First up: Props to #CHEST2020 learning partners for that amazing wait music. Ne'er been a fan of wait music. But this is ... well .. peppy. Am in the mood to learn about #AirwayManagement!

Speakers: @Chaeface @J_Mendelson_MD @KDoerschug

Coverage: @virenkaul

.@J_Mendelson_MD: HFNC and proning in severe hypoxic resp failure:

- Can reduce dead space ventilation, assist with WOB, improved resp mechanics
- Pre-COVID data: Can be successful in potentially preventing invasive ventilation vs NIV and low flow O2

#CHEST2020 #CHESTCritCare Image
.@Chaeface: Pre-oxygenation modifications to reduce aerosolization

Use V-E technique vs C-E technique for rescue BMV. Improved efficacy for ventilation and better seal. (Lower picture):

#CHEST2020 #COVID19 Image
.@Chaeface: The "intubating box":
- Increase intubation times, exposed patients to hypoxia, esp being critically ill from #COVID19
- Breached PPE
- Increased cognitive load
- Not advised

Ref: Begley et al:

#CHEST2020 #CHESTCritCare Image
.@KDoerschug: In #COVID19, advised intubating practices:
- Use videolaryngoscopy
- Avoid flexible / direct laryngoscopy
- Use HME filter on the bag-mask apparatus

Consensus guidelines for airway mgmt in #COVID19:

#CHESTCritCare #CHEST2020 ImageUse the VE technique for ba...
Dr. Dushay: Guidelines based care while ensuring minimum exposure to operator during #COVID19. Avoid extraglottic airway use, fiberoptic intubation

Re: Paralytic use: Favor use of high dose Roc to allow first-pass success +depth of paralysis to perform a safe RSI

#CHEST2020 ImageImage
Tips to airway success:
- Have plan A, B, C and D
- Clearly assigning roles and close looped communication
- Basics: OPA/NPA use, BMV: Revert to safety with them
- #COVID19: Use most experienced provider to ensure first-pass success

.@J_Mendelson_MD: Failed difficult airway algorithm
- Stop further attempts, just work to ventilate (BMV!)
- Supraglottic airways: Can be inserted successfully in < 30 sec in > 90% times
- Refer to and know the failed algorithm


DAS guidelines: Image
.@Chaeface: SGA established after failed attempt. Now?
- Adequate sedation/paralysis
- Modality: Intubating SGA w/ flexible scope vs. Salvage DL + consider bougie vs. Cont ventilation via SGA
- All fails/not ideal: Tracheostomy


#CHEST2020 #CHESTCritCare Image

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21 Oct
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Trade off between high sensitivity and high specificity depending on if you use SIRS vs. qSOFA.

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Covering pardon the interruption with @davidschulman moderating!!!!!

Power-packed speaker list covering a gamut of critical care topics at #CHEST2020

@SMHollenberg @ammo_uw @KristinBurkart3 and Dr. Bowton

And punches are already being thrown. D'oh! Image
Here are the competitors:
Dr. Bowton: The Real Deal Tarheel
@KristinBurkart3: The Beat of the Northeast
@SMHollenberg: The Heartless Cardiologist
@ammo_uw: Dr. "Who Can Ask for Anything" Morris

Here are the ground rules!

New rules this year!!

#CHEST2020 Image
Role of glucocorticoids in CAP:
Dr. Bowton: No mortality benefit
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#CHEST2020 Image
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18 Oct
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@RMavesMd highlighted that several countries in the South Hemisphere didn't have as much flu this season as in previous years, and hopefully we will see the same phenomenon in the US now that flu season is coming #CHEST2020 #CHESTCritCare
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