Discover and read the best of Twitter Threads about #OnePagers
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I'm excited to share that I've been extensively updating my OnePagerICU.com site to make it run smoother and add a bunch of highly requested features. For example:
1️⃣ Search 🔎
This should make it easier & much faster to find content! Less scrolling, more learning!
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1️⃣ Search 🔎
This should make it easier & much faster to find content! Less scrolling, more learning!
1/
2️⃣ References 📚
The site now includes links to all the references cited in each OnePager. In most cases I try to point out the seminal papers & their findings. Hopefully this makes it easier for learners to find the "key studies" on a topic!
(DM me ones I've missed! 🙏)
2/
The site now includes links to all the references cited in each OnePager. In most cases I try to point out the seminal papers & their findings. Hopefully this makes it easier for learners to find the "key studies" on a topic!
(DM me ones I've missed! 🙏)
2/
3️⃣ Related OnePagers 🖇️
Thumbnails to related OnePagers - for example if you just learned about ECMO Fundamentals perhaps you'd like to see OnePagers about ECMO troubleshooting, LVADs, Balloon Pumps, etc?
Hopefully this makes it easier to find your next topic to learn about!
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Thumbnails to related OnePagers - for example if you just learned about ECMO Fundamentals perhaps you'd like to see OnePagers about ECMO troubleshooting, LVADs, Balloon Pumps, etc?
Hopefully this makes it easier to find your next topic to learn about!
3/
#JanuAIRWAY Day 27 – The Neurosurgical Airway (thanks to @gasgal13 for her expert contribution to today’s content!). Head Vs Spine. Elective Vs Emergency. So many points of interest for airway managers. Here's a pair of #OnePagers to kick off!
#JanuAIRWAY 1/5
#JanuAIRWAY 1/5
Key principles:
- Prevent rises in ICP
- Avoid hypoxia & low BP
- Minimise C-spine movement where indicated
- Be aware of positioning
- Beware of potential difficult airway in neurosurgical pathology
- Beware of post-op issues e.g. haematoma post-ACDF
#JanuAIRWAY 2/5
- Prevent rises in ICP
- Avoid hypoxia & low BP
- Minimise C-spine movement where indicated
- Be aware of positioning
- Beware of potential difficult airway in neurosurgical pathology
- Beware of post-op issues e.g. haematoma post-ACDF
#JanuAIRWAY 2/5
We can, in general, divide acute / emergency patients into 2 groups:
1) Cooperative – awake techniques may be the best option in anticipated difficulty
2) Uncooperative – asleep laryngoscopy or asleep FOI (consider LMA conduit)
#FOAMed #JanuAIRWAY 3/5
1) Cooperative – awake techniques may be the best option in anticipated difficulty
2) Uncooperative – asleep laryngoscopy or asleep FOI (consider LMA conduit)
#FOAMed #JanuAIRWAY 3/5
#JanuAIRWAY Day 24 -Paediatric Airways. (ft. expert contributions from Alistair Baxter and @ENT_UK’s Adam Donne). Let’s dive in … Here's some #OnePagers covering anatomy, induction, airway manoeuvres and basic airway equipment.
#JanuAIRWAY 1/10
#JanuAIRWAY 1/10
Top tip from Alistair Baxter: Remember that a Macintosh blade is a hyperangulated blade in an infant and requires an intubation stylet shaped to match the curve of the blade
#JanuAIRWAY 2/10
#JanuAIRWAY 2/10
The difficult paediatric airway = #SCARY. Upper airway obstruction in children – broad range of presentations, three important diagnoses; Croup, Epiglottitis and Inhaled Foreign Body. Here’s some #OnePagers.
#JanuAIRWAY 3/10
#JanuAIRWAY 3/10
#JanuAIRWAY Day 23 (the final stretch!). Malacias and SVC Obstruction. Here's a pair of #OnePagers to get started..
