Editor’s Note: The EMS1 Academy features “Respiratory Emergencies,” a 30-minute accredited course for EMTs. This course provides examples of the common signs and symptoms a patient with inadequate breathing may present with in an emergency situation. Visit the EMS1 Academy to learn more and schedule a demo.
High-fidelity simulation has gained in popularity over the past few years, and rightfully so – it’s awesome, realistic stuff.
The reality of training, especially when it comes to airway management, is that it can also come with a hefty price tag. Don’t get me wrong, by no means am I opposed to spending money on training (I am an educator, after all). But for some of those instances where you’re on a budget, or even in some of those clinical situations where traditional methods simply aren’t available, you may just need to indulge in some MacGyver-style improvisation.
Here are some ways to DIY an airway management training exercise.
Relieving tension
Ask yourself these questions:
- Are lung sounds diminished or absent? Check.
- Is there jugular vein distention? Check.
- How about tracheal deviation (as if we would actually see this on a patient!)? Check; check!
Sounds like you’re dealing with building pressure – a tension pneumothorax.
Now’s the tricky part – preparing to perform this skill. Gather your 10-gauge needle (go big or go home), three-way stopcock, 10 mL syringe, and whatever else you have in your pre-packaged kit. Next, feel for the second and third ribs (mid-clavicular) or the fourth and fifth ribs (mid-axillary).
Who wants to be your volunteer?
Seeing how attempting this at home isn’t recommended, we may have to substitute something else into our training equation – a rack of ribs, perhaps. Whether you try to put some sort of inflated, resealing bladder underneath is up to you, but at least using this fairly inexpensive option can help you gain some muscle memory build-up as you feel for the ribs and insert your catheter over the inferior third or fifth rib for proper technique.
Suction, stat!
We’ve seen some changes over the recent years regarding our rigid suction catheters, such as transitioning away from dentistry models and toward continuous suction devices, but there are still some times when a portable or wall-mounted suction device might not be readily available. Or, when we might need big suction options to clear out big airway problems.
If you’re part of a bike medic team, backpacking out to find a downed hiker or your prior crew didn’t replace the hand-pump suction device in your response bag, for example, you might try out the following trick.
Take your largest syringe (commonly 60 mL) and a 30FR French nasal airway trumpet and insert the syringe into the lumen of the trumpet end of your nasopharyngeal airway (NPA) at the opposite end of the bevel. Voila. Now you have a low-key – but still somewhat effective – portable suction device. While this may not clear out copious amounts of emesis, it may offer short-term relief from blood or other viscous secretions.
Note: 30 FR seems to work best on most NPA models, but other sizes may work just as well. So, I recommend that you practice before you start reaching for equipment in the heat of the moment.
For those moments where you need big suctioning power, or for those suction-assisted laryngoscopy and airway decontamination (SALAD) method situations, why not turn to something a bit more large-diameter and readily available?
Take your standard 8.5 mm endotracheal tube and pluck off the top adapter. Next, flip it over and insert the tube back into the larger side of the adapter. This will turn your endotracheal tube into a large-bore suction tube that is great for clearing out copious amounts of secretions (or even some larger chunks). If you already have that same 8.5 inserted into your patient’s trachea, you can now flip the adapter and clear out the patient’s frothy sputum. Lastly, flip it back to the proper positioning/side and resume ventilation.
Cricothyrotomy trainer 1.0
Going into the future, 3D printers will no doubt have an impact on cricothyrotomy training options, but with their limited availability (and still increasing cost), what other options exist to help us train on this very high-acuity, low-frequency airway management skill?
Enter, the Cricothyrotomy Trainer 1.0, something that any of us can make. All you really need are the components from two nebulizer sets, a set of CPR manikin lungs, a piece of wood (for a base), super glue and duct tape or medical tape.
Start by setting-up the T-piece on top of the nebulizer chamber (creating two of these), then place your corrugated tubing section between the two T-pieces. Glue the base of the nebulizer chambers to the piece of wood in a position so that your entire assembly creates a straight line. Then tape one end of the exposed T-pieces closed while taping the mannequin lungs to the other, thus creating a closed-circuit for ventilations. Boom, you’re done.
For added effect, tape a thicker “membrane” over one end of the corrugated tubing to simulate skin. Or feel for the corrugated tubing (simulating the tracheal rings), then find the “flat” spot (the cricothyroid membrane) and make your incision.
Note: Don’t push the corrugated tubing too far onto the T-piece; this may result in students trying to cut through the plastic T-piece instead of the “flat” portion of the corrugated tubing.
This article, originally posted in February 2020, has been updated.
