Board #320 - Technology Innovation A Model of an Expanding Neck Hematoma (Submission #9512)

Abstract

Introduction An expanding neck hematoma after thyroid surgery is a potentially fatal post-operative complication that requires immediate surgical response. Due to the relatively inflexible space in the neck, an expanding hematoma causes venous drainage obstruction in the larynx which leads to life-threatening vocal cord edema and then complete airway occlusion and patient suffocation. Decompression of the hematoma at the bedside is a vital maneuver that requires the surgical wound to be reopened at the bedside with removal of the hematoma. A controlled intubation can then occur and the source of bleeding should be resolved in the operating room. To simulate this event for surgical, anesthesia, and nursing care teams, we developed a simple and inexpensive model that can be fastened to a manikin simulator. Description The expanding hematoma model is constructed of Fast-10 silicone (Smooth-On, Easton, PA). A clay mold of a band of a size to fit the neck of a manikin simulator (approx. 40cm x 12cm x 0.75cm) is fashioned and filled with two-part silicone colored to match the simulator. A length of tubing and two elbow connectors are set in the mold while the silicone is curing such that the long portion of the tubing exits along the side and a short portion extends up through the center of the band. A two-piece clay mold is fashioned to form the bulge on the neck. It too is filled with two-part silicone colored with various shades of red and purple. A layer of nylon from stocking material is placed in the silicone at a depth of 0.5mm to enhance the holding of stitches. Once the two pieces are cured, they are glued together to form the model. An incision is made in the hematoma and then can be stitched or stapled, as is the local surgical practice. Small pieces of red silicone can be used as clot and placed in the model before closing the incision. Closure of the band around the manikin can be effected with Velcro. A syringe of simulated blood can be attached to the tubing end to allow bleeding to be controlled from a control room. Conclusion We have used this model over fifty times to simulate the expanding hematoma scenario. The model has proven accurate as it is usually immediately recognized and the appropriate actions taken. Also, it has proven durable as it is resutured or stapled each time and has only required minor maintenance. The total cost of materials to make this model is under $100. Disclosures None