#JanuAIRWAY 1/10
#JanuAIRWAY 1/10
What are malacias? = rare dynamic airway obstruction - (congenital / acquired) due to loss of cartilaginous support
Decreased intratracheal pressure + increased intrathoracic pressure lead to airway compression
Severity is proportional to expiratory force
#JanuAIRWAY 2/10
Decreased intratracheal pressure + increased intrathoracic pressure lead to airway compression
Severity is proportional to expiratory force
#JanuAIRWAY 2/10
Issues
Obstruction can occur even if aymptomatic
Maintain spont. Vent. if poss
Emergency management =+ve pressure (splint airways open) or bypass obstruction
Surgery depends on location / extent
Extubate deep (avoid coughing) or directly to CPAP
#JanuAIRWAY 3/10
Obstruction can occur even if aymptomatic
Maintain spont. Vent. if poss
Emergency management =+ve pressure (splint airways open) or bypass obstruction
Surgery depends on location / extent
Extubate deep (avoid coughing) or directly to CPAP
#JanuAIRWAY 3/10
#JanuAIRWAY Day 19. The Obstructed Airway – Think SPIMS
-Supra-
-Peri-
-Infra-glottic – extra/intrathoracic
-Malacias
-SVC Obstruction
Today we’re going to focus on Supraglottic Airway Obstruction. Here's a #OnePager to get started! #FOAMed
#JanuAIRWAY1/7
-Supra-
-Peri-
-Infra-glottic – extra/intrathoracic
-Malacias
-SVC Obstruction
Today we’re going to focus on Supraglottic Airway Obstruction. Here's a #OnePager to get started! #FOAMed
#JanuAIRWAY1/7
Possible issues:
-Risk of total obstruction with low tone
-Distorted anatomy
-NP/OP airway too short?
-+++jaw thrust may/may not relieve obstruction
-Difficult BVM/laryngoscopy
-+++ laryngoscopy may make manageable unmanageable (e.g.bleeding)
#FOAMed
#JanuAIRWAY 2/7
-Risk of total obstruction with low tone
-Distorted anatomy
-NP/OP airway too short?
-+++jaw thrust may/may not relieve obstruction
-Difficult BVM/laryngoscopy
-+++ laryngoscopy may make manageable unmanageable (e.g.bleeding)
#FOAMed
#JanuAIRWAY 2/7
Planning in airway obstruction = Key. NASENDOSCOPY can save lives here! ASSESSMENT informs STRATEGY. Let’s revisit some #OnePagers on key questions and airway planning. Remember the decision-making process is multifactorial (maintain situational awareness).
#JanuAIRWAY 3/7
#JanuAIRWAY 3/7
#JanuAIRWAY Day 18. Extra CICO Equipment. At least 2 pieces of equipment deserve extra attention – Rapid-O2 & the Melker airway (key components of the cannula technique one for initial oxygenation & one for securing the airway)! Here’s a pair of #OnePagers to get started.. 1/5
A bonus #OnePager on the QuickTrach airway – used for wide bore cricothyroidotomy, it may still lurk in a few departments throughout the land! Here’s a video as well #FOAMed
#JanuAIRWAY 2/5
#JanuAIRWAY 2/5
Double bonus #OnePager – on the Ventrain Device – a newer, but interesting, device! Can be used both electively & as part of CICO. Here’s a recent paper that highlights its potential read.qxmd.com/read/33432628/… #FOAMed
#JanuAIRWAY 3/5
#JanuAIRWAY 3/5
#JanuAIRWAY Day 17. CICO - Scalpel Techniques. Absolutely ESSENTIAL knowledge for anyone involved in airway management! Here’s a #OnePager with the @dasairway algorithm. Let’s dive in… #FOAMed
#JanuAIRWAY 1/6
#JanuAIRWAY 1/6
DAS advocates scalpel-bougie-tube technique for palpable anatomy and scalpel-finger-bougie-tube technique for impalpable anatomy. Here are some #OnePagers #FOAMed
#JanuAIRWAY 2/6
#JanuAIRWAY 2/6
Perhaps the most difficult part of the process is making the mental leap to pick up the scalpel. That's why mental models and thinking tools like the @VortexApproach are so useful. Check out @NicholasChrimes & Peter Fritz's work
🔗vortexapproach.org
#JanuAIRWAY 3/6
🔗vortexapproach.org
#JanuAIRWAY 3/6
#JanuAIRWAY Day 16 (we’re over ½ way!) Cannot Intubate Cannot Oxygenate (CICO) Scenario - Needle Techniques. Potentially controversial (DAS primarily advocates scalpel techniques), but worth knowing about - particularly for paeds! Here’s some #OnePagers to start..
