It’s always a challenge to stay up to date in the field of airway management, but we do try. The recently published All Indian Difficult Airway Association Guidelines (just released in the December 2016 edition of IJA) have been added to our Algorithms page, as well as an update of the Vortex 2 video and revised links to the Resuscitation Council of South Africa algorithms. If you spot missing algorithms or broken links, please comment!
A short presentation on a selection of airway themes and some of the papers from 2016 for our FCA Part 2 candidates. Definitely not intended to be a systematic or exhaustive review! Click the image to download a PDF of the slides, or the link below for the resources.
You can watch a 9-minute video of the slides and attendant video clips below. Please note that this is not narrated.
This real-life videolaryngoscopy example (RSI of a patient with a head injury for craniectomy) shows some commom errors, and room for improvement. Three major areas that could be better to spot here:
- Less-than-ideal positioning of the VL blade. The tip is too deep (over the epiglottis, rather than in the vallecula), which reduces the available space to manipulate both VL and ETT, the field of vision, and the ability to perceive the approach of the ETT.
- Quick suctioning of the secretions/saliva/mucus would reduce the risk of losing the view or the patient aspirating.
- An introducer (stylet/bougie) would greatly assist passage of the ETT through the cords.
A classic example of good videolaryngoscopy technique being thwarted by not always using an introducer (stylet or bougie). Note the clinician performing the intubation gets perfect, optimised VL view (Rule of 3), but then struggles to pass the ETT anteriorly enough, losing time. Although this was no problem for the well-oxygenated patient in this case (and the intubation is still under 45 seconds duration), in a critical case it can lead to desaturation, frustration, and possible intubation trauma.
Ross’s talk from the 2015 SMACCdub meeting, with credit to #SMACC and the Intensive Care Network.
This and many other talks available on the SMACC home pages.
OpenAirway has been collaborating with the UCT Department of Anaesthesia & Perioperative Medicine and the Southern African Society of Anaesthesiologists to include anaesthesia guidelines and reference materials in the Essential Medical Guidance (EMGuidance) app. Although only currently targeted at South African medics, this free app is accessible to all registered medical practitioners, and includes georeferenced guidelines from around the country. The content is continually being updated, with some exciting new developments just around the corner.
Get the app on EMGuidance.com
While not exclusively airway themed, this talk for the #badEM symposium in September 2016 addresses the concepts of making mistakes in medicine, and how to make them meaningful. badEM are a shining light in South African #FOAM, and I’m very grateful for the invitation to speak and share at their event. For more info and pearls from the talk, see their page here. The podcast is shared below.
Jean-Christopher Ozenne (@JCOzenne) of Gouvieux, France has generously published this great video on how to build “The Mustache” – a breathing, bleeding cricothyroidotomy simulator – using cheap and ubiquitous equipment. Can’t wait to try this one out…I particularly like the artistic touch. To paraphrase V himself: A cric trainer without bleeding is not a cric trainer worth having.
Herewith a quick tutorial on the use and placement of the bifurcated, dual-balloon ‘EZ-Blocker’ bronchial blocker. More videos on the DLT vs BB debate, the other blockers, and troubleshooting advice to follow. Comments welcomed as always!
If you’ve found OpenAirway by search or accident, and the concept of #FOAM (Free, Open-Access Meducation) is new to you, then you’ll find the following video enlightening. The SMACC (Social Media And Critical Care) meeting is the yearly gathering of #FOAM enthusiasts, although it’s spiritual home, arguably, is within the ether of the Internet. OpenAirway was proud to be represented at SMACC this year in Dublin – truly an opportunity to interact, connect and be inspired by the best minds in acute and critical care from all disciplines.