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Difficult Airway Society (DAS) Trainees

@dastrainees

7 Jan

#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

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

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

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Difficult Airway Society (DAS) Trainees

@dastrainees

5 Jan

@doctortimcook

#JanuAirway Day 5. Airway Planning. Decision making is the true art of airway management, and something that we don’t really get taught! NAP4 @doctortimcook showed that poor judgement was implicated in many airway complications. Here’s a #OnePager covering the major themes. 1/16

@AirwayMxAcademy

#JanuAirway Why is this an issue? Difficult airways = relatively rare & complications = rarer still. Low exposure --> high anxiety. Add in multiple options @AirwayMxAcademy & Bouwman suggest >1,000,000 combinations of options to oxygenate. More options = more anxiety 2/16

#JanuAirway
Cognitive load can lead to decision fatigue/increased bias/poor choices. Chew et al’s ncbi.nlm.nih.gov/pmc/articles/P… TWED metacognition checklist may help: -
Threat– define problem
Wrong- What if I’m wrong?
Evidence
Dispositional factors – environment/hunger/fatigue 3/16

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Difficult Airway Society (DAS) Trainees

@dastrainees

4 Jan

#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

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

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Difficult Airway Society (DAS) Trainees

@dastrainees

3 Jan

#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

@Huitink

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

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Difficult Airway Society (DAS) Trainees

@dastrainees

2 Jan

@doctimcook

#JanuAIRWAY Day 2. Bedside Airway Assessment. NAP4 @doctimcook showed poor airway assessment contributes to poor outcomes. Thorough assessment = essential. Here’s a #OnePager on bedside tests to help assess for potential difficult airway management. #FOAMed #JanuAIRWAY 1/8

Airway Assessment should be holistic & comprised of three basic parts: -
1) History - including review of previous management (if possible),
2) Examination - visual examination and bedside tests &
3) Investigations (we'll look at these more later this month).
#JanuAIRWAY 2/8

NAP4 gives us a structure to focus our examination on anatomical/procedural difficulty: -
1) Difficult bag mask vent.
2) Difficult SAD insertion
3) Difficult laryngoscopy
4) Difficult intubation
5) Difficult Front of Neck Airway (FONA)
6) Difficult extubation
#JanuAIRWAY 3/8

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Difficult Airway Society (DAS) Trainees

@dastrainees

1 Jan

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

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

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Difficult Airway Society (DAS) Trainees

Difficult Airway Society (DAS) Trainees

Difficult Airway Society (DAS) Trainees

Difficult Airway Society (DAS) Trainees

Difficult Airway Society (DAS) Trainees

Difficult Airway Society (DAS) Trainees

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