Study Model | • Adult patient simulatora with advanced airway options. • The manikin was built up with a large thorax and a thick neck, as in adipositas and goitre, and put in a “cannot intubate”-modus. • After the first skin incision, the facilitator emptied a 10 cc syringe with theatre-blood in the field. • Vital signs and values (Blood pressure (BP), oxygen saturation (SpO2), heart rate (HR), 3-lead electrocardiogram (ECG), End-tidal CO2) given remotelyb to the patient monitor when accomplished. |
Anamnestic details | • A paramedic-manned ambulance is requesting Air Ambulance for assistance. • The patient is a 60-year-old female, obese with an un-operated goitre and a history of breathing-problems and reduced general health for the last week. She is in respiratory distress, aggravated in the last hours. |
Instruction for facilitators: | • Initial physiological status: GCS 13 points, SpO2 = 85%, SBP 105 mmHg, HR = 110 / min. • After appropriate first intervention (positioning and supplemental oxygen) transient improvement. • Ultimately, patient deteriorates with falling SpO2, followed by decreasing GCS, forcing the crew to attempt an RSI. The manikin was put in a “cannot intubate”-modus, forcing the team to perform an EC. |
Equipment | • Advanced Life Support-Ambulance. • Emergency bag equal to standard national Air Ambulance-leve l[11]. • Equipment for surgical airway including: Scalpel, tracheal hook, Cuffed 6.0 mm endotracheal tube and a Frova Intubating Introducer® (Cook Medical, USA). |
Learning objectives | • Identify a difficult airway • Ensure adequate monitoring, preparations and conduction of RSI. • Solve CICO with an EC |