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
Day 18 – CICO Extra Equipment


Day 19 – The Obstructed Airway: Supraglottic

Day 20 – The Obstructed Airway: Periglottic

#JanuAIRWAY 2/4
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
*Disclaimer: Inclusion of content (equipment, techniques and scoring systems etc.) in #JanuAIRWAY does not constitute DAS endorsement

#JanuAIRWAY 4/4

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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
#JanuAIRWAY Day 21. Airway Obstruction – Infraglottic (extrathoracic). Presents a unique set of challenges. Let’s dive in … Here's a #OnePager
#JanuAIRWAY 1/6
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
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 19
#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
Read 7 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

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