Refinements on SALAD Sim

Along with many others, am playing around with various combinations of airway trainer, simulated vomit, pump and suction to develop a self-contained portable SALAD sim (SALAD – suction assisted laryngoscopic airway decontamination)

SALAD is of course the brainchild of James DuCanto, Milwaukee airway fanatic and well known to the FOAMed world. Instructions on the SALAD set up are here and training videos here

I’ve had the privilege of assisting Jim in airway workshops in Chicago and Dublin as part of the smacc conference series most recently assisted by UK anaesthetists Ben Shippey @rallydoc and Barbara Stanley (@theneurosim).  We’ve managed to train several hundred people in the nuances of airway decontamination, under both ‘static’ (simple deposit of simulated airway contaminant) and ‘dynamic’ tests (an ongoing tsunami of vomit which threatens to overwhelm the intubator unless master the art of continuous suction whilst intubating – not as easy as it sounds!)

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SALAD sim shenanigans in Dublin
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Barbara Stanley (@TheNeuroSim) ready to serve up some SALAD in Dublin
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Even experienced airway operators feel the pressure under the SALAD Sim (smacc Chicago 2015)

 

The future challenge will be to create a SALAD sim set up that is both compact & self-contained

Present SALAD setups rely upon an open container of ‘simulated airway contaminant’ (a heinous mix of xanthem gum, white vinegar and food colouring) which is then pumped to the oropharynx using variously

  • a drill-powered inline siphon pump
  • a submersible bilge or pond pump
  • a dirty water sump pump

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Flow rates can be adjusted by either use of inline valves or a variable rheostat speed-controller to reduce pump speed and hence flow of vomitus.

The contaminated airway is then suctioned out, using a medical grade suction device. I struggled with this in Dublin, as the two loan units rapidly became overwhelmed…I didn’t realise that the bags within suction cannister are designed as single use and the inlet valve soon became clogged.

In contrast Jim DuCanto’s units (from SSCOR) functioned brilliantly despite multiple rounds (200 litres each I reckon) of vomit passing through.

The SSCOR Medical Grade Suction Pump performs brilliantly - but this, submersible pump & head consume a lot of space!
The SSCOR Suction Pump performs brilliantly – but suction, submersible pump & head consume a lot of space!

Problem is, lugging around suction pumps, submersible pumps and the containers for vomit is quite bulky.

The purist in me wants to design a closed system, namely

  • bladder which can be removed, filled with vomit and then emptied at end of session
  • both submersible pump and suction pumps small enough to sit within Pelican case and be self-contained
  • suctioned contents to be automatically returned to the bladder, for further pumping to airway head
  • controls for pumps to be available on outside of case, once closed
  • variable controller built in

So the challenge will be to create something that can be carried in a Pelican case (Storm IM2500, on wheels).

It might look something like this:

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I’d envisage the whole unit being self-contained, the “simulated airway contaminant” (vomit) being cycled from bladder to oropharynx and back via the two pumps.

Bladder needs to be removable for filling/emptying at start/finish of session and able to tolerate periods where inflow < outflow (suction out < pump in to oropharynx).

Ideally the whole unit should function with lid of Pelican case closed, with control switches for pumps accessible on outside.  Marine rocker switches are ideal, as would a variable control rheostat panel control, flush with case.

Marine rocker switch
Marine rocker switch

A simple mains socket could be mounted in the Pelican case, such that the SALAD Pelican case can be plugged into mains power.

Really interested to hear from anyone with ideas on how to make this happen…preferably on a budget!

 

One Comment

  1. Looking at the dilemma of the reservoir of vomitus: If you approach the local pub and ask for old “post mix” bags, these may help.
    Post mix soft drinks are essentially a mix of carbonated water and proprietary syrup of whatever evil industrial waste passes as soft drinks these days.
    The syrup bags are several litres capacity and tough enough for transport. Think overgrown wine cask bladder.
    Pretty sure you can McGuyver up a fitting, preferably a 3-way, and never run out of capacity.
    (The benefits of paying for your training by cleaning out pubs as a student).

    Reply

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