#JanuAIRWAY 1/7
#JanuAIRWAY 1/7
CICO Key = decide on your plan before you're in the situation. @dasairway promotes scalpel techniques (final common pathway of CICO) MUST be taught. For more on the Needle technique check of Dr Andy Heard’s work at the Perth ‘wet’ lab. 🔗bjanaesthesia.org.uk/article/S0007-…
#JanuAIRWAY 2/7
#JanuAIRWAY 2/7
Integrating the needle technique into CICO algorithms could look something like this #OnePager. There are 2 scenarios for each technique (needle & scalpel):
-palpable and
-impalpable anatomy
another reason to decide early –> lower cognitive load. #FOAMed
#JanuAIRWAY 3/7
-palpable and
-impalpable anatomy
another reason to decide early –> lower cognitive load. #FOAMed
#JanuAIRWAY 3/7
#JanuAIRWAY Day 14. One Lung Ventilation – one of @vapourologist’s favourite procedures in anaesthesia – physiology in action! Here’s a #OnePager. Let’s dive in…
#JanuAIRWAY 1/9
#JanuAIRWAY 1/9
Several indications for OLV, commonest are thoracic surgery & some oesophagectomies. Essentially three ways to achieve OLV - use of:
- Double lumen tube
- Bronchial Blocker
- Elective endobronchial intubation
Here are some #OnePagers covering the basics
#JanuAIRWAY 2/9
- Double lumen tube
- Bronchial Blocker
- Elective endobronchial intubation
Here are some #OnePagers covering the basics
#JanuAIRWAY 2/9
The key physiological change is the creation of a large shunt – deoxygenated blood (which would normally be oxygenated), returns to the left heart resulting in hypoxaemia.
#JanuAIRWAY 3/9
#JanuAIRWAY 3/9
#JanuAIRWAY Day 13. Jet Ventilation – this is a bit more niche in anaesthesia / airway management, but fascinating. Here’s a #OnePager covering the basics. Let’s dive in…
#JanuAIRWAY 1/8
#JanuAIRWAY 1/8
2 modes of jet ventilation – low frequency (<60 jets/min) & high frequency (>60). Frequency determines device. 2 commonly used devices – Manujet (modified hand operated Sanders injector) or Monsoon (specialised jet ventilator). Here’s a some #OnePagers
#JanuAIRWAY 2/8
#JanuAIRWAY 2/8
Several different potential mechanisms to apnoic oxygenation during HFJV, including:
-Bulk flow
-Laminar flow
-Taylor dispersion
-Pendelluft
-Molecular diffusion
-Cardiogenic mixing
derangedphysiology.com has a great article & this diagram #FOAMed
#JanuAIRWAY 3/8
-Bulk flow
-Laminar flow
-Taylor dispersion
-Pendelluft
-Molecular diffusion
-Cardiogenic mixing
derangedphysiology.com has a great article & this diagram #FOAMed
#JanuAIRWAY 3/8
#JanuAIRWAY Day 12. Awake Techniques (ft. expert contributions from @dr_imranahmad). This is a key skill for an airway manager. Here’s a #OnePager covering the basics of Awake Tracheal Intubation (ATI) and nasendoscopy. Let’s dive in…
#JanuAIRWAY 1/11
#JanuAIRWAY 1/11
Key = topicalization (if right, may not need sedation). Top tips:
- Know nerve supply CN V, IX & X.
- Block Ant.ethmoidal AND Sphenopalatine ganglion supply to the nasal septum
#JanuAIRWAY 2/11
- Know nerve supply CN V, IX & X.
- Block Ant.ethmoidal AND Sphenopalatine ganglion supply to the nasal septum
#JanuAIRWAY 2/11
Often you don’t need high dose LA if in right spot – this video is @Vapourologist after only gargling instilagel.
#JanuAIRWAY 3/11
#JanuAIRWAY 3/11
#JanuAIRWAY Day 7. Equipment. Laryngoscopy is an essential skill for airway managers. Let’s start with #OnePagers looking at a classification of the different types of laryngoscopes
1/6
1/6
A fundamental understanding of ‘position’ theory can help e.g. the two-curve theory for videolaryngoscopy. Primary Curve either needs to be flattened or ‘looked around’. Here’s some #OnePagers
#JanuAIRWAY 2/6
#JanuAIRWAY 2/6
2 basic techniques direct (DL) & video (VL), but different scopes require specific techniques. We may even combine multiple scopes (there’s no universally agreed term for this, here we’ve called it Flexi-Assisted Laryngoscopy (FL) Here’s some #OnePagers
#JanuAIRWAY 3/6
#JanuAIRWAY 3/6
#JanuAIRWAY Day 6. Equipment. Good workers know their tools – knowing our equipment is essential! Here’s some #OnePagers - the fundamentals of masks, NP/OPs, SADs, and ETTs.
