A patient is having a medical emergency and is having difficulty breathing. If the airway isn’t managed well, the consequences could be tragic. If asked to step in, would you? Could you?
More hospitalists are being faced with this situation, said Joshua Lenchus, DO, RPh, SFHM, chief medical officer at the Broward Health Medical Center in South Florida. But when they are, they tend to be hesitant – usually with good reason, since training is frequently lacking.
Dr. Lenchus and a group of five other physicians who are experienced in airway management led 25 hospitalists in emergent airway management training on Monday at HM19, a first-of-its-kind session at the annual conference.
“Not all facilities that hospitalists practice at would require or even ask a hospitalist to step into a situation like this,” said Dr. Lenchus, who oversaw the training. “But as you walk around the exhibit hall at SHM, you find that of the locum tenens companies that ask for hospitalists to perform procedures, airway management is very high on the list.”
The trainers were Armando Ariza Giammaria, MD, an anesthesiologist and clinical assistant professor at Tulane University, New Orleans; Jorge Cabrera, DO, an intensivist and assistant professor of medicine at the University of Miami; Alice Gallo de Moraes, MD, a pulmonary critical care doctor at Mayo Clinic, Rochester, Minn.; Fernando Caceres, MD, a pulmonary critical care specialist at the Billings (Mont.) Clinic; and Aldo Pavon Canseco, MD, a hospitalist and assistant professor of medicine at the University of Miami who was trained as a pediatric anesthesiologist.
Over 3 hours, hospitalists first heard tips for airway management, with words of caution, and then did hands-on work using manikins under the guidance of the faculty members with a low trainee-to-instructor ratio.
“Do the basics well and the scary things will become manageable,” Dr. Cabrera said in the session.
Instructors said it was vital to have a checklist in the form of a mnemonic device, and to have not just Plan A for clearing an airway, but Plans B and C, too.
Dr. Ariza told the learners not to focus too much on intubation — it’s not always necessary. In fact, he said he couldn’t over-emphasize the importance of mastering bag-mask ventilation, a go-to method when other approaches fail.
Participants learned about devices that can be deployed through the nose to keep the airway clear, those that can be used in the mouth but that might not go down quite as far as the lung, an inflatable bag that can be placed over patients’ mouths and squeezed to help with their breathing, and endotracheal tubes.
Dr. Lenchus said that more training would likely be needed for most clinicians – perhaps with other faculty at their own institutions – before they could be expected to employ these techniques in a real-life emergency situation.