Australian retrieval medicine guru and Flying Doctor Dr Minh Le Cong sent me a copy of the ‘Prehospital Anaesthesia and Airway management Syllabus 2012’ that he’d authored, a thorough and evidence-based approach to airway management for practioners involved in pre-hospital care and critical care transport.
In the surgical airway section, Minh describes the use of ultrasound as an adjunct to the identification of the cricothyroid membrane. It includes this image of Minh ultrasounding his own neck in his office.
I couldn’t help but be distracted by an object on his desk, which on closer inspection, appears to be a rubber chicken.
I emailed Minh to find out about that chicken. He replied:
..even I did not pick that my rubber chicken was visible in the shot!
A great tip from an ex SAS soldier…always carry a rubber chicken into high stress, high risk situations. You would be surprised how well it works in defusing high tension, arguments and standoffs as well as personally allowing you to take a moment and ground yourself when the shit is flying.
The chicken comes with me, along with my king vision, portable USS and Leatherman Multitool and head torch.I used all of those items recently on the same patient!
Minh Le Cong
Medical Education Officer
RFDS Queensland Section
What are the essential items you have with you on every shift? Is your list anything like Minh’s Retrieval Toolkit?
Think about what you would do if faced with the following situation:
You sedate and paralyse a patient with severe injuries in order to intubate them. You are unable to intubate due to a poor view and massive orofacial haemorrhage. An iGel provides temporary oxygenation while you prepare for a surgical airway.
Your first surgical airway attempt fails due to insertion of the bougie through a false (too superficial) passage. You spot your mistake and re-do the procedure successfully with a deeper incision. The patient’s airway is secure and there is good oxygenation and ventilation.
You discover that a colleague has videoed the procedure on his iPhone. However he only captured the first, unsuccessful attempt. The patient is not identifiable in the close up video. It’s late at night and only he and you know of the existence of the video. He asks you what you want him to do with it.
(a) Ask your colleague to delete the video?
(b) Watch the video with him and look for learning points, and then delete it?
(c) Ask him for a copy of it and request that he doesn’t show it to anyone else?
(d) Other course of action
Consider your course of action given this situation, and then click below to reveal what my colleague did recently in exactly the same scenario…
[EXPAND What did he do?]
(d) He did something else entirely: he got a copy of the video, burned it onto a CD, and left it on his boss’s desk!
It takes a certain kind of practitioner to risk embarrassment and criticism in the pursuit of the greater educational good.
He had already ascertained what he would need to do differently next time, so had nothing personal to gain from his chosen action.
Instead, he believed that sharing the video would help prevent his colleagues from repeating the same mistake, and help his supervisors review their cricothyroidotomy training in order to better prepare their team for the procedure. Ultimately, this gesture was directed towards the good of our patients.
His actions may have saved more than one life that evening.