway management. In this same manner, the SALAD method can facilitate the insertion of Supraglottic Airways as well, including the Laryngeal Tube. Modern suction catheters beyond standard hospital-issued Yankauer suctions are discussed and demonstrated as well as portable suction systems are demonstrated.