#JanuAIRWAY Day 3. The Difficult Airway. Many definitions. NAP4 has a procedural framework. Useful but not the whole picture. @HansHuitnik and Bouwan’s seminal pubmed.ncbi.nlm.nih.gov/25511477/ introduces ‘complexity factors 1/7
Complexity factors make easy things difficult e.g. operator experience, location, time pressure. Must be considered. @Huitink also suggest ditching the term ‘difficult’ in favour of ‘basic & advanced’ Here’s a #OnePager covering the basics
#JanuAIRWAY #FOAMed 2/7
Our airway assessment aims to determine difficulty of management. We want to use our holistic assessment (Hx, Ex and Ix) answer several questions.

Here’s a #OnePager outlining some of the key information we need

#FOAMed #JanuAIRWAY 3/7
After complexity factors, we need situational awareness. Imagine ‘thinking zones’ emanating from the patient.
Patient (anatomy, physiology)
Airway manager (experience, fatigue, stress)
Team (experience, number)
Environment (time, familiarity, safety)

#JanuAIRWAY 4/7
When we want to integrate our assessment info and situational awareness, the cynefin framework (by @snowded) and the Johari window can help our mental model for decision-making in ‘difficult airways’.

We’ll talk more about decision-making later this month! #JanuAIRWAY 5/7
Here are some papers / links that you might find interesting: -
a.nationalauditprojects.org.uk/NAP4_home
b.pubmed.ncbi.nlm.nih.gov/25511370/
c.pubmed.ncbi.nlm.nih.gov/25511477/
If you have any others of interest, tweet them to us for inclusion next time!

#JanuAIRWAY 6/
Hope that helps. Tomorrow we'll look at investigations /ultrasound and how we can use them to assess airways. See you then! #JanuAIRWAY 7/7

*Disclaimer: Inclusion of content (equipment, techniques and scoring systems etc.) in #JanuAIRWAY does not constitute DAS endorsement

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More from @dastrainees

May 13
Next up - Dr Craig Lyons, editor at @Anaes_Reports
@Anaes_Reports Challenges HFNO research: choosing an outcome of value is tricky (may not be patient centred), research unblinded, and research world is different (closed mouth, no talking, proper 3 minutes). to how we practise in the real world! Airway providers are different & so are patients
@Anaes_Reports We can't necessarily amalgamate info from many different categories of patients from lots of different contexts in meta-analyses
Read 12 tweets
Jan 2
#JanuAirway Day 2. Yesterday highlighted the need for strategy, so let’s talk Airway Planning. Decision making = the true art of airway management! NAP4 @doctimcook showed that poor judgement is implicated in many airway complications. This #OnePager covers the major themes. 1/9 Image
#JanuAirway What's the issue? We encounter difficult airways relatively infrequently, & complications are rare. Low exposure leads to high anxiety. Add in multiple options @huitink & Bouwman suggest >1mill combinations of options to oxygenate. More options = more anxiety 2/9 Image
Cognitive load can lead to decision fatigue & increasing bias & poorer decisions. Metacognition can help debias. Chew et al’s () came up with the TWED checklist which can help: -
3/9 ncbi.nlm.nih.gov/pmc/articles/P…
Image
Read 9 tweets
Jan 1
Welcome to #JanuAIRWAY2024. Every weekday we'll be bringing you Airway #FOAMed. Starting off with management of transgender airway -here's a #OnePager. It's a huge topic going beyond just the airway. Thanks to Drs @LukeFlower1 @drkamillak & Alice Humphreys for all their help! 1/7 Image
The facts are that there's a huge knowledge gap when it comes to healthcare providers and gender diverse patients. Let's start with terminology, the gender continuum and principles of gender-affirming care - here's a #OnePager covering just that! 2/7 Image
When it comes to peri-operative care, there are a number of effects that hormone therapy can have that depend on the type of transition. Additionally biochemical values also need to be interpreted with care. Check out this #OnePager 3/7 Image
Read 7 tweets
Oct 6, 2022
The law and airway management, looking at what we do through a different lens now with Maryanne Balkin. The tort of negligence has 4 elements:
1. duty of care
2. breach of standard of care
3. causation
4. injury or harm

#DAS2022
Expert witnesses are paramount in establishing the standards of care in cases where there is an issue with diagnosis or treatment #DAS2022
Recent medicolegal claim data from the NHS in England - …-publications.onlinelibrary.wiley.com/doi/abs/10.111…
Read 5 tweets
Oct 6, 2022
Peri-extubation complications - where are we? @MatteoParotto #DAS2022
For every study on extubation there are almost 10 on intubation, we don't appear to pay as much attention for extubation....#DAS2022
NAP 4 showed that extubation is where a significant amount of airway complications occur #DAS2022
Read 7 tweets
Oct 6, 2022
Why do we used cuffed tracheal tubes in children? Starting the international session this afternoon, the links @dasairway has with other airway societies is wonderful
The subglottic area is the narrowest part in children, the resistance whilst advancing the ETT is due to stenosis in the subglottic region #DAS2022
Microcuff paediatric ETT have really changed practice, moving from uncuffed tubes to cuffed tubes in paediatric patients #DAS2022
Read 5 tweets

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