#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 Image
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 ImageImageImage
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 Image
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

• • •

Missing some Tweet in this thread? You can try to force a refresh
 

Keep Current with Difficult Airway Society (DAS) Trainees

Difficult Airway Society (DAS) Trainees Profile picture

Stay in touch and get notified when new unrolls are available from this author!

Read all threads

This Thread may be Removed Anytime!

PDF

Twitter may remove this content at anytime! Save it as PDF for later use!

Try unrolling a thread yourself!

how to unroll video
  1. Follow @ThreadReaderApp to mention us!

  2. From a Twitter thread mention us with a keyword "unroll"
@threadreaderapp unroll

Practice here first or read more on our help page!

More from @dastrainees

Jan 22
#JanuAIRWAY Day 22. Airway Obstruction – Infraglottic (intrathoracic). Again, presents its own set of challenges. Let’s dive in … Here's a #OnePager (Ft. expert contribution Sadie Khwaja @ENT_UK )
#JanuAIRWAY 1/7 Image
Issues:
- Upper/Mid lesions usually low risk – ETT may pass beyond
- Low tracheal/Bronchial lesions = high risk, best managed in specialist centres
- CT scan = essential
- Sudden obstruction can occur at ANY time
- Potential compression of heart/vessels
#JanuAIRWAY 2/7
Severe Obstruction:
- Check position patient breaths best in
- Spont vent may help, IPPV may cause airway collapse
- Opinion re: IV vs inhalational = mixed
- Ketamine ?preserves chest wall tone
- Need back up plan
- Consider Heliox/bypass/ECMO before starting
#JanuAIRWAY 3/7
Read 7 tweets
Jan 21
And just like that we’re 3 weeks into #JanuAIRWAY. Here’s your week 3 round up!

Day 15 – Tracheostomies

Day 16 – CICO Needle Techniques

Day 17 – CICO Scalpel Techniques


#JanuAIRWAY 1/4 Image
Day 21 – The Obstructed Airway: Infraglottic Extrathoracic

Week 4 starts tomorrow continuing the theme of obstructed airways with Infraglottic Intrathoracic Obstruction. See you then!

#JanuAIRWAY 3/4
Read 4 tweets
Jan 21
#JanuAIRWAY Day 21. Airway Obstruction – Infraglottic (extrathoracic). Presents a unique set of challenges. Let’s dive in … Here's a #OnePager
#JanuAIRWAY 1/6 Image
Physiology
- Theory=fixed lesion unaffected by respiratory cycle / anaesthesia induction (most have dynamic element)
- Extrathoracic lesions usually better in expiration +ve pressure splints airway open
- Lets’ revisit flow-volume loops as they can be helpful
#JanuAIRWAY 2/6 Image
Issues:
- Laryngoscopy likely to be uneffected. However, major concern = inability to pass ETT atraumatically beyond the level of obstruction
- Nasendoscopy can be useful to view lesion
- AFOI/FOI may cause ‘cork in bottle’ effect depending on lesion size/location
#JanuAIRWAY 3/6
Read 6 tweets
Jan 20
#JanuAIRWAY Day 20. Airway Obstruction – Periglottic. Often the most challenging for the general anaesthetist. Let’s dive in … Here's a #OnePager
#JanuAIRWAY 1/6 Image
Issues:
- Must d/w with ENT colleagues
- Preop nasendoscopy by experienced nasendoscopist = essential
- AFOI may worsen obstruction – cork in bottle
- Inhalational induction may be difficult

Key Q's
- Static or dynamic obstruction?
- Will ETT pass?
#JanuAIRWAY 2/6
Options:
- May be able to pass ETT – consider MLT or jet vent.
- Apnoeic (HFNO) or intermittent oxygenation technique depending on type of surgery (elective/emergent)
- Awake Tracheal Intubation
- Transtracheal catheter (+/- jet ventilation)
- Awake tracheostomy
#JanuAIRWAY 3/6
Read 6 tweets
Jan 18
#JanuAIRWAY Day 18. Extra CICO Equipment. At least 2 pieces of equipment deserve extra attention – Rapid-O2 & the Melker airway (key components of the cannula technique one for initial oxygenation & one for securing the airway)! Here’s a pair of #OnePagers to get started.. 1/5 ImageImage
A bonus #OnePager on the QuickTrach airway – used for wide bore cricothyroidotomy, it may still lurk in a few departments throughout the land! Here’s a video as well #FOAMed
#JanuAIRWAY 2/5 Image
Double bonus #OnePager – on the Ventrain Device – a newer, but interesting, device! Can be used both electively & as part of CICO. Here’s a recent paper that highlights its potential read.qxmd.com/read/33432628/… #FOAMed
#JanuAIRWAY 3/5 Image
Read 5 tweets
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
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
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

Did Thread Reader help you today?

Support us! We are indie developers!


This site is made by just two indie developers on a laptop doing marketing, support and development! Read more about the story.

Become a Premium Member ($3/month or $30/year) and get exclusive features!

Become Premium

Too expensive? Make a small donation by buying us coffee ($5) or help with server cost ($10)

Donate via Paypal

Or Donate anonymously using crypto!

Ethereum

0xfe58350B80634f60Fa6Dc149a72b4DFbc17D341E copy

Bitcoin

3ATGMxNzCUFzxpMCHL5sWSt4DVtS8UqXpi copy

Thank you for your support!

Follow Us on Twitter!

:(