AIRWAY COMPLICATIONS➡️What can b done 2 prevent airway management complications? A 🧵with tips ✅how you could improve your airway work (my clinical observations, talks with experts, >15 yrs experience with full scale advanced airway team training & research)1/15
#meded
#foamed
When our
#MICU
ambulance🚑departed from a Dutch🇳🇱hospital to transfer COVID patient to Germany🇩🇪, because of shortage of ICU beds, nurses asked the team 2take a small gift for their foreign colleagues to thank them for their support: Dutch stroopwafels
@shossontwits
@aboutanurse
Ik ben anesthesioloog en heb COVID golven meegemaakt achterin de mobile intensive care unit ambulance van Rotterdam o.a. naar Goes, Leeuwarden, Maastricht, Groningen…Urenlang gezeten naast doodzieke mensen. Waarom nu snel versoepelen?
@HansvanSchuppen
@shossontwits
@DonRoelofsen
👁️
Managing the “right-angled neck airway” for eye surgery.
Highly complex advanced airway.
This patient had a 90-degree Bechterew neck fixation and needed cataract surgery, but could not be operated with local eye-block because the microscope could not be positioned. We did…
Plse retweet: delta🦠is airborne👉it infects you via air➡️Protect others by wearing a surgical mask. Protect yourself with a FFP3 mask. If only 1 person reads this tweep & realises that masks can stop
#COVID19
the power of
#twitter
will win from🦠
@NightShiftMD
@MDaware
@ketaminh
Hey
#emergencyphysicians
It is NOT a competition who will manage the airway, Even if you intubate 2 or 3 patients a day in your busy emergency room, thats a lot less of experience than an anesthesiologist who manages 10-15 cases a day including emergencies and critical care and…
🎯 Extreme ownership: this means that when you have a desaturating patient or a challenging intubation, you must show leadership, you do not blame others or a device, you have to remain calm and you just fix it with the help of your team. And you take responsibility and try to…
Combination of airway and oxygenation techniques can bail you and your patient out of trouble. Ventrain can be used to oxygenate and ventilate a patient when advancement of the tracheal tube is not possible during flexible intubation (stenosis, trachea compression, tumor).…
I am tired of health care professionals who are not really…professionals.
It takes energy, endurance, self-reflection and compassion to work in a health care setting.
And it’s life long learning.
There is no place for amateurs. No place for ego’s, no place for “eminence…
I had my first Ai Endoscopic airway lesson in Baveno 🇮🇹 during
#EAC23
with David Guralnick, COO of Ai Endoscopic. Very interesting and exciting new technology. Will it make our airway management procedures safer? The future will tell...
@jducanto
@DaveOlvera1
@airwayGladiator
…
“Just a routine operation” , the courageous documentary of pilot Martin Bromiley about the death of his wife in 2005. The message is still clear, powerful and unchanged: lack of leadership, underestimation of the severity of the clinical situation, miscommunication and tunnel…
Hey
#anaesthesia
How many of you have worked with all 4 of these anaesthetic volatile drugs? Do you miss any? I work 22 years a specialist anesthesiologist and have worked with all.
#volatile
✅To all airway managers and
#VL
lovers.
Today I intubated an ASA 1 patient, with a basic airway. A healthy 50 yo male with normal vital signs, BMI 22, normal mouth opening MP 1 for elective surgery.
I used a direct laryngoscopy technique with a disposable Macintosh blade 3…
☑️When you perform an awake oral flexible optical tracheal intubation, use a conduit. The lens stays dry and clean, the tongue is easily bypassed and if lucky the target is in view within seconds. And dont forget, patient cannot damage the scope with 🦷 😷
@jducanto
@NaveenEipe
☑️VLs of all designs likely reduce rates of failed intubation&result in higher rates of successful intubation on 1st attempt. Macintosh‐style & channelled VLs likely reduce rates of hypoxaemia. HA VLs probably reduce rates of oesophageal intubation.
@VirtueOfNothing
@doctimcook
☑️Acute perforated appendicitis, 62 yo male, extreme overbite, MP III, mouthopening 3 cm, BMI 28, vital parameters stable. Needs intubation for surgery. This is an advanced airway with low complexity. How would you intubate this patient? (we already did as you can see😇😷)
☑️Five steps to replace an Igel with tube. CPR with Lucas+Igel➡️ROSC and need to go to cathlab. 1️⃣Aintree catheter around flex scope 2️⃣Flex tip just above carina3️⃣Leave Aintree in trachea4️⃣remove Igel 5️⃣use laryngoscope and railroad tracheal tube into trachea
@jducanto
@EM_RESUS
Why do companies that manufacture laryngoscopy blades think we use more and more and brighter LED lights? Today I used a disposable Macintosh blade for RSI direct laryngoscopy and because the light reflected on saliva, I could not see the glottis at all until I suctioned the…
⚠️Deadly similar!! Capnogram and pressure curves on a ventilator. In case of accidental oesophageal intubation, you may confuse pressure curves with CO2 trace.
