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Table 2 Description of the simulation scenario: Study Model, anamnestic details, facilitator instructions, equipment and learning objectives

From: Emergency cricothyroidotomy in difficult airway simulation – a national observational study of Air Ambulance crew performance

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

  1. aLærdal SimMan 3G, Lærdal Foundation, Norway
  2. bSimMon, Castle+Andersen Aps, Denmark