#15 – Difficult Airway Case Study – Eric Carlson, MSN, CRNA

Kristin talks with Eric Carlson, MSN, CRNA who shares a gripping personal tale of managing an unexpected difficult airway during an emergency Cesarean section.  Eric found himself in a “cannot intubate/cannot ventilate” situation which evolved into performing a cricothyrotomy followed by a surgical airway.  Eric’s vulnerability, humility and professionalism in bringing this story forward is astounding.  Don’t miss his account of what happened and the personal and professional ramifications of those involved in this difficult situation.

Eric Carlson, MSN, CRNA has been a practicing CRNA for over 30 years.  He did his anesthesia training at the University of George Washington and was recruited into the Air Force to continue his anesthesia training.  He worked as a CRNA for the Air Force at Keesler Air Force base in Biloxi, Mississippi and then pursued employment at All Care Clinical Associates in Asheville, NC, where he currently works.

Topics Discussed:

  • Personal case study of a difficult airway during an emergent C-section
  • Decision making in emergencies
  • Communication strategies in emergencies
  • Challenges faced during this particular case
  • Legal ramifications
  • Algorithms for airway management
  • Benefits to advanced airway training

 

 

Update, June 2015:

This interview was posted by the North Carolina Association of Nurse Anesthetists in an email on 15 May 2015 to members titled “Spotlight on CRNAs” where a North Carolina CRNA is introduced at greater depth to the membership.  Of note, Eric was interviewed by Dustin Degman, CRNA, who has also contributed to our podcast in the Combat Trauma Anesthesia series.  In the interview, Dustin talks with Eric about his experience with the difficult airway case that he speaks to in the show featured on this page.  This interview is posted with the permission of the NCANA.

 

Eric Carlson, CRNA

Interviewed by Dustin Degman, CRNA

You were recently on the pod cast “From the Head of the Bed” where you explained a case that, I guess you could say, changed the way you practice today. You got to give your history, the beginning of the scenario, and there was a moment that you said “I had a difficult airway case”. I must tell you that I was completely locked-in at that moment. Nothing was going to distract me from listening to the next 25 minutes. What I want to ask is, what about that event changed you most, either as a person or in practice?

This is a challenging question to answer. I am sure the event changed me both as a person and a CRNA practitioner. At the time of the event, I was very early in my career and riding high in self confidence. The event changed my level of confidence and reinforced the significance of the risks we take as CRNAs performing our job every day. I had to actively work on rebuilding my confidence over the ensuing months, slowly, I was able to regain some of the loss, but for better or for worse, I probably did not get back to the level I had been. In the long run, I think it made me a better CRNA because I realized that bad things can occur in our line of work at any time and you always need to have a back-up plan in mind. Be prepared for the unexpected. As a person, the event may have made me a more humble individual and helped me realize that we are all susceptible to very challenging occurrences in our profession.

People, who know you, know that you are a wonderful provider. Your patients, colleagues, and the students really look up to you. Is there something you would like to share about being a great mentor?

I appreciate the feedback and compliment. I consider myself very fortunate to have made the decision to become a CRNA more than 30 years ago. We all have many forks in the road when we have to make a choice that could affect the rest of our lives. When I had been a nurse for five years, I began to consider what specialty I may want to pursue to fulfill my desire to have a career pathway I may enjoy for the long term versus bouncing from one subspecialty to another. As an ED nurse at a teaching hospital, I was exposed to CRNAs both directly helping out in difficult cases, and assisting/teaching new Anesthesiologist residents with different tasks in the ED. These episodes spurred my interest so I talked to the Chief CRNA and learned more about the profession. That conversation led to my decision to pursue becoming a CRNA versus my other consideration of becoming a flight nurse. To this day, it was one of the best decisions I ever made. I am very proud of my profession and can honestly say I still love my job after three decades. I still tell my students they have chosen one of the coolest careers they could ask for. I guess my enthusiasm spills over.

I find the NCANA to have some of the most motivated members I have ever met. I feel like they bring out the best in me and am so thankful for the work that they do for our profession. You have been involved with the board and different committees for the past 15 years. Why did you choose the government relations committee for this term?

I was involved with the NCANA in the early 2000s. I decided to take leave from the active involvement in order to devote time to my family and help my wife raise our two children. Now that my children are grown, I have the opportunity to participate in the NCANA once again. Overall, the NCANA is under appreciated by the majority of its members, the active members serving on the Board and Committees are doing a lot of work that most members are never aware of. These dedicated members are volunteering their time and efforts to help preserve our profession and our livelihoods. Major changes can take place in the laws and regulations that govern our profession. These changes could directly effect our day to day job description, if the NCANA is not keeping watch over the potential changes in the laws and regulations then who is? We could go to work one day and find that our scope of practice has been completely redefined and we would be at a loss to change it at that point. One role of the NCANA, and the primary role of the Government Relations Committee is to monitor and respond to activity of the North Carolina General Assembly, the Board of Nursing, and the Board of Medicine that may effect our profession. Being part of this committee has allowed me to learn more about the importance of its function.

Any sound advise you would like to pass on to students who are about to graduate and become members of the NCANA?

Yes, be proud of your accomplishments and your career choice! Be active in the NCANA, so you and others can continue to enjoy the many rewards of being a CRNA. Someone has to take the helm, if not you….then who?

In the past 30 years, you have witnessed significant changes. We now typically use the ultrasound for central line placement, new adjuncts in airway management, and a significant increase in monitoring, e.g. pulse oximetry. What was the biggest adjustment for you as a provider? And, was there anything that occurred during your practice where you said “This is really going to change the way we do anesthesia”?

When I first started anesthesia school, we had to fight for the one automated non-invasive blood pressure machine in the department. The practice of anesthesia was full of many risks at that time, and still is today. The primary change has been technology allowing us to identify a problem before it becomes a crisis. The first time I used a pulse oximeter, I was annoyed by the beeping. At the time, I had no idea how much technology would change the practice of anesthesia.

This work is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License.

Posted in All Podcasts, Clinical Topics Tagged with: , , , , , , , , , , , , ,
2 comments on “#15 – Difficult Airway Case Study – Eric Carlson, MSN, CRNA
  1. Karen Dolan says:

    Thanks to Kristin for this great interview…you are a natural

    Eric, your account was powerful. It impressed upon so many levels for me…your transparency in reliving this raw moment is beyond words for me right now….I just want to thank you again and again for sharing..we all have a story and sharing them, no matter how painful is the definition of ‘living legacy’…my respect for you is exponential….Karen

    • Jon Lowrance says:

      Karen,

      Thanks for your thoughts. I, too, was impressed by Eric’s story. It’s amazing how a situation like he experienced nearly 30 years ago still shapes his clinical practice today. It inspires me to approach each airway with respect and awareness of what could go wrong. And nice interview, Kristin!

      Jon

Leave a Reply

Your email address will not be published. Required fields are marked *

*