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3 results

  • P032: Perceived versus actual cricothyroid membrane landmarking accuracy by emergency medicine residents and staff physicians

  • N. Schouela, M. Woo, A. Pan, W. Cheung, J. Perry
  • Journal:
    Canadian Journal of Emergency Medicine / Volume 22 / Issue S1 / May 2020
    Published online by Cambridge University Press:
    13 May 2020, pp. S75-S76
    Print publication:
    May 2020
    • Article
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  • Introduction: Cricothyrotomy is an intervention performed to salvage “can't intubate, can't ventilate” situations. Studies have shown poor accuracy landmarking the cricothyroid membrane, particularly in female patients by surgeons and anesthesiologists. There is less data available about emergency physician performance. This study examines the perceived versus actual success rate of landmarking the cricothyroid membrane by resident and staff emergency physicians using obese and non-obese models. Methods: Five male and female volunteers were selected as models. Each model was placed supine, and a point-of-care ultrasound expert landmarked the borders of each cricothyroid membrane. 20 residents and 15 staff emergency physicians were given one attempt to landmark five models. Data was gathered on each participant's perceived likelihood of success and attempt difficulty. Overall accuracy and accuracy stratified by sex and obesity status were calculated. Results: Overall landmarking accuracy amongst all participants was 58% (SD 18%). A difference in accuracy was found for obese males (88%) versus obese females (40%) (difference = 48%, 95% CI = 30-65%, p < 0.0001); and non-obese males (77%) versus non-obese females (46%) (difference = 31%, 95% CI = 12-51%, p = 0.004). There was no association between perceived difficulty and success (correlation = 0.07, 95% CI=−0.081-0.214, p = 0.37). Confidence levels overall were higher amongst staff physicians (3.0) than residents (2.7) (difference = 0.3, 95% CI = 0.1-0.6, p = 0.02), but there was no correlation between confidence in an attempt and its success (p = 0.33). Conclusion: We found that physicians demonstrate significantly lower accuracy when landmarking cricothyroid membranes of females. Emergency physicians were unable to predict their own accuracy while landmarking, which can potentially lead to increased failed attempts and longer time to secure the airway. Improved training techniques and a modified approach to cricothyrotomy may reduce failed attempts and improve the time to secure the airway.

  • Perceived versus actual cricothyroid membrane landmarking accuracy by emergency medicine residents and staff physicians

  • Nicholas Schouela, Michael Y. Woo, Andy Pan, Warren J. Cheung, Jeffery J. Perry
  • Journal:
    Canadian Journal of Emergency Medicine / Volume 22 / Issue 4 / July 2020
    Published online by Cambridge University Press:
    10 February 2020, pp. 523-527
    Print publication:
    July 2020
    • Article
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  • Objectives

    Cricothyrotomy is an intervention performed to salvage “can't intubate, can't ventilate” situations. Studies have shown poor accuracy with landmarking the cricothyroid membrane, particularly in female patients by surgeons and anesthesiologists. This study examines the perceived versus actual success rate of landmarking the cricothyroid membrane by resident and staff emergency physicians using obese and non-obese models.

    Methods

    Five male and female volunteers were models. Each model was placed supine, and a point-of-care ultrasound expert landmarked the borders of each cricothyroid membrane; 20 residents and 15 staff emergency physicians were given one attempt to landmark five models. Overall accuracy and accuracy stratified by sex and obesity status were calculated.

    Results

    Overall landmarking accuracy amongst all participants was 58% (SD 18%). A difference in accuracy was found for obese males (88%) versus obese females (40%) (difference = 48%, 95% CI = 30–65%, p < 0.0001), and non-obese males (77%) versus non-obese females (46%) (difference = 31%, 95% CI = 12–51%, p = 0.004). There was no association between perceived difficulty and success (correlation = 0.07, 95% CI = −0.081–0.214, p = 0.37). Confidence levels overall were higher amongst staff physicians (3.0) than residents (2.7) (difference = 0.3, 95% CI = 0.1–0.6, p = 0.02), but there was no correlation between confidence in an attempt and its success (p = 0.33).

    Conclusion

    We found that physicians demonstrate significantly lower accuracy when landmarking cricothyroid membranes of females. Emergency physicians were unable to predict their own accuracy while landmarking, which can potentially lead to increased failed attempts and a longer time to secure the airway. Improved training techniques may reduce failed attempts and improve the time to secure the airway.

  • Chapter 7 - Difficult airways: causation and identification

  • from Section 2 - Clinical
  • Edited by Ian Calder, Adrian Pearce
  • Book:
    Core Topics in Airway Management
    Published online:
    10 January 2011
    Print publication:
    16 December 2010, pp 53-62

  • Summary

    This chapter offers a selective account of the functional anatomy of the adult head, neck and airway as it applies to anaesthetic clinical practice. The anatomy of both inside and outside of the nose has anaesthetic relevance. The epiglottis has evolved to shield the glottis not from anaesthetists, but from nutrients headed towards the stomach. As the trachea must run posteriorly from the glottis to reach the carina in the mediastinum, it is most superficial at its start. As the bronchial tree ramifies beyond the trachea, its initial divisions are crucially asymmetric. The position of the vein and other vessels, and indeed the trachea, can usefully be identified by ultrasound before cricothyroidotomy or tracheostomy. Mouth opening ability depends on craniocervical flexion/extension. The normal cervical spine is largely relevant only to the extent that it obstructs anaesthetists' access to the airway.