Browsing by Author "Backfish-White, Kevin"

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    Anterior Cricoid Shelf: Subglottic Stenosis or Normal Anatomy?
    (2021-09-18) Brown, Kayla; Cochran, Sean; Backfish-White, Kevin; Yu, Corinna J.
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    Cricothyrotomy in Acute Upper Gastrointestinal Bleed: A Difficult Airway Simulation Case for Anesthesiology Residents
    (Association of American Medical Colleges, 2024-01-16) Yu, Corinna J.; Rigueiro, Frank; Backfish-White, Kevin; Cartwright, Johnny; Moore, Christopher; Mitchell, Sally A.; Boyer, Tanna; Anesthesia, School of Medicine
    Introduction: Patients with acute upper gastrointestinal bleeding may have challenging airways. This simulation teaches anesthesiology residents the skill of cricothyrotomy as a surgical last resort while managing acute bleeding in the airway. Methods: The simulation involved a 55-year-old patient with history of alcohol abuse admitted to the ICU with hematemesis and acute blood loss for esophagogastroduodenoscopy in the ICU setting. The mannequin had tubing in the posterior oropharynx connected to a pressurized bag of simulated blood hidden from view. While conversing, the patient began to cough and gag, and the bag of fluid was opened, filling the posterior oropharynx with blood, which prompted immediate intubation attempts, designed to fail no matter what the learners attempted. When residents requested a surgical airway, they were provided with a cricothyrotomy kit and a task trainer to perform the procedure. Residents were evaluated using a behavior checklist, debriefed, then asked to complete a postsimulation survey. Results: Fifty-eight anesthesiology residents completed the simulation and provided feedback via a 5-point Likert scale of agreement. Most residents quickly recognized the need for emergency intubation. Eighty-eight percent of participants strongly agreed that the simulation was a valuable learning experience, with 99% stating it increased their confidence and clinical decision-making in handling similar scenarios in the future. Discussion: This simulation provides a chance to practice valuable airway management skills that increase resident confidence in cricothyrotomy. Future work may examine if these skills and confidence levels are sustainable over time and if they are applied in future patient encounters.
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    A Simulation Case of Cricothyrotomy in an Acute Upper GI Bleed
    (2022-04-28) Yu, Corinna; Rigueiro, Frank; Backfish-White, Kevin; Boyer, Tanna
    Introduction: Although difficult airway management is an expected skill of anesthesiologists, there is no mandatory training focused on this skill set in anesthesiology residency programs. Difficult airways are taught when the clinical situation arises, leading to variable resident expertise. Formal instruction in cricothyrotomy is lacking and the procedure is clinically rare. This lack of training has led to a rise in fellowship programs in airway management, demonstrating the need for greater attention to this skill set. Procedural times for cricothyrotomy improve after educational interventions, providing further evidence to support formal instruction in invasive airway management training. Patients presenting for upper endoscopies are considered full stomach due to the bleeding, and endotracheal intubation is preferred over sedation to prevent aspiration. These airways can be challenging to manage and may require surgical intervention as a last resort. We created a difficult airway simulation scenario to teach residents cricothyrotomy. Objective: To teach anesthesiology residents how to perform a cricothyrotomy and improve their confidence in difficult airway management. Methods: A patient presents with an acute gastrointestinal bleed for an upper endoscopy. A pressurized bag of red fluid was hidden out of view with tubing placed into the SimMan’s posterior oropharynx. Anesthesiology residents obtain the history from the patient when the patient coughs vigorously and its mouth fills with simulated blood. Residents attempt intubation, which is difficult if not impossible on this SimMan. When they communicate their decision for surgical intervention, a secondary mannequin was provided to perform the actual cricothyrotomy. At the end of the simulation, a behavior checklist is used for evaluation and the residents are asked to complete a simulation feedback form. Results: 26 PGY-4 anesthesiology residents completed the simulation from April-May in 2019 with 25 residents providing feedback with a 5-point Likert scale of agreement. Most residents quickly recognized the patient’s need for emergency intubation. 16 residents had prior experience managing the airway in an acute upper GI bleed (average 3 patients) whereas 9 residents reported no prior experience. 88% of participants strongly agreed that the simulation was a valuable learning experience with 92% stating it increased their confidence and clinical decision making in handling similar scenarios in the future. In addition, there were no negative scores to any of the survey questions. Discussion: Difficult airway skills include management of a patient with an upper gastrointestinal bleed requiring surgical cricothyrotomy. This is a valuable skill that can be taught with simulation. Our simulation led to an increase in resident confidence in the procedure, but it would be useful to follow up with the cohort and see if these skills prepared them for patient encounters afterwards and if the learning was sustainable. Conclusion: Our simulation case was a valuable learning experience for residents and provided critical surgical skills for future anesthesiologists in difficult airway management. It is worthwhile to include this simulation in the anesthesiology resident curriculum.