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BME 272 Senior Design Group 20 Project Undertaken by: Fritz Haimberger

Emergency Airways Modification of Transtracheal Jet Ventilation and Retrograde Intubation Techniques. BME 272 Senior Design Group 20 Project Undertaken by: Fritz Haimberger Advisor: Dr. Steven J. White, Asst. Professor of Emergency Medicine, VUMC. Background. Emergency Airway Maintenance

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BME 272 Senior Design Group 20 Project Undertaken by: Fritz Haimberger

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  1. Emergency AirwaysModification of Transtracheal Jet Ventilation and Retrograde Intubation Techniques BME 272 Senior Design Group 20 Project Undertaken by: Fritz Haimberger Advisor: Dr. Steven J. White, Asst. Professor of Emergency Medicine, VUMC

  2. Background • Emergency Airway Maintenance • Pre-hospital care • PtL • Combitube • Endotracheal (ET) Tube • Nasotracheal Tube • Laryngeal Mask Airway • Hospital Care • ET tube

  3. Transtracheal Jet Ventilation (TTJV) • Used to rapidly initiate ventilation in a trauma case with difficult airway access in the ER • Temporizing measure until a patent airway can be secured via ET tube placement • Usually followed by retrograde intubation

  4. Retrograde Intubation • Performed via second puncture hole in cricothyroid membrane • Catheter is aimed cephalad instead of toward the lungs • Wire inserted through catheter, advanced up trachea and out mouth • ET tube placed over guide-wire and advanced down the windpipe into position for use as a patent airway • Video • Video2

  5. Tracheal Anatomy and Device Placement

  6. Project Definition • Come up with one device that conforms to the following requirements: • Provide rapid temporary airway with manual jet ventilator • Provide means to perform retrograde intubation • Accomplishes retrograde intubation through separate lumen in catheter that allows for insertion of wire to be eventually withdrawn from mouth and used for ET tube insertion • Safely combines these two sequential procedures (one being rapid and temporizing while the other is more time-consuming yet definitive) into one step that significantly decreases the composite risk

  7. Progress Completed Thus Far • Researching • History of TTJV and retrograde intubation • Materials involved in catheter design • One ER observation on a Friday night in December, very productive – this and previous meeting led to two possible design ideas • Manipulated catheter and jet ventilator to get better idea of procedure and materials

  8. Equipment

  9. Proposed Design #1(modification of Dr. White’s original thought) Thread to pull guide tube Tube in retroflexed position TTJV Catheter Red=oxygen exit to lungs Blue=guide wire insertion

  10. Proposed Design #2 • Typical TTJV catheter • Inserted toward lungs • Normal TTJV ventilation • Catheter pulled out slightly, flexed (not kinked) to point hole cephalad • Catheter pushed back in and guide wire inserted for RI procedure Armoring of the Catheter here Guide wire insertion Hole for guide wire exit

  11. Future Work • Schedule more ER observation time in hopes of catching the TTJV and RI procedures being done on a human • Arrange for using the VUMC advanced skills lab or airway laboratory • Test two proposed designs for efficacy of each and find out how each performs on a “human airway” (using a mannikin)

  12. Questions???

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