#JanuAIRWAY Day 16 (we’re over ½ way!) Cannot Intubate Cannot Oxygenate (CICO) Scenario - Needle Techniques. Potentially controversial (DAS primarily advocates scalpel techniques), but worth knowing about - particularly for paeds! Here’s some #OnePagers to start..
#JanuAIRWAY 1/7
CICO Key = decide on your plan before you're in the situation. @dasairway promotes scalpel techniques (final common pathway of CICO) MUST be taught. For more on the Needle technique check of Dr Andy Heard’s work at the Perth ‘wet’ lab. 🔗bjanaesthesia.org.uk/article/S0007-…
#JanuAIRWAY 2/7
Integrating the needle technique into CICO algorithms could look something like this #OnePager. There are 2 scenarios for each technique (needle & scalpel):
-palpable and
-impalpable anatomy
another reason to decide early –> lower cognitive load. #FOAMed
#JanuAIRWAY 3/7
All techniques require a degree of muscle memory for each step, and knowledge of potential pitfalls / ancillary equipment. Here’s some #OnePagers on needle approaches for palpable and impalpable anatomy. We’ll cover extra equipment on Tuesday! #FOAMed
#JanuAIRWAY 4/7
You’re not alone in having airway skills – remember your surgical colleagues & involve them early. BUT remember not all surgeons are equal (same as anaesthetists!) – having subspecialty interests a rhinologist might not be comfortable doing FONA either!
#JanuAIRWAY 5/7
Here are some papers / links that you might find interesting:
🔗pubmed.ncbi.nlm.nih.gov/20645953/
🔗pubmed.ncbi.nlm.nih.gov/21423020/
🔗youtube.com/user/DrAMBHear…
🔗link.springer.com/article/10.100…
If you have any others of interest, tweet them to us for inclusion next time!
#JanuAIRWAY 6/7
Hope that helps. Tomorrow we'll take a look at Scalpel Techniques for CICO Scenario. 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

Jan 17,
#JanuAIRWAY Day 17. CICO - Scalpel Techniques. Absolutely ESSENTIAL knowledge for anyone involved in airway management! Here’s a #OnePager with the @dasairway algorithm. Let’s dive in… #FOAMed
#JanuAIRWAY 1/6 Image
DAS advocates scalpel-bougie-tube technique for palpable anatomy and scalpel-finger-bougie-tube technique for impalpable anatomy. Here are some #OnePagers #FOAMed
#JanuAIRWAY 2/6 ImageImage
Perhaps the most difficult part of the process is making the mental leap to pick up the scalpel. That's why mental models and thinking tools like the @VortexApproach are so useful. Check out @NicholasChrimes & Peter Fritz's work
🔗vortexapproach.org
#JanuAIRWAY 3/6
Read 6 tweets
Jan 15,
#JanuAIRWAY Day 15. Tracheostomies – more than just an ETT through the neck. Here’s a #OnePager covering some of the different tube types. Let’s dive in…
#JanuAIRWAY 1/9
Tracheostomies have potentially been performed since ancient Egypt. The first non-emergency trache was thought to be performed by Asclepiades. He was also a proponent of music therapy (might be of interest to Veena).
#JanuAIRWAY 2/9
There are 4 basic indications for tracheostomy:
1. Provide patent airway
2. Protect the airway
3. Clear secretions
4. Aid weaning from ventilator – the timing of which was investigated in the Tracman study in 2013 (jama.jamanetwork.com/article.aspx?a…)
#JanuAIRWAY 3/9
Read 9 tweets
Jan 14,
#JanuAIRWAY Day 14. One Lung Ventilation – one of @vapourologist’s favourite procedures in anaesthesia – physiology in action! Here’s a #OnePager. Let’s dive in…
#JanuAIRWAY 1/9
Several indications for OLV, commonest are thoracic surgery & some oesophagectomies. Essentially three ways to achieve OLV - use of:
- Double lumen tube
- Bronchial Blocker
- Elective endobronchial intubation
Here are some #OnePagers covering the basics
#JanuAIRWAY 2/9
The key physiological change is the creation of a large shunt – deoxygenated blood (which would normally be oxygenated), returns to the left heart resulting in hypoxaemia.
#JanuAIRWAY 3/9
Read 9 tweets
Jan 13,
#JanuAIRWAY Day 13. Jet Ventilation – this is a bit more niche in anaesthesia / airway management, but fascinating. Here’s a #OnePager covering the basics. Let’s dive in…
#JanuAIRWAY 1/8
2 modes of jet ventilation – low frequency (<60 jets/min) & high frequency (>60). Frequency determines device. 2 commonly used devices – Manujet (modified hand operated Sanders injector) or Monsoon (specialised jet ventilator). Here’s a some #OnePagers
#JanuAIRWAY 2/8
Several different potential mechanisms to apnoic oxygenation during HFJV, including:
-Bulk flow
-Laminar flow
-Taylor dispersion
-Pendelluft
-Molecular diffusion
-Cardiogenic mixing
derangedphysiology.com has a great article & this diagram #FOAMed
#JanuAIRWAY 3/8
Read 8 tweets
Jan 12,
#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
Read 11 tweets
Jan 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
Read 5 tweets

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