Herewith my final presentation from NAPEM 2017 in Hyderabad, India. Not really an airway talk, but in the spirit of #FOAM, I’m reproducing it here.
The SASA Paediatric Procedural Sedation and Analgesia (PSA) Guidelines (2016 Update) are available from the ‘Publications’ section of the SASA web page (and are open access), but for ease of access, I have made the file available here as well:
SASA Paediatric Sedation Guidelines (2016 update)
Demonstration of an unhurried intubation using a bougie preloaded in the reinforced endotracheal tube in an Airtraq optical laryngoscope with Airtraq Cam video adapter. You can note ideal positioning of the Airtraq (“Rule of 3”) and the steering ability of a coude-tipped bougie.
As promised, my presentation from the 9th National Assembly on Paediatric Emergency Medicine currently being held at the Apollo Institute of Medical Sciences & Research in Hyderabad, India. There is much more content in the audio, which I will try to add to the post later when it is available.Thoughts? Comments? Post them below!
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!
One of the greatest influences on my understanding of the geometry of the airways, and thereby the technical skills and processes required to place airway devices of all types, has been the work on publications of Dr Kenneth Greenland. Greenland’s publication in the BJA in 2010 should be required reading for anybody who performs intubation. However, if you want to really understand theories of the airway curves and columns, I highly recommend getting it from the horses mouth. Here below are several videos in which can Greenland explains his thinking and theories. While they are a little longer than your average #FOAM material, I cannot recommend them strongly enough.
Although not an airway course, we have been greatly influenced by the methods used in BASIM for creating and undertaking airway simulations. Highly recommended course presented by the master Dr David Grant himself.
More information about the course can be found on the BMSC site here. To register for the workshops in Cape Town in March 2017, click this link.
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.
2016 Airway Update 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.