Prehospital Emergency Cricothyrotomy in Dogs Part 1: Experiences With Commercial Cricothyrotomy Kits

The surgical cricothyrotomy (CTT) has been recommended for emergency front of neck airway access (eFONA) during a cannot intubate, cannot oxygenate scenario for military working dogs (MWD) and civilian law enforcement working dogs (operational K9s). In prehospital and austere environments, combat medics and emergency medical service providers are expected to administer emergency medical care to working dogs and may only have emergency airway kits designed for humans at their disposal. The objective of this article is to provide a detailed description of the application of such devices in cadaver dogs and highlight potential alterations to manufacturer guidelines required for successful tube placement. The kits evaluated included the Portex® PCK, Melker universal cricothyrotomy kit and H&H® emergency cricothyrotomy kit. A novel technique for awake cricothyrotomy in the dog is also described, which can also be considered for in-hospital use, together with the open surgical method described for the H&H® kit. To the authors' knowledge, this is the first publication documenting and providing instruction on the application of commercial cricothyrotomy kits in dogs.

Ginkgo leaf sign on X-ray chest due to subcutaneous emphysema in a COVID-19 patient

Subcutaneous emphysema (SE) is usually encountered in cases of structural lung diseases and secondary to direct trauma or iatrogenic procedures for airway access. It is mostly associated with pneumothorax. The diagnosis is made clinically by palpation of the affected area and radiology. Here we presented a case of COVID-19 pneumonia presenting with extensive subcutaneous emphysema resulting in airway compression which was a very rare manifestation of COVID-19 infection. The COVID-19 infection led to extensive alveolar damage to the lungs and the chronic cough which may have led to this complication due to sudden change of pressure differences in the chest wall cavity. The limitation of using of personal protective equipments hindered the diagnosis of this condition as auscultation and the palpatory feelings were greatly hindered. The chest X-ray shows air in subcutaneous space and the prominence of the fibres of bilateral pectoralis muscles which gives an impression of the venous system of a Ginkgo leaf, so named as Ginkgo leaf sign.

Cricothyrotomy Is Faster Than Tracheostomy for Emergency Front-of-Neck Airway Access in Dogs

Objectives: In novice final year veterinary students, we sought to: (1) compare the procedure time between a novel cricothyrotomy (CTT) technique and an abbreviated tracheostomy (TT) technique in canine cadavers, (2) assess the success rate of each procedure, (3) assess the complication rate of each procedure via a damage score, (4) evaluate the technical difficulty of each procedure and (5) determine the preferred procedure of study participants for emergency front-of-neck access.Materials and Methods: A prospective, cross-over, block randomised trial was performed, where veterinary students completed CTT and TT procedures on cadaver dogs. Eight students were recruited and performed 32 procedures on 16 dogs. A generalised estimating equation approach to modelling the procedure times was used.Results: The procedure time was significantly faster for the CTT than the TT technique, on average (p < 0.001). The mean time taken to complete the CTT technique was 49.6 s (95% CI: 29.5–69.6) faster on average, with a mean CTT time of less than half that of the TT. When taking into account the attempt number, the procedure time for a CTT was 66.4 s (95% CI: 38.9–93.9) faster than TT for the first attempt, and for the second attempt, this was 32.7 s (95% CI: 15.2–50.2) faster, on average. The success rate for both procedures was 100% and there was no difference detected in the damage or difficulty scores (P = 0.13 and 0.08, respectively). Seven of eight participants preferred the CTT.Clinical Significance: CTT warrants consideration as the primary option for emergency front-of-neck airway access for dogs.

UNUSUAL CASE OF RETROPHARYNGEAL HEMATOMA WITH USE OF ORAL ANTICOAGULANT THERAPY – CASE REPORT AND REVIEW OF LITERATURE

Retropharyngeal space is a rare site of spontaneous haemorrhage and the formation of a hematoma in this location is a rarer complication of therapy with anticoagulants. Airway compromise can occur in rapidly increasing retropharyngeal hematoma. Emergent airway stabilisation is the key to a successful management of such cases, apart from reversal of causative factor. W e r e p o r t a c a s e o f s p o n t a n e o u s retropharyngeal hematoma in an elderly female on anticoagulant therapy for Rheumatic heart disease, and has developed rapidly progressive swelling in neck, post bout of violent cough. She was successfully managed with emergent airway access and reversal of causative factors. Keywords: Retropharyngeal hematoma, Retropharyngeal space, Anticoagulant therapy

Airway Management for Endoscopic Laryngotracheal Stenosis Surgery During COVID-19

The novel coronavirus disease 2019 (COVID-19) pandemic presents unique challenges for surgical management of laryngotracheal stenosis. High viral concentrations in the upper aerodigestive tract, the ability of the virus to be transmitted by asymptomatic carriers and through aerosols, and the need for open airway access during laryngotracheal surgery create a high-risk situation for airway surgeons, anesthesiologists, and operating room personnel. While some surgical cases of laryngotracheal stenosis may be deferred, patients with significant airway obstruction or progressing symptoms often require urgent surgical intervention. We present best practices from our institutional experience for surgical management of laryngotracheal stenosis during this pandemic, including preoperative triage, intraoperative airway management, and personal protective measures.