Random physiology / physics / HEMS / airway thread here! 🥳🧐😋
Everyone knows that as you go up in altitude the pressure in an ETT cuff, or a bag of chips, increases, right? But have you ever tried to explain why?
Hints:
- It's not Boyle's law, and
- Technically, it doesn't! "😠 WHAT!?" I hear you exclaim. "Of course the pressure increases! Anyone who's taken a bag of chips on a plane can see that! Look; it's even been proven:"
doi.org/10.1111/j.1365…

Sure, OK, but then why?

THREAD!! 🥳😁
Why @josimpson11’s paper on intubation barrier devices (that is, aerosol boxes AND plastic drapes) is, by a good margin, the most important thing that’s been published on these devices.
@Anaes_Journal
onlinelibrary.wiley.com/doi/abs/10.111… Here's the first thing I LOVE about this paper: an engineer is an author!
Doctors are so frequently happy to step into other fields (law, stats, engineering, etc) without ever asking the experts for their input. Not these guys- they actually got an engineer involved!

Surely if the stakes are higher we should be more careful in our decision-making, not less. If you’re not willing to treat one patient based on a press-release, why would you be willing to treat one hundred?

(Thread...)

https://twitter.com/rupert_pearse/status/1273266740059951104

And while people who were involved in recruiting for the study may feel like they can evaluate it just from a 3-line summary, it shouldn’t surprise anyone that those of us elsewhere do not feel that a press release is enough for us to decide to safely change our practice.

https://twitter.com/jblascarrou/status/1272938313951911939

My thread on the @Anaes_Journal @IntubateCovid paper, and why it doesn't say what you might think it does.
There's also a really important finding that hasn't received anywhere near the attention it needs... but that's a teaser for the end of the thread!

https://twitter.com/Anaes_Journal/status/1270611658222657536?s=20

@IntubateCovid used (and still uses) an online app to prospectively record clinicians' exposures to intubating suspected or actual COVID-19 patients, and then follow to see which developed symptoms and/or the disease.
Data is still being collected: link: intubatecovid.org/info

Let's do a 'deep dive' into this @NEJM intubation-box paper. Although it won't be too deep; the paper itself is only a page long!
nejm.org/doi/full/10.10… The first thing is that this paper is not a 'study'; it's a Letter to the Editor. Letters are not peer-reviewed and it's not actually fair to the authors to critique it as a study either.
(It also means you may not get CPD points for reading it... if that's important to you! 😅)

When this is all done, I think we Australian doctors need to write a joint letter to our public health specialists apologising for thinking that our three-months of reading and experience made us more qualified to respond to a pandemic than them. A couple of points to clarify based on responses:
- Politicians are not public health physicians! My tweet wasn’t about politicians.

I have colleagues testing intubation boxes. Here’s a short list of experienced/anticipated problems..... and their relationship to cobras!

https://twitter.com/trishgreenhalgh/status/1244249951997177856

Firstly, it seems obvious that intubations will be more difficult with these, but some people are very surprised at just how difficult it is in reality!
Using new equipment in a complex situation may be part of this.

So I've been doing a bit of reading on malignant hyperthermia (MH) and learned a few things.
Here are some interesting facts on MH, presented in no particular order... Most patients who suffer MH have had prior uneventful anaesthetics. In fact, in most cases the patient had 2 or more uneventful anaesthetics previously!!
ncbi.nlm.nih.gov/pubmed/20081135

@drBato from @RCHAnaesthesia at #ASM19KL:
Anatomically difficult intubations in children are rare (0.1-0.2%, but 1% in neonates/infant), however morbidity is high (5%) including cardiac arrest. #ASM19KL

@doctorwozza Trauma Director at RCH:
“I really, really hate children getting injured.”
#ASM19KL

Astronaut Dr Michael Barratt talking of lost collages and friends and space flight safety.
#ASM19KL Very high risk tolerance, but lots of unknown unknowns too.
Predicted decompression illness rate was >20% for space walking, but they did it anyway. Turns out this never eventuated, but other unpredicted health effects did.