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More from @cliffreid

Cliff Reid

@cliffreid

Nov 17

🧵 Managing Challenging Behaviours in Resuscitation Teams: A Thread for Team Leaders (1/13)

Every resuscitation team leader can face difficult team dynamics

Here are 6 key challenging behaviours you'll encounter and how to manage them effectively in real-time 🚨

The Dominant/Overconfident Member 🦁 (2/13)

- Takes over without authority
- Dismisses others' input
- Makes unilateral decisions

Solution: Acknowledge expertise and redirect energy to specific tasks "Thank you Dr. Smith, I need your expertise on airway management right now."

The Anxious/Overwhelmed Member 😰 (3/13)

- Freezes under pressure
- Hesitates repeatedly
- Shows visible stress

Solution: Give clear, simple tasks and pair with experienced team member

"John, focus on recording vitals. Sarah will help you."

Give immediate positive feedback

Read 13 tweets

Cliff Reid

@cliffreid

Oct 13

Extubation Readiness: A to L Checklist

We're obsessed with safe intubation, but what about taking the tube out?

How do we assess extubation readiness?

Here's my simple, alphabet-based A to L checklist:

1/17

A - Airway: MAINTENANCE & PROTECTION

Check:

Neuromuscular tone (correlates with consciousness)

Risk of airway swelling (prolonged intubation, difficult intubation, burns) - consider cuff leak test (deflate cuff and assess for leak. Dexamethasone might be indicated)

2/17

A (cont'd):

Protective reflexes (swallowing, cough reflex, secretion management)

Are secretions excessive? Thick?

Will the patient be able to clear them unaided?

3/17

Read 18 tweets

Cliff Reid

@cliffreid

Sep 29

Early 40s male with chest pain and collapse, looks horrible, SBP 80, lactate 7.
Previous large PE with pulmonary hypertension on echo 2 months ago, discharged on apixaban
POCUS on arrival shows:

The POCUS findings are consistent with cor pulmonale but in view of his previous echo, how do we know this is the acute cause of his shock? Should we thrombolyse?

His ECG shows right axis deviation and T wave inversion. This was NEW compared with the ECGs on record from his previous admission

Read 19 tweets

Cliff Reid

@cliffreid

Jul 19

Here’s how I think we often fail our patients when treating ’sepsis’

a 🧵

1/11

In my capacity as both an emergency medicine and intensive care specialist I’ve observed that we sometimes:

- 1. Inappropriately diagnose other shock states as sepsis

2/11

- 2. Fail to use System 2 thinking when faced with hyperlactatemia

- 3. Fail to examine septic patients mindfully with a thorough ‘sepsis secondary survey’

3/11

Read 11 tweets

Cliff Reid

@cliffreid

Nov 23, 2023

WTF is a ‘difficult airway’?

A 🧵

1/14

I avoid the term ‘difficult airway’ altogether

How we describe a situation can have a psychological framing effect that can affect our performance

2/

Mindset, confidence, and therefore performance are likely to be worse if you expect the airway to be ‘difficult’ rather than prepare for it to be ‘potentially challenging’

3/

Read 14 tweets

Cliff Reid

@cliffreid

Nov 20, 2023

Let's review an intubation together - a 🧵

A previously well patient in her 60's presents with a first seizure & post-ictal coma
A nasopharyngeal airway has been placed for airway patency
She weighs 100kg
She receives 70mg propofol /100mg rocuronium after checklist completion, pre-ox & application of nasal cannula O2

This video shows what a nasopharygeal airway looks like, and how far it can go down

It was removed during laryngoscopy- not sure why. Consider leaving it in in case you need it to support facemask ventilation if laryngoscopy is unsuccessful