Tracheotomy on an awake COVID-19+ patient

This case was designed during the COVID-19 outbreak in order to assess and improve team preparedness for safely and effectively caring for a critically ill patient with COVID-19 who is already intubated and requires a tracheotomy.

Note: Expired or simulated/replica personal protective equipment was used in our simulation, in order to redirect precious PPE from the University of Ottawa Skills and Simulation Centre to the front-line workers at The Ottawa Hospital.

This case is for educational purposes only. For clinical protocols, please see your local hospital or health system guidelines.

Authors:
Drs. Ross Campbell, Kristina Pulkki, Department of Otolaryngology – Head and Neck Surgery, The Ottawa Hospital and the University of Ottawa
Dr. Michelle Chiu, Department of Anesthesiology and Pain Medicine, The Ottawa Hospital and the University of Ottawa
Megan McCoy, Nurse Educator, The Ottawa Hospital

Directed by: Dr. Vicki LeBlanc, Director, University of Ottawa Skills & Simulation Centre; Chair, Department of Innovation in Medical Education, University of Ottawa
Edited by: Dr. Glenn Posner, Medical Director, The Ottawa Hospital Simulation Patient Safety Program
VR Collaboration between The Ottawa Hospital and the Department of Medicine at the University of Colorado
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Case History:
You are the on-call surgeon and your next patient requires an emergent awake tracheotomy for an obstructing laryngeal lesion. They are suspected positive for COVID-19.

The patient is a 65-year-old male, long-time smoker, who presented to the emergency department with stridor, cough, and was found to have a near-obstructing laryngeal tumor. He also complains of anosmia. It was determined that intubation would be very-high risk or impossible. He has been in close contact with a COVID-19 positive family member. He is otherwise healthy, no routine medications, and no allergies. He is in respiratory distress and requires an emergent awake tracheotomy to secure his airway.

Learning Objectives:
1. Demonstrate knowledge of and effective management of a patient with COVID-19 to reduce the risk of contamination to oneself, OR staff, and OR environment;
2. Apply Best Practice Guidelines for tracheotomy in a COVID-19 positive patient;
3. Manage a high-risk aerosolization procedure of an infectious agent – tracheotomy

Видео Tracheotomy on an awake COVID-19+ patient канала Glenn Posner