Thread by @PulmCrit

this fresh review article in NEJM on acute upper airway obstruction is the most horrifically wrong & dangerous piece of literature I've encountered in a while 😳 (#rantorial 1/6)
nejm.org/doi/full/10.10…

the authors recommend a *generic* algorithm for airway management. this strategy is often unwise for a patient with suspected upper airway obstruction (there is no mention of awake fiberoptic intubation... or a double-setup ?!?)(#rantorial 2/6)

there is an oddly generic & opinionated discussion of direct laryngoscopy versus video laryngoscopy... I'm just including this to rile up the twittersphere...😛 (#rantorial 3/6)

then things take a weird turn and sugammadex mades an impromptu appearance... that's right, the article implies that sugammadex can be used to avoid cricothyrotomy in patients with respiratory failure due to upper airway obstruction... (#rantorial 4/6)

and finally the airway section finishes up with this bizarre discussion of emergency front of neck access. no mention of finger-scalpel-bougie cricothyrotomy... instead the article seems to be promoting surgical tracheostomy for emergency airway management ? (#rantorial 5/6)

hopefully folks reading this thread will realize how the article ignores many life-saving principles of managing upper airway obstruction ... if not, pls see these posts by Scott Weingart:
- surgical airway: emcrit.org/emcrit/surgica…
- awake intubation:
emcrit.org/emcrit/awakein…