Thread by @dastrainees

#JanuAIRWAY Day 19. The Obstructed Airway – Think SPIMS
-Supra-
-Peri-
-Infra-glottic – extra/intrathoracic
-Malacias
-SVC Obstruction
Today we’re going to focus on Supraglottic Airway Obstruction. Here's a #OnePager to get started! #FOAMed
#JanuAIRWAY1/7

Possible issues:
-Risk of total obstruction with low tone
-Distorted anatomy
-NP/OP airway too short?
-+++jaw thrust may/may not relieve obstruction
-Difficult BVM/laryngoscopy
-+++ laryngoscopy may make manageable unmanageable (e.g.bleeding)
#FOAMed
#JanuAIRWAY 2/7

Planning in airway obstruction = Key. NASENDOSCOPY can save lives here! ASSESSMENT informs STRATEGY. Let’s revisit some #OnePagers on key questions and airway planning. Remember the decision-making process is multifactorial (maintain situational awareness).
#JanuAIRWAY 3/7

Lawson’s choices:
• Awake/asleep
• Device on face/in face/thru neck
• Paralyse/Not
• Device in/out at end

In severe supraglottic obstruction awake techniques may be best:
• ATI/AFOI
• Awake transtracheal catheter & asleep FOI
• Awake tracheostomy

#JanuAIRWAY 4/7

Here are some papers / links that you might find interesting:
🔗bjaed.org/article/S2058-…
🔗…-publications.onlinelibrary.wiley.com/doi/10.1111/an…
🔗anaesthesiology.gr/media/File/pdf…
🔗onlinelibrary.wiley.com/doi/full/10.11…
🔗journals.lww.com/johnajournal/F…
#JanuAIRWAY 5/7

How would you manage severe supraglottic airway obstruction?
•RSI/Standard induction
•Awake technique (eg ATI / AFOI)
•Alseep FOI +/- transtracheal catheter
•Other (eg. Awake tracheostomy. Comment below)
#JanuAIRWAY 6/7
Note: Twitter poll limits us to only 4 options

Hope that helps. Tomorrow, continuing with obstructed airways we’ll be looking at Periglottic Airway Obstruction. See you then! #JanuAIRWAY 7/7

*Disclaimer: Inclusion of content (equipment, techniques and scoring systems etc.) in #JanuAIRWAY does not constitute DAS endorsement