• Registration
  • Login
JETem
  • Home
  • About
    • Aim and Scope
    • Our Team
    • Editorial Board
    • FAQ
  • Issues
    • Current Issue
    • Ahead of Print
    • Past Issues
  • Visual EM
    • Latest Visual EM
    • Search Visual EM
    • Thumbnail Library
  • For Authors
    • Instructions for Authors
    • Submit to JETem
    • Photo Consent
    • Policies
      • Peer Review Policy
      • Copyright Policy
      • Editorial Policy, Ethics and Responsibilities
      • Conflicts of Interest & Informed Consent
      • Open Access Policy
  • For Reviewers
    • Instructions for JETem Reviewers
    • Interested in Being a JETem Reviewer?
  • Topic
    • Abdominal / Gastroenterology
    • Administration
    • Board Review
    • Cardiology / Vascular
    • Clinical Informatics, Telehealth and Technology
    • Dermatology
    • EMS
    • Endocrine
    • ENT
    • Faculty Development
    • Genitourinary
    • Geriatrics
    • Hematology / Oncology
    • Infectious Disease
    • Miscellaneous
    • Neurology
    • Ob / Gyn
    • Ophthalmology
    • Orthopedics
    • Pediatrics
    • Pharmacology
    • Procedures
    • Psychiatry
    • Renal / Electrolytes
    • Respiratory
    • Social Determinants of Health
    • Toxicology
    • Trauma
    • Ultrasound
    • Urology
    • Wellness
    • Wilderness
  • Modality
    • Curricula
    • Innovations
    • Lectures
    • Oral Boards
      • Structured Interview
      • Communication Case
    • Podcasts
    • Simulation
    • Small Group Learning
    • Team Based Learning
    • Visual EM
  • Contact Us
Article has an altmetric score of 1

Modified Manikin for Tracheoinnominate Artery Fistula

Emily M Tarver, MD*, Gina D Jefferson, MD, MPH ^, Patrick Parker‡, Kristina Readman‡, Susana M Salazar Marocho, BDS, PhD** and Anna A Lerant, MD, CHSE‡^^

*University of Mississippi Medical Center, Department of Emergency Medicine, Jackson, MS
^University of Mississippi Medical Center, Department of Otolaryngology, Jackson, MS
‡University of Mississippi Medical Center, Simulation and Interprofessional Education Center, Jackson, MS
**University of Mississippi Medical Center, Department of Biomedical Materials Science, School of Dentistry, Jackson, MS
^^University of Mississippi Medical Center, Department of Anesthesiology, Jackson, MS

Correspondence should be addressed to Emily M Tarver, MD at emtarver@umc.edu

DOI: https://doi.org/10.21980/J8Z93H Issue 6:3
InnovationsProceduresRespiratory
No ratings yet.

ABSTRACT:

Audience:

This simulator is designed to instruct emergency medicine residents in tracheostomy training that involves bleeding from the tracheostomy site. Any resident, fellow, or attending physician who cares for patients with complications from their tracheostomy might benefit from this innovation.

Introduction:

The emergency medicine provider must maintain proficiency in caring for patientswith complications from their tracheostomy. In the United States, over 110,000 patients receive tracheostomies per year.1 A rare but catastrophic complication of tracheostomies, usually within the first month of placement, is a tracheoinnominate artery fistula (TIAF).  This complication occurs in 0.7% of tracheostomy patients and carries a 50-70% mortality.1,2 We modified a low-fidelity tracheostomy manikin to instruct learners in the stepwise management of hemorrhage from a TIAF.

Educational Objectives:

By the end of this educational session, learners will be able to: 1) perform a focused history and physical exam on any patient who presents with bleeding from the tracheostomy site; 2) describe the differential diagnosis of bleeding from a tracheostomy site, including a TIAF; 3) demonstrate the stepwise management of bleeding from a suspected TIAF, including cuff hyperinflation and the Utley Maneuver; 4) verify that definitive airway control via endotracheal intubation is only feasible in the tracheostomy patient when it is clear, upon history and exam, that the patient can be intubated from above; and 5) demonstrate additional critical actions in the management of a patient with a TIAF, including early consultation with otolaryngology and cardiothoracic surgery as well as emergent blood transfusion and activation of a massive transfusion protocol.

