#JanuAIRWAY Day 10. The Cook Airway Exchange Catheter – it’s a useful piece of equipment, but one not everyone will be familiar with. Here’s a #OnePager. Let’s dive in… #JanuAIRWAY 1/6
Main function is as a stop-gap to maintain tracheal access & facilitate ETT exchange. They are long, hollow, radiopaque, soft-tipped tubes – types for use with single / double lumen tubes. #JanuAIRWAY 2/6
All users MUST be trained & knowledgeable of how to use such devices together with their limitations and dangers. The Gordon Ewing case makes for tragic reading – but highlights this point. Essential reading for airway practitioners.
🔗scotcourts.gov.uk/search-judgmen… #JanuAIRWAY 3/6
To highlight – NEVER insert beyond 26cm. NEVER insufflate with an oxygen flow >2L/min ...or just NEVER insufflate with oxygen! #JanuAIRWAY 4/6
#JanuAIRWAY Day 12. Awake Techniques (ft. expert contributions from @dr_imranahmad). This is a key skill for an airway manager. Here’s a #OnePager covering the basics of Awake Tracheal Intubation (ATI) and nasendoscopy. Let’s dive in… #JanuAIRWAY 1/11
Key = topicalization (if right, may not need sedation). Top tips:
- Know nerve supply CN V, IX & X.
- Block Ant.ethmoidal AND Sphenopalatine ganglion supply to the nasal septum #JanuAIRWAY 2/11
Often you don’t need high dose LA if in right spot – this video is @Vapourologist after only gargling instilagel. #JanuAIRWAY 3/11
#JanuAIRWAY Day 11. The Aintree Intubation Catheter – an amazingly useful piece of equipment – every airway practitioner should be familiar with. Here’s a #OnePager. Let’s dive in… #JanuAIRWAY 1/5
Main function is as a stop-gap to maintain tracheal access & facilitate tracheal intubation through a supraglottic airway device (SAD) using a fibreoptic scope. They are Long, hollow, semi-rigid, powder blue, polyurethane catheters #JanuAIRWAY 2/5
To highlight: NEVER insert beyond 26cm. NEVER insufflate with an oxygen flow >2l/min … or just NEVER use for insufflation! #JanuAIRWAY 3/5
#JanuAIRWAY Day 9. High Flow Nasal Oxygen (HFNO). This has been a game-changer in recent years. Thank you A.Patel and S Nouraei for their amazing landmark paper on THRIVE! 🔗pubmed.ncbi.nlm.nih.gov/25388828/
Let’s dive in… #JanuAIRWAY 1/6
Oxygen consumption continues during apnoea, gradual loss of alveolar volume/reduction in pressure. If upper airway remains patent, gas can be drawn into lower airways and oxygenation can continue and delay desaturation. #JanuAIRWAY 2/6
HFNO: 1. Reduces heat and moisture loss from the airway 2. Decreases anatomical deadspace 3. Provides PEEP 4. Improves Oxygenation
#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 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
#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