#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
What are we trying to see? Here’s a #OnePager on the basics of direct laryngoscopy views. It gets trickier with indirect laryngsocpy. There is no agreed classification system. Here’s #OnePager on a potential model (*this does not constitute DAS endorsement) #JanuAIRWAY 4/6
Hope that helps. Tomorrow we'll look at Capnography. See you then! 6/6
*Disclaimer: Inclusion of content (equipment, techniques and scoring systems etc.) in #JanuAIRWAY does not constitute DAS endorsement
systems etc.) in #JanuAIRWAY does not constitute DAS endorsement
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#JanuAIRWAY Day 8. Capnography. This is one of essential pieces of monitoring equipment needed during airway management. But its presence isn’t enough, correct interpretation is vital. Let’s start with a #OnePager looking at the different waveforms. #JanuAIRWAY 1/10
Oesophageal intubation still occurs & EtCO2 = key tool to help prevent avoidable deaths such as Glenda Logsdail’s. Key message = flat or no trace indicates oesophageal intubation until proven otherwise #NoTraceWrongPlace #JanuAIRWAY 2/10
#JanuAIRWAY Day 6. Equipment. Good workers know their tools – knowing our equipment is essential! Here’s some #OnePagers - the fundamentals of masks, NP/OPs, SADs, and ETTs.
We’ll cover specific airway devices such as Cook airway exchange catheters, Aintree Intubation Catheters, Staged Extubation Kits, OLV equipment, Tracheostomies, etc later in the month. But in the meantime here's a #OnePager on Frova intubating introducers
#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
#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
#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.
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 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
#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