This came up recently during an M&M discussion of a very challenging spinal surgery/airway case. Here’s a quick overview of the technique:
Critique? These videos are all unscripted, so please comment so that we can improve them over time!
Video: Overview of intubating through SGAs
Yip, another whirlwid tour, this time of the situations and considerations that may lead to intubating through a supraglottic airway. Each method will be expanded upon in later videos.
These videos are made off-the-cuff and can certainly be improved, so if you have suggestions, please put them in the comments!
Video: Using supraglottic airways
A whirlwind tour through selection, indications, precautions, sizing and troubleshooting. For an overview of the types and classifications, see this post.
These videos are all unscripted, so if you have suggestions for improvement, please leave a comment below!
VIdeo: Supraglottic airway overview
A brief (7 min) overview of the some of the types, classification and classes of SGAs, as part of some preparatory material for SMACCdub Airway Workshop participants.
For the next video on using SGAs, see this post.
These videos are all unscripted, so if you have suggestions for improvement, please leave a comment below!
Cannula Cricothyroidotomy
In response to a great Twitter discussion with PHARM‘s @ketaminh:
See Minh le Cong’s PHARM blog post, video and podcast here. Please note that using a BVM is not the advised technique of oxygenation, but is used here because we don’t have an oxygen source in the skills lab.
Lots of ensuing discussion of the ideal angle of puncture of the cricothyroid membrane. 90 degrees (perpendicular to skin) has least risk of puncturing posterior wall of the trachea, but greatest risk of cannula kinking. I advocate around 60 degrees for puncture and then decreasing angle to advance cannula:
Four methods of endotracheal tube passage in simulated airways – Poster from ICEM 2016
Here’s the poster by Kingma, Hofmeyr, Zeng, Cooramasamy and Brainard that has generated a fair amount of interest (>10k impressions on Twitter). Full analysis hopefully coming soon to a journal near you. Bottom line? In a difficult airway, you’d best be using a bougie or stylet, no matter who you are. As far as bougies go, preloading rather than railroading is faster and seems better. Click on the image for a full-resolution PDF (2Mb).
Want to talk about this? Comment below or ping @surferkirst @rosshofmeyr @TheSharpEndCrew on Twitter!
Straightforward AirTraq Intubation
A video example of performing a straightforward intubation using the AirTraq optical laryngoscope, here coupled with the WiFi-enabled camera unit to allow image capture. Note the optimal positioning (“Rule of 3”):
- Epiglottis visible at the top of the screen
- Vocal cords central in the vertical axis
- Interarytenoid cleft in the lower half of the screen.
This intubation is using a reinforced (“armored”) endotracheal tube, which is sometimes more difficult than a standard ETT, as it is a little floppier. The AirTraq makes it simple in this instance. The reinforced ETT was used to facilitate patient positioning for a neurosurgical case.
ICEM2016 Pediatric Emergency Medicine Course resources
The first African presentation of the PEMC (Pediatric Emergency Medicine Course) is being run as one of the pre-conference workshops for ICEM 2016 at Red Cross War Memorial Children’s Hospital today. OpenAirway is present, assisting with the airway stations. Course instructors have given their blessing to host some of the supplementary material online for the #FOAM community, so we have created a PEMC resources page here! More content will be added as it becomes available.
Is fibreoptic intubation a dying art?
Over the past two weeks, I have been involved in three cases where all means of laryngoscopic intubation failed – including multiple different blades, introducers and highly skilled hands – and the airway could only be intubated with a flexible fibreoptic ‘scope. These three cases illustrate the type of pathology that can make even video laryngoscopy (VL) difficult or impossible:
- A morbidly obese patient in traction with a high spinal injury
- A patient presenting with late-stage, advanced laryngeal carcinoma with both supra- and infraglottic involvement and masses
- A child with Pierre-Robin Sequence presenting for mandibular distraction surgery.
In an article on the Airway E-Learning site, Dr Matthew Wiles details why he thinks fibreoptic intubation (FOI) is becoming a rare beast, and why we should work hard to maintain excellence in this important skill.
Despite being a huge fan and daily user of VLs, I am completely in agreement with his sentiments.
Overview of the use of fibreoptic bronchoscopy in thoracic surgery
The well-known thoracic anaesthesia guru, Prof Jay Brodsky, has written a succinct and simple overview of the use of fibreoptic bronchoscopy (FOB) in thoracic anaestheisa, which is equally applicable to the modern flexible video endoscopes. If you are looking for a brief primer (including the appropriate use for placement of bronchial blockers and double-lumen ETTs), read the article on the Airway E-Learning site here.
Importantly, he elucidates the reasons for becoming proficient in the clinical placement and confirmation of DLTs without the use of a FOB, which is of particular relevance here in the developing world.
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