I was completing my chart when the OHCA patient came in. An obese female noted with sudden onset loss of conscious. She was noted with no sign of life when the rescue ambulance arrived. My heart sunk when I entered the resuscitation room. She was 150cm and almost 150kg… “A case of difficult airway”, I mumbled while getting the laryngoscope. I could barely open her mouth and not to mention about inserting the blade. I gave up the direct method and requested a laryngo-mask intubation kit. I could barely insert the mask and failed to insert the guide wire…

Well, I asked my nurse to call OR and asked if the anesthetist could help me with the intubation and before she walked out from the door, I changed my mind and told her to come back.

No point of calling for the anesthetist as the mouth was too small to pass in a blade…

The process was not satisfied at the beginning. There was no tracheostomy set when I ordered. Someone passed me a scalpel and open up a normal dressing set while I cleansed the neck; I asked for a pair of retractor and Kelly forceps. Definitely would be a chaotic situation I thought when I completed the cleansing, however with grace, I had a good surgical assistant and I managed to poke a hole through the trachea while is located 3cm from the skin within minutes.

Well, ROSC was noted but still I lost her later…

Well, I did not screw up and secured the airway within a reasonable period, my team was quite shock and had a good talk about my decision…..

Training and exposure are what the Taiwan emergency staff lack; lucky that I picked up the skill elsewhere….