The EMBER Project

Surgical Airway Summary


Our online walkabout on the emergency surgical airway is coming to an end. I hope you’ve found this helpful, I know I enjoyed doing it. The emergent cricothyroidotomy presents many educational challenges. It is a high stakes, low-frequency procedure performed in the stressful failed airway situation, where time is not on your side.

Preparing yourself for this scenario requires several key technical and non-technical skills outlined in summary here:

  • A working knowledge of airway anatomy and the confidence to quickly identify important anatomical landmarks.
  • Familiarity with the necessary procedural skills – ideally practiced and reviewed in cadaver as well as sim labs so that the muscle memory is there when you need it.
  • Situational awareness: a term that encompasses the logistical, emotional and psychological skills necessary to take appropriate and effective action. In this case it is defined by how effectively you can identify the failed airway and move through the failed airway algorithm in order to put scalpel to skin. It includes the recognition of normalcy bias and focus lock and the danger of repetitive attempts at laryngoscopy to the hypoxic patient,

This exercise is not a substitute for good clinical training, rather it is designed to highlight key concepts by drawing together disparate online resources into a coherent and educational narrative. As the name EMBER Project (EM Bundles & Education Research) suggests, our goal is to provide bundles of educational material and to discover innovative ways to bring it to you. This time. the entire bundle of resources presented over the last couple of weeks, along with commentary and opinions from other physicians and experts will be up on the EMBER Project’s Facebook page and on Storify today for review – and for future reference. Please join the conversation and add your insight. Until then, may the airway be ever in your favor!


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EM Walkabout – Smooth Sailing in the ED

Western Coast of Australia Near Broome

In honor of the first EM walkabout, I thought it was only fitting to start with an inspired article from the BroomeDocs.  Some of the greatest “thank-you” moments I have had exploring online EM education comes from people sharing bits about how they practice the daily art of caring for patients. Maybe it’s a validation of something you have done unconsciously for years, but never had it pointed out to you, maybe it is the relief of knowing others struggle with the same issues, maybe it is a moment of clarity on a topic that never quite solidified until now.

Whatever its origin, the momentary sense of community, clarity, and gratefulness is without equal in education. I happened to have one of those moments with this post by Casey Parker. Consult Skills 2: When Agendas Collide or “Physician Know Thyself”.  This post on dealing with the patient who may have a radically different agenda than yours got me thinking about how I interact and share with patients, and how the subtle tone of that has changed over the years for the better, making the number of good days in the ED far outweigh the bad ones for me.

Surviving a 12 hour shift in the ED is all about charting your course for smooth sailing.  From the moment you start taking sign-out, to the last patient you see 15 minutes before your shift ends, I have learned the hard way that confrontation sets you up for failure.  Now I’m not saying you don’t drop the hammer when you need to, or stand your ground when you feel it is in the best interest of patient care, but if you do it the wrong way, even if you win you lose.

Whether you walk out of your shift emotionally drained looking for a quiet place to curl up in a fetal position, or come home happy and sane with the energy to go for a run with your dog all depends upon the subtle ways you learn to interact with your patients, colleagues, consults, lab techs, and everyone else essential to your daily practice.  So this EM walkabout will be dedicated to all those moments when I learned something about how to find smooth sailing during my shifts in the ED.  Thanks Dr Casey Parker for giving us a great starting point.

Smooth Sailing off the coast of Western Australia

EM Walkabout

I have a certain fascination with Australia, maybe its the fact that I’ve been there and wanted to stay, maybe its the phrase “no worries”, or that 7 out of the 10 deadliest creatures call it home.  More recently, I have fallen for Australia again because there is a lot of great EM education to be found online by the Aussies.   One of my favorite EM Blogs BroomeDocs, is a worthy addition to your Google Reader.  In fact, I believe one of their posts will be the inspiration for our first EM walkabout.

Walkabout refers to a rite of passage during which male Australian Aborigines would undergo a journey during adolescence and live in the wilderness for a period as long as six months.[1] In this practice they would trace the paths, or “songlines”, that their people’s ceremonials ancestors took, and imitate, in a fashion, their heroic deeds. – Wikipedia.

So what is the EM walkabout?  The walkabout format is my attempt to go deep on a topic while staying within the constraints of the blog format. It will start with some important aspect of our EM practice as a focus for our online exploration, no other structure, no rules, no limit to where it will go or when it will end.   So when you see the title EM walkabout you know to strap on your Roo bar and get ready to enter the EM outback.  What will the first topic be and where will it lead?  Stay tuned.

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