This is preventable: always use shaded capnography curves
@ProfEllenO
@jducanto
@doctimcook
@EM_RESUS
…
What I hate most about supraglottic airway devices in the operating theatre?
In some patients they will leak and it cannot be fixed without tracheal intubation, whatever you try.
But here is the problem: it always seems to occur in patients that would greatly benefit from a…
I am an experienced consultant anaesthetist, PGY 22, others consider me an airway expert, I know how important human factors are in clinical medicine, and have been a simulation instructor for >15 years…but I still forget my car keys, I take the wrong road even when driving with…
💢
#medtwitter
When you induce anaesthesia do you realise that you will use a potentially lethal combination of drugs? The hypnotic will cause hypotension and/or apnea, opioid will cause apnea and/or bradycardia and/or muscle rigidity and muscle relaxant apnea and/or anaphylaxis😳
💢This…was a surprise finding in a 60 yo male patient on videolaryngoscopy during induction of routine elective minor surgery with general anaesthesia. Do you recognise this? What would be your next step?
#foamed
#meded
#airway
☑️Awake face to face flexible intubation in male patient (BMI 61): start HFNO 30l/, use STOP-CENTER-MOVE to find epiglottis, vocal cords and trachea during advancement scope (with patient consent)
#ATI
#medtwitter
☑️How would you manage the airway and pull out a broken metal stent out of left bronchus after lungtransplant and protect + ventilate right lung in case of bleeding? 👇🏼 ✅Rigid scope, flex scope, Tritube in right lung and ventrain emergency ventilation
@dr_imranahmad
Hey
#medtwitter
You have induced anaesthesia in a 75 yo 90 kg pt (knee replacement) with 180 propofol, 200 fentanyl, 50 rocuronium. Bag mask ventilation was difficult, this is your best VL view during laryngoscopy. SpO2 92%. What are your options?
@EM_RESUS
@jducanto
@NaveenEipe
@DGlaucomflecken
Very true, and beware of 80 yo farmers 🚜 without a medical history! They do not have a history because they never ever go to the doctor😷
🩺The more I know and learn about airway management and the more experienced I become, the more I realise how close we are to potential disaster every time we induce general anaesthesia for a surgical procedure or tracheal intubation.
Using a videolaryngoscope with an hyperangulated blade is a smart idea for smooth intubation with a nasal tracheal tube. Glidescope LoProS3 blade with tube 7.0. No Magill forceps needed.
@jducanto
🌼Since publication of Airway Triage method for airway assessment in 2015 I have encountered only 1 “unanticipated difficult airway” in 7 years, but that was easily managed with VL because it was the primary technique. It was a pt with advanced low complex…
Heine VisionPRO VL (no COI) has arrived in the Netherlands. First impression great: a bit heavy but balanced, good monitor, with Mactype blade and rechargeable. DL and VL combo. Any experience
#medtwitter
@jducanto
@NaveenEipe
@oldandbaffled
This image and question about a rather low SpO2 has been viewed >130K within 24 hours and I have received many answers. Time for a low oxygen saturation 🧵 1/6
#foamed
#meded
@bergmansbas
De gemiddelde leeftijd van de COVID 🦠 patienten die op intensive cares zijn opgenomen, maar die we met mobiele intensive care unit teams met de
#micu
🚑 naar elders transporteren ivm plaatsgebrek is momenteel rond de 55 jaar. Jonger dan tijdens eerdere golven.
The difficult airway cannot be defined, so it does not exist. It is also very context sensitive.
It’s a myth.
Airway management revisited. 📖
If you like this article, download the Airway Triage application from the app stores. Non-profit patient…
☑️When are you getting nervous? Look closely, you only have 30-45 seconds before you will see 60% on your monitor in all patients when the SpO2 hits 80% and oxygenation is not restored
@StGgas
@ProtectedAirway
@fuzzymittens
@airwayGladiator
Okay, here it is. Caught on 📷 camera
“Glottic impersonalisation”.
This was an elective surgical case of a young female patient with a number of airway complexity factors. Assessment and risk stratification, airway strategy and timeout done with
@AirwayTriageApp
First…
This is an important message / finding👇🏼ED intubation of 🩸 bleeding trauma patients has higher complication rate than intubation in OR. What are the reasons for this? Less time loss? More experienced intubators? Better team work? Any comment?
@bobfunn
@airwaycam
@JohnCSakles
…
Among 9,667patients that underwent hemorrhage control surgery ED vs OR intubation was associated w/ increased risk of death & major complications. Trauma centers w/high-tendency for ED intubation were associated w/higher risk of in-hospital cardiac arrest
☑️Tracheal intubation no longer a ME procedure as with direct laryngoscopy, but a WE procedure with videolaryngoscopy. You can engage the whole medical team because everyone can watch the monitor screen
#team
#VL
#medtwitter
☑️Practising VL in lateral position. Find out which technique works for you! In clinical practise this may b needed prehospital and in OR when converting hip surgery spinal to GA. What is your preferred technique in this position?
@VirtueOfNothing
@EM_RESUS
@ketaminh
@jducanto