You’re in a small community ED and the only overnight doctor and you’ve found yourself with a difficult airway. Direct laryngoscopy has failed, video didn’t get a great view, bougie was surprisingly unhelpful, your LMA isn’t the best, and now you’ve reached a point where you know you need a surgical airway. But you hesitate. “Maybe I can try another attempt? Maybe anesthesia will get here with a scope (they won’t)?” Why do you have these hesitations and thoughts?

Most physicians in the ED are much more comfortable with intubation as opposed to a surgical airway and much of the trepidation comes from lack of practice and very few real live attempts. Especially with increasing use of video assisted devices and fiberoptic techniques, the need for surgical airways has diminished. But it is an important and lifesaving procedure that every ED doctor needs to be comfortable with, and the only way to do that is practice. But who can make it to their neighborhood SIM lab to practice on the commercial trainers. So how do you practice?

Making a homemade surgical airway trainer is a cheap and effective alternative to the commercial devices and can be done with materials found around the home and ED. Below are 2 examples with a video on construction of a device, but all that is required is a hard surface, some tubing to simulate the trachea, and some rolls of different kinds of tape. With 5 min of construction time you can practice repeatedly until the hesitation and fear of a surgical airway is a thing of the past.

Link to video on construction

Link to pdf on construction

Bottom Line: Make a trainer, practice until you can do it with your eyes closed, never have a difficult airway again.

References:

Weingart, Scott. “How to Build the Ultimate Cricothyrotomy Trainer with Chris Bond.”EMCrit Project, 3 June 2017, emcrit.org/racc/ultimate-cricothyrotomy-trainer/.

Varaday, S. S., et al. “A Homemade Model for Training in Cricothyrotomy*.” Anaesthesia, Blackwell Science Ltd, 16 Sept. 2004, onlinelibrary.wiley.com/doi/10.1111/j.1365-2044.2004.03810.x/pdf.