#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
These #OnePagers cover ergonomics and the basics of the flexible bronchoscope.
- Know your equipment: set-up, usage and limitations
- Two positions for scope handling: Bazooka (facing patient) or Statue of Liberty (standing at head end) #JanuAIRWAY 4/11
Ancillary equipment can make or break an awake intubation. Here’s a #OnePager covering the 3 main types. Those which aid:
- Oxygen delivery
- Drug delivery
- Scope delivery (oral airways) #JanuAIRWAY 5/11
There are many different recipes for ATI. Here’s some #OnePagers looking at some of the different drugs that can be used, some special circumstances with additional considerations and another #OnePager summarising the DAS approach to ATI conduct. #JanuAIRWAY 6/11
There are a lot of potential problems that can be encountered during ATI – these need to be planned for. Here’s some #OnePagers covering the basics of troubleshooting, complications and how to manage unsuccessful ATI. #JanuAIRWAY 7/11
Remember HFNO can help and a good knowledge of airway pharmacology is essential for awake techniques. Why not revisit our #OnePagers from #JanuAIRWAY Days 5 and 9.
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
#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
#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
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…
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
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
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
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
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