Category Archives: Guidelines

NAPEM’17: Paediatric Difficult Airway in the ED

As promised/per usual, here’s my presentation from the current National Assembly on Paediatric Emergency Medicine, being held now (16-19 Feb 2017) at the Apollo Institute of Medical Sciences & Research, Hyderabad, India.  Much of the content is in the audio, of course…which I will post if/when available.
Comments welcome below as usual!

EMGuidance App

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.

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Get the app on EMGuidance.com

Cape Town FCA2 Refresher: DAS 2015 Guidelines

Here’s the excellent simulation/re-enactment video from Simpact on the Elaine Bromiley Case that I featured in the lecture.

You can download my accompanying lecture notes on the DAS 2015 guidelines here:

FCA2 Refresher 2016 Notes – Hofmeyr – Difficult Airway Society 2015 Guidelines

Frerk et al’s article on the 2015 guidelines is available from the BJA here (open access), and the excellent recent editorial on front-of-neck access by Timmerman, Chrimes and Hagberg is here.  This is not in the notes, as it has only just been published online.

The links to the different algorithms are on the Algorithms page, or you can browse the DAS website.

The surgical airway technique video that woudn’t play is below.

Video: Surgical cricothyroidotomy (DAS 2015)

Quick overview of the surgical cricothyroidotomy technique as presented in the 2015 Difficult Airway Society guidelines.  This is simply presenting the technique in a manikin model, not intended as a debate about the relative merits of needle vs. surgical, blade vs. hook, scalpel-finger-bougie vs. scalpel-bougie-tube, etc!

Don’t forget to wear your PPE (gloves, mask, eye protection) and appropriately secure the tube afterwards.

As always, constructive criticism and suggestions for improvement are always welcomed in the comments section.

OAA/DAS Guidelines for Difficult & Failed Intubation in Obstetrics!

Hot of the press – the Obstetric Anaesthetists’ Association and Difficult Airway Society have released their combined guidelines on difficult and failed intubation in obstetrics, which are freely available from Anaesthesia online.

The guidelines are presented as a ‘Master Algorithm’ and several sub-algorithms to deal with specific aspects of obstetric airway management, and a guide to making the decision to awake the patient or continue with surgical delivery after an airway event:

Decision guide for awakening or proceeding with surgery, from the guidelines.
Decision guide for awakening or proceeding with surgery, from the guidelines.

Some thoughts (COI – the author did provide feedback on the draft algorithms):

  • Stressing good positioning for airway management is absolutely critical in this population, and especially in practice environments where patients tend to have a high BMI (a common situation in our South African setting).  The guidelines include ramping and the ear-to-sternal-notch (E2SN) position.
  • The inclusion of cricoid pressure will inevitably spark the usual debate, but it is this author’s contention that this is likely an appropriate use until more evidence to the contrary emerges.  The guidance to consider CP reduction or release in the event of difficulty is apt.
  • The inclusion of gentle face-mask assisted ventilation during RSI is a welcome inclusion.  Will we see NPO2 or HFNC included in later editions as more outcomes evidence emerges?
  • Advocating the use of VL in obstetrics certainly sounds like a good idea, but is not attainable for most of the developing world.  This is a huge area for growth/research – the development of low-cost VL solutions.

This is a great step forward in promoting safe airway management and guiding training in a particularly dangerous corner of our practice.

For some more thoughts and images, here is a Prezi on the subject presented at the SASA Difficult Airway workshop in 2014: