On Difficult Airways
Part I
Our first difficult airway story comes from Dr. Adam Vella, a pediatric emergency physician at Weill Cornell Medicine, and Associate Chief Quality Officer of New York-Presbyterian Hospital. He shared this story because he understands the stress involved in managing airways at critical moments and also understands that the more we share these stories with each other the more supported we will all feel in our work.
by Dr. Adam Vella
He was so sick and was obviously going to need intubation.
Room full of people. Stress palpable. Get the line. Give the meds.
Time for the spotlight to be on me. Then he vomits. Oh shit. Give me the suction.
It’s a slippery mess, how am I supposed to work like this??
Clean up on aisle airway please.
Suction suction suction, reminder kid not breathing. Meds given.
Bag him up. 60s, 70s 80s 80s 80s. Hmmm, this might be the best we will get.
Let me take a look. Thank God I see the cords. Think i got it?
Did I see what I thought I saw? End tidal please, color change? Think so,
but honestly I’m seeing flashing lights and my HR is 140-150.
Bagging, think I see good chest rise and sats now in the low 90s.
OK on to the fact that he needed the airway because he was critically ill,
and still is.
At least the airway is out of the way.
We were not able to resuscitate that beautiful little boy.
I’ll never forget that day and moment.
Sometimes I wonder why I put myself in this position?
It is such a rare event, but once stays with you for a lifetime.
Adam Vella is a pediatric emergency physician at Weill Cornell Medicine, and Associate Chief Quality Officer of New York-Presbyterian Hospital. He earned his medical degree from SUNY Downstate College of Medicine, and completed his pediatric residency at Columbia Presbyterian Babies and Children’s Hospital, followed by fellowship at Children’s Hospital Los Angeles. During his career, he has been a fellowship director and then division director of a pediatric emergency department.
Part II
Our second difficult airway story comes from Dr. Vince Uy, a pediatric emergency hospitalist at Weill Cornell Medicine, and Assistant Director of Clinical Services for the Pediatric Emergency Department at NYP- Lower Manhattan Hospital. He shared this story because he believes that practice makes perfect and one event does not define the clinician.
by Dr. Vincent Uy
It was supposed to be a relaxed intubation. My patient was a baby, only 2 days out of the womb and extremely premature. I was a senior resident.
The NICU attending stressed that it should be a relaxed intubation. But imagine, being a trainee, being asked to introduce a tiny “straw” into a funnel smaller than the size of my pinky.
As I passed the blade into the baby’s mouth, it felt like looking into a keyhole covered in a pool of saliva. I literally had one eye closed to improve my vision, and I was sweating bullets.
I did not get it, and my attending stepped in and got it in one shot. I will never forget her words of encouragement after: “Today’s experience will never define you.”
A few days later, still a senior resident, I successfully intubated a five year old in the ED. I knew I was home.
Vincent Uy is a pediatric emergency hospitalist at Weill Cornell Medicine, and Assistant Director of Clinical Services for the Pediatric Emergency Department at NYP- Lower Manhattan Hospital. He earned his medical degree at Royal Pontifical University of Santo Tomas in the Philippines, and completed his pediatric residency training at SBH Health System in the Bronx, staying on to serve as chief resident before becoming an attending in the pediatric emergency department. His clinical interests involve education, quality improvement and community outreach.
Part III
Our third difficult airway story comes from Dr. Deborah Levine, a pediatric emergency physician at Weill Cornell Medicine. prevention. She shared this story because the difficulty airway is her biggest fear in the ED. This patient represented a time when she felt very humbled by her feelings of inadequacy and her ongoing quest to overcome this fear.
by Dr. Deborah Levine
A young adult with hereditary angioedema, not taking his meds, tells me he is
having difficulty breathing and feels his throat is closing.
Taking in those words, feeling fear in my belly, knowing my pulse is rising
Calling for help… anesthesia, ENT
Trying to reassure the patient we will take care of him
Worried he might die in front of me
Waiting for the consults, feeling like it was hours
Getting ready for intubation to calm myself
Help couldn’t arrive soon enough…
Deborah Levine is a pediatric emergency physician at Weill Cornell Medicine. She earned her medical degree at SUNY Downstate and completed her pediatric residency at New York-Presbyterian Weill Cornell Medical Center, followed by fellowship at NYU/Bellevue. Her clinical research focuses on infectious diseases and injury prevention.
Part IV
Our fourth difficult airways story comes from Dr. Susan Fraymovich, a pediatric emergency physician at Weill Cornell Medicine. She shared this story to show others it is normal to be scared when caring for a sick patient.
from Dr. Susan Fraymovich
Susan Fraymovich is a pediatric emergency physician at Weill Cornell Medicine. She earned her medical degree at the New York Institute of Technology College of Osteopathic Medicine, and completed her pediatric residency at Maimonides Medical Center, staying on to serve as a pediatric chief resident. She completed her fellowship at Cohen Children’s Medical Center. Her career is focused on medical education and curriculum development. She shared this story to show others it is normal to be scared when caring for a sick patient.
