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I'm working through the adverse airway event terminology requests following the meeting in Bratislava.
A couple of questions for consideration;
1) Have not found much to help with definitions for "difficult supraglottic airway device insertion" and " Failed supraglottic airway device insertion". Any thoughts, suggestions, suitable references please let me know.
2) Emergency Front of neck access - are there any other procedures to include as well as tracheostomy and cricothyroidotomy?
Point 2 first.
Cricothyroidotomy may be needle (Ravussin) or cannula (Melker), or be categorised as tube over bougie https://www.das.uk.com/files/das2015intubation_guidelines.pdf
Both of the first two techniques may also be performed as elective procedures alhough Melker rarely is!
Point 1. https://www.ncbi.nlm.nih.gov/pubmed/7486037
are the best i can find. I will ask Tim Cook.
Do you wish to include as part of this work a review of concepts related to clearance of airway and suctioning e.g. Mini Trach?
It might not be a bad plan but would it get too big? Mini trach is rarely used now and airway suction might be anything from blind soft nasal suction (physio) to rigid suction (Yankauer) by anaesthetist, to rigid endotracheal suction (ENT surgeon). I would have thought that keeping to the critical incident framework would be a good start. What are your feelings?
Cant comment on frequency now, apart from coded frequency and actual may be completely different, see http://www.ncepod.org.uk/2014report1/downloads/OnTheRightTrach_FullReport.pdf Whilst this refers to the classification coding many of the points made in the paper may well help prioritise. Apologies I was not intending to extend the scope to suctioning necessarily, but I am interested that the mini trach is now out of favour, I wonder if this depends on where in the world.
Thanks for the useful comments on this debate. We did discuss types of cricothyroidotomy (needle, cannula, scalpel) in Bratislava and the consensus of those present was that we would not request differing procedure terms for the different types of cricothyroidotomy. However, if anyone feels differently, we can of course discuss it again at our next Zoom meeting on 28th November.
Also thanks for the references - I have done the draft requests for the difficult and failed supraglottic airway ventilation terms, but hopefully we will get a bit nearer to useful definitions after our next meeting.
Zac - I had not really considered adverse events related to tracheostomy care, and confess the NCEPOD report on tracheostomy care had slipped my mind, but agree it would be something worth coming back to, but would like to get the current scope adverse event terms - i.e. fundamentally related to anaesthesia completed first.
Another interesting little question - is there any difference between 173067007 Cricothyroidotomy (procedure) qualifier = emergency and 398142004 Emergency cricothryotomy (procedure) (note the misspelling in SNOMED). It will need to be considered when I do the requests for FONA (front of neck access) and the procedures to be included within that axis. I mention it as emergency cricothyrotomy really needs to be changed/ retired as it's parent term is 78817002 Construction of anastomosis (procedure) which the Anesthesia CRG regards as incorrect. Cricothyroidotomy is an "incision of larynx" which is fine.
https://emedicine.medscape.com/article/1830008-overview suggests they are the same and the emergency is pre or post-coordinated. Suggest just correcting the modelling so that its parenting gets sorted. Incision seems sensible
Another thought - should we think of differentiating failed / difficult supraglottic airway insertion and ventilation - There is already a longstanding SNOMED CT term for failed laryngeal mask insertion.
Failed and difficult are different as is the airway insertion and ventilation. One may cause the other but it doesn't make them the same.
//dd-mm-yyyyJust come to these comments.