The Double Set-up

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Hi all,

This is going to be a short but important POTD!

I wanted to write about an airway set up technique, colloquially termed “The Double Set Up” that the trauma and northside teams used yesterday during a level 1 trauma.

Without giving any secrets away for a case that will likely be an M&M in the future, for some situational background, the patient was getting progressively hypoxic with vomitus covering the entire airway. It was hard to get visualization of the airway using the Glidescope. The airway options were clear: either tube via DL or crich.

The team smartly employed the double set up technique to secure the airway. 

What does this term mean?

The double set up is when you have simultaneously set up for an orotracheal intubation and for a cricothyroidotomy. The EM/ anesthesia physician is at the head of the bed with the orotracheal airway equipment, while the surgeon is completely prepared for the crich with the scalpel in hand at the neck of the patient. The neck should already be prepped, and the landmarks should be identified.

When should we do the double set up?

Strayer has an amazing blog post about this (see below). Here are some indications where you might want to do the double set-up:

  • An unstable maxillofacial trauma patient

  • As a last ditch effort to secure the orotracheal tube after a failed attempt

  • Rapidly desaturating patient with challenging anatomical features / cannot be successfully bagged

  • Concern for an obstructed airway

If the intubator is ultimately unsuccessful, they indicate to the surgical airway physician to proceed. If the orotracheal intubator is successful, then the surgical airway physician can stop.

References:

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