Failed airway video

[NomadicMedic]

This worth a watch. Don't judge, just observe and see if you've ever been there. I know I've said, "let me have one more look..." When I really should have moved on down the algorithm.

Time passes in an instant during a failed airway.

There is a second video that address a team approach to problem solving.

 

[phideux]

I don't know if I would have called that "time passing in an instant".

 

[Carlos Danger]

Didn't watch this video particular, but I'm familiar with the case, having read several articles and watched other stuff on it.

I think newer airway devices and techniques and improved general awareness has probably started to help reduce incidents such as this, but still, I would bet that this still happens somewhere......every single day.

 

[NomadicMedic]

I don't know if I would have called that "time passing in an instant".

Not in real time, but I'd bet that subjectively, it felt significantly shorter to the provider.

 

[chaz90]

Gah. This was anxiety provoking. Worth watching for sure. Observing this playing out in real time has some real value.

 

[chaz90]

http://www.chfg.org/resources/07_qrt04/Anonymous_Report_Verdict_and_Corrected_Timeline_Oct_07.pdf

Here's an independent review of the case from another anesthetist. According to this, the primary anesthetist involved in Mrs. Bromiley's care discussed exactly what we were talking about above. In interviews after the case, he admitted to losing track of time during repeated attempts at tracheal intubation. In retrospect, he states if he would have accurately tracked how long this severe hypoxia had been ongoing he would have resorted to a surgical airway as indicated, particularly as an ENT surgeon was in the room assisting with the case.

It's easy to get tunnel vision on a particular objective, and I imagine it's worse for a far more experienced intubator who has flawlessly placed thousands of ET tubes in seemingly more difficult airways. To me, this is the value in my service's strict three ETI attempt rule. Without exception, three attempts is the max. First provider can attempt 2x, second can attempt 1x. At that point (or before!!) a rescue airway, mandatory return to BLS airway maneuvers, or surgical airway access is required.

Sometimes we need that observer who's watching to tell us when to check our own egos or pride. Skillful intubation is well and good, but I aim to be beyond the point of being embarrassed to walk into an ED with a King LT or LMA in place. This is understandable and even reasonable in many cases. A failed or mismanaged airway due to pride or ignorance is the true sin at this point.

 

[triemal04]

The Elaine Bromiley case is something that everyone who electively intubates patients should be very well informed about. While the video is a re-enactment of what happened, watching it and reading the reports and aftermath are very good, clear examples of just what can, and will happen when you auger into a decision and become unable to step back and reevaluate the situation.

It is also a good reminder that each provider must be able to do this on their own. As I recall there ended up being two or three anesthesiologists involved in trying to ventilate and intubate this lady; none either realized that it was time to say "we need to cut" or felt that it was their place to overrule someone else who was "in charge" of the patient.

Very unfortunate situation. But just proof that as a provider you must maintain a level of detachment and objectiveness, and be able to change plans part way through the process.

 

[Aprz]

There was another video of this posted forever ago. I cannot find it for the life of me. I even shared it on my Facebook and I know of another EMTLifer that shared it too, but I cannot find it on this website or on Facebook, lol. I found it quickly just Googling Elaine Bromiley.

I like it because the husband is kinda narrating it.

 

[LACoGurneyjockey]

This just made me so anxious. I wonder what my girlfriend thinks when I'm screaming at my phone "cric the ***** already!"
This was a constant fear of mine during our OR time in clinicals.

 

[WolfmanHarris]

This case was used during a training on human factors and root cause analysis we did last year. Human factor identification and "just culture" have been the main thrust of patient safety initiatives this year at my service.

 

[Tigger]

This was shown in my AMR academy on the airway day, which I thought was excellent. A good reminder that trying the same thing repeatedly probably isn't going to miraculously work and that sometimes you just need to bow out.

 

[Aprz]

This was shown in my AMR academy on the airway day, which I thought was excellent. A good reminder that trying the same thing repeatedly probably isn't going to miraculously work and that sometimes you just need to bow out.

In the video, I don't think they kept trying the same thing. They tried to insert the LMA at a different angle, use a smaller size LMA, use an OPA for bag-mask ventilation, use padding under the head, switch person attempting to intubate, the BURP maneuver, and use a fiber optic laryngoscope. I think the most important take home points of this video was the failure of the doctors to recognize a fail airway and the other staff failing to speak up about the cricothyrotomy kit when they recognized that it was a failed airway which is why some people bring up crew resource management.

I think Manual of Emergency Airway Management goes over recognizing a failed airway pretty well.