#JanuAIRWAY 1/4
#JanuAIRWAY 1/4
We’ll cover specific airway devices such as Cook airway exchange catheters, Aintree Intubation Catheters, Staged Extubation Kits, OLV equipment, Tracheostomies, etc later in the month. But in the meantime here's a #OnePager on Frova intubating introducers
#JanuAIRWAY 2/4
#JanuAIRWAY 2/4
Here are some papers / links that you might find interesting:
a.anaesthesiajournal.co.uk/article/S1472-…
b.ncbi.nlm.nih.gov/pmc/articles/P…
c.das.uk.com/content/diffic…
d.ncbi.nlm.nih.gov/pmc/articles/P…
If you have any others of interest, tweet them to us for inclusion next time!
#JanuAIRWAY 3/4
a.anaesthesiajournal.co.uk/article/S1472-…
b.ncbi.nlm.nih.gov/pmc/articles/P…
c.das.uk.com/content/diffic…
d.ncbi.nlm.nih.gov/pmc/articles/P…
If you have any others of interest, tweet them to us for inclusion next time!
#JanuAIRWAY 3/4
#JanuAIRWAY Day 4. Airway Investigations. 2 broad categories we can use to round out our airway assessment; flow/volume-based lung function tests & imaging techniques. They vary in their usage and usefulness. Here's some #OnePagers #FOAMed on Spirometry and Flow-volume loops 1/17
Spirometry (literally ‘measuring breath’) and flow-volume loops give us information on the mechanics of ventilation. They can be helpful in a more global assessment of respiratory function, but are less helpful in acute airway management.
#JanuAIRWAY #FOAMed 2/17
#JanuAIRWAY #FOAMed 2/17
Diffusing Capacity / Transfer factor can augment lung function tests and give us info about alveolar diffusion and alveolar thickness. Again, helpful in global assessment, but less helpful acutely. Here’s another #OnePager covering the theory and the practice
#JanuAIRWAY 3/17
#JanuAIRWAY 3/17
Happy New Year Everyone. Welcome to #JanuAirway. Let’s start with the basics – Oxygen. Meaningful delivery of adequate oxygen is the fundamental aim of airway management. Think A.B.O. – Always, Be, Oxygenating. Here’s a #OnePager covering the basics of oxygen physiology 1/7
Knowledge of the three basic equations for oxygen physiology is essential: -
Arterial Oxygen Content
Oxygen Delivery
Oxygen Consumption
They can steer us towards various physiological parameters that we can manipulate to treat hypoxia / hypoxaemia. 2/7
#JanuAIRWAY
Arterial Oxygen Content
Oxygen Delivery
Oxygen Consumption
They can steer us towards various physiological parameters that we can manipulate to treat hypoxia / hypoxaemia. 2/7
#JanuAIRWAY
Oxygen cascade shows levels and processes involved and differentials for hypoxia/hypoxaemia: -
Oxygenation (e.g. low O2)
Diffusion (e.g. pulm fib)
Ventilation (bullae)
Perfusion (low cardiac output)
Oxygen carriage (anaemia)
Oxygen demand / use (sepsis) 3/7
#JanuAIRWAY
Oxygenation (e.g. low O2)
Diffusion (e.g. pulm fib)
Ventilation (bullae)
Perfusion (low cardiac output)
Oxygen carriage (anaemia)
Oxygen demand / use (sepsis) 3/7
#JanuAIRWAY
Getting the most out of your monitor: a tweetorial thread. Inspired by a twitter question from @mork66236485 and @GongGasGirl's chairing of the @aagbi's latest recommendations on monitoring. Lets start with a series of #OnePagers on aspects of the ECG #FOAMed #MedTwitter
One more on the ECG. So much of what we do is pattern recognition, so the next three look at waveforms for three of our most used monitoring devices; arterial/SaO2, capnography and CVP. #FOAMed
NMT and EEG are becoming more and more ubiquitous. Here's a pair of #Onepagers. And we're now going to move on to the information we can get from the monitoring that's part of our ventilators. #FOAMed