Educational Methods:

This modified manikin is a useful training tool for any healthcare provider who is involved in the treatment and stabilization of a variety of tracheostomy emergencies, from bleeding to infection to obstruction or dislodgement.  Our case was presented on two separate occasions, to otolaryngology interns (PGY-1), and emergency medicine residents (PGY 1-3).  It involved the care of a patient with a sentinel bleed and subsequent hemorrhage from a tracheoinnominate artery fistula (TIAF).  This low-fidelity tracheostomy manikin provides the ideal platform for any complex, tracheostomy case, particularly where ongoing bleeding from the tracheostomy site might permanently damage the electrical circuitry of a high-fidelity model. We initially fashioned this modified manikin for tracheostomy training during a simulation “boot camp” for otolaryngology PGY-1 residents. Our use of this modified manikin for tracheostomy training was a useful teaching tool during our otolaryngology intern “boot camp.”  As a result, we organized a subsequent simulation training session with our PGY 1-3 emergency medicine residents to provide similar instruction in management of a TIAF.

Research Methods:

We provided a pre- and a post-simulation survey for the 33 emergency medicine residents who participated in the TIAF simulation with our modified tracheostomy manikin.  There were 11 residents from each of the PGY-1, PGY-2, and PGY-3 year-groups. Thirty-two residents (97%) completed the pre-simulation survey, and 33 residents (100%) completed the post- simulation survey.  We used a 6-point Likert Scale from “strongly agree” to “strongly disagree” to assess a resident’s knowledge of multiple learning objectives within this simulation.

Results:

The pre- and post-simulation survey supported this simulation and manikin innovation as a useful teaching tool for tracheostomy emergencies such as a TIAF.

Discussion:

This was a useful innovation for emergency provider training in the recognition and management of a TIAF, a rare but emergent tracheostomy complication. In addition to this bleeding complication, this innovation might be useful for a variety of tracheostomy emergencies such as site infection, obstruction, and tube dislodgement.  We highly recommend the involvement of both an emergency medicine and otolaryngology content expert in the design and debriefing of tracheostomy cases with this modified manikin.  In our experience, a facilitated debriefing by an experienced clinician and educator from both fields provided a diverse perspective for challenging cases such as bleeding from a TIAF.

Topics:

Difficult airway, tracheostomy, tracheoinnominate fistula, hemorrhagic shock, tracheostomy complications, Utley Maneuver.

Icon

Modified Manikin for Tracheoinnominate Artery Fistula - Manuscript

1 file(s) 64.04 MB
Download

 

Issue 6:3

Reviews:

No ratings yet.

Please rate this





Tracheoinnominate Artery Fistula

07 Jul, 21
Creative Commons images

Case Report of an Empyema Identified on Lung...

07 Jul, 21

JETem is an online, open access, peer-reviewed, journal-repository for EM educators. We are PMC Indexed.

Most Viewed

  • The Silent Saboteur: Teaching the Clinical Implications of Occult Hypoxemia & Social Determinants of Health via a Pulmonary Embolism Case
  • Diabetic Ketoacidosis and Necrotizing Soft Tissue Infection
  • My Broken Heart
  • Stabilization of Cardiogenic Shock for Critical Care Transport, a Simulation
  • Innovative Ultrasound-Guided Erector Spinae Plane Nerve Block Model for Training Emergency Medicine Physicians

Visit Our Collaborators

Creative Commons Licence
This work is licensed under a Creative Commons Attribution 4.0 International License.

About

Education

Learners should benefit from active learning. JETem accepts submissions of team-based learning, small group learning, simulation, podcasts, lectures, innovations, curricula, question sets, and visualEM.

Scholarship

We believe educators should advance through the scholarship of their educational work. JETem gives educators the opportunity to publish scholarly academic work so that it may be widely distributed, thereby increasing the significance of their results.

Links

  • Home
  • Aim and Scope
  • Current Issue
  • For Reviewers
  • Instructions for Authors
  • Contact Us

Newsletter

Sign up to receive updates from JETem regarding newly published issues and findings.

Copyright Creative Commons Attribution 4.0 International