Low-Cost Portable Suction-Assisted Laryngoscopy Airway Decontamination (SALAD) Simulator for Dynamic Emesis
The suction-assisted laryngoscopy airway decontamination (SALAD) simulator is designed to instruct emergency medicine residents, paramedic students, and students interested in emergency medicine.
The ability to establish an adequate airway by intubation is a core procedural skill taught throughout emergency medicine training. Frequently, active emesis, massive regurgitation or hemorrhage during endotracheal tube placement can obstruct visualization of the larynx, increase risk of aspiration and complicate airway management.1 Consequently, providers are expected to quickly stabilize a patient’s airway during episodes of airway contamination to reduce complications and improve outcomes. Suction-assisted laryngoscopy airway decontamination (SALAD) is a systematic method that uses suction and the laryngoscope to clear the airway and visualize landmarks for placement of the endotracheal (ET) tube. Emergency medicine resident physicians are expected to perform a minimum of thirty-five intubations throughout training to become proficient in the procedure;2 however, simulated intubation exercises that replicate dynamic fluid contamination from emesis or blood are often expensive or not utilized.3 This SALAD model was created by Dr. DuCanto to economically replicate the airway of an actively vomiting patient requiring endotracheal tube placement. The dynamic trainer was developed for residents to learn and practice complicated intubation techniques and to be prepared for ET tube placement in the event that visual obstruction from gastric contents, vomitus or blood were to occur. We took the DuCanto model and made a modified, lower budget system with portability using a repurposed mannequin head. Attempts have been made previously but none published in the literature.4
The economic and dynamic SALAD innovation recreates an actively vomiting patient and replicates visual obstruction from fluid contents during airway management.
By the end of the session, learners are expected to: 1) discuss the risks, benefits, indications and contraindications associated with intubation of a vomiting or hemorrhaging patient. 2) Work with colleagues to effectively stabilize a patient who is actively vomiting or bleeding during airway management. 3) Competently perform intubation in the acute setting of visual obstruction from active emesis, hemorrhage, or massive regurgitation. 4) Increase speed and dexterity of intubation by applying the SALAD method when fluid obstructs visualization of the larynx.
A dynamic, high fidelity simulation trainer will be used to recreate the scenario of a patient actively vomiting or bleeding during emergent airway intubation. Polyvinyl chloride (PVC) tubing, a hand-operated water pump, an airway management trainer, and an LTV vent connector are used to create a low-cost circuit that models active emesis. BARFume puke spray, Laerdal stomach contents, and Campbell’s soup were used to create artificial vomitus. Residents will use suction and the laryngoscope to practice intubating on the airway management trainer while liquid is pumped to simulate visual obstruction from fluid contents.
Difficult airway, SALAD, intubation, airway placement, airway management, ET placement, airway, emesis, active emesis, vomit, vomiting, hemorrhage, hemorrhaging, oropharynx, airway contaminant, obstructed airway, visual obstruction, airway obstruction, airway visualization, rapid sequence intubation.