The Protected Airway Collaborative
@ProtectedAirway
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Collaborative #MedEd design I integrating digital & physical space for better learning. #nextgen I #airwaytraining I #realworld I #JointhePAC
New York, NY
Joined February 2019
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A FONA pearl: patients can have thick necks but everyone has skinny membranes. A long vertical incision will help you identify the CTM (cricothyroid membrane) more quickly and ensure the next horizontal cut is in the correct location. Learn more here 👉
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Our learning space on the management of upper airway inhalation burns is out, so this week we're going to share some clinical pearls with you on how to manage them successfully. Watch this space.
#burn
#intubation
#MedEd
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Don’t just “plunge and pray” hoping to find the cords. An incremental approach to laryngoscopy that progressively identifies key anatomical landmarks is best.
#intubation
#laryngoscope
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The “d-grip” preloaded bougie is ideal for independent airway management when you don’t have an extra set of hands. Watch the incredible economy of movement displayed by
@ResusOnTheRoad
one of our airway faculty at PAC. Learn more here 👉
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Don't underestimate how important patient positioning is, or how difficult it can be to get it right in a busy resuscitation. You need a simple way to get the job done. This technique, will enhance your ability to get that ideal ear to sternal notch position quickly.
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When people perform 2 thumbs-down FMV they often make this mistake. DON'T place your fingers under the chin and push the tongue and other structures into the oropharynx. INSTEAD, place them at the angle of the mandible and PULL UP into the mask in a JAW THRUST. You can see a…
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TUBE DELIVERY: Has its own set of skills. To be successful you need to know 1. The anatomic structures that might impede your progress 2. Have an understanding of the spatial relationships of the tube as it travels your line of sight, approaches the glottis & enters the trachea.
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Prioritize Oxygenation and live by the first law of airway management. Visit this foundational airway curriculum at the Protected Airway Collaborative.
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- Inserting your blade too deep? 😱
- Trouble controlling the tongue? 🤪
- Difficulty seating in the valeculla? 😢
Whether DL or VL, holding it "LIGHT&LOW" gives you better control of the
#laryngoscope
& allows switching to a firm grip of the handle if necessary
#howtoholdit
👇
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Thought for the day: the term "difficult airway" is subjective. It is a complex interplay of anatomy, physiology, context, experience and ability. The mental model(s) we use to address these issues is what makes the difference.
#airwaymanagement
#meded
#clinicalpearl
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@Soapiestbat2
@PatologCritica
This in an inhalation burn. Prolonged exposure to heat and soot blackens the airway. The heat cause the swelling and the often pale appearance. Hope that helps!
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Visualization of anatomic landmarks is just the beginning of understanding the path to successful tracheal access and tube delivery. Learn more here👉
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Tomorrow PAC23 will begin: bringing together 1000+ pieces of multimedia content, 400+ pieces of equipment, 130+ graphic posters, 40+ faculty, 30+ hands on stations, 12 themes & 6 sims into 1 immersive, interactive & self-directed learning experience. We can't wait!
#PAC23Live
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Endotracheal tubes are designed for gas exchange. A bougie's only purpose is to help you access the trachea. One of the many reasons you should consider using one to improve your first pass success. Watch this👉
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STRESS impairs recall, erodes fine motor skills & your ability to complete complex tasks. SCALPEL☝️BOUGIE streamlines FONA - removing unnecessary steps so you can act efficiently in a crisis. Another form of cognitive offloading & part of a fearless FONA mindset.
#fearlessFONA
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Different devices impact your ability to visualize anatomy (VA) and deliver the tube (TD). As you move from DL to VL to HAVL visualization of anatomy generally becomes easier while tube delivery becomes a bit harder. This graphic explains why👇
#mentalmodel
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Visit us on
#Instagram
for more videos and help us design the next video format for
#PAC
learning spaces.
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What do you do in an airway emergency if you don’t have wire cutters and your patient’s jaw is wired shut? This trick is a lifesaver!
#fona
#cric
#emergencymedicine
#protectedairway
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One of our favorite airway checklists from
@kovacsgj
Head over to the coaching station and practice using it!
#protectedairway
#checklist
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Leveraging Instagram Reels to create rapid review content for the latest iteration of our immersive
#MedEd
learning spaces.
#FOAMed
#protectedairway
😊🔥
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One skill to confirm tube placement & avoid unrecognized OI? Secure ETT to handle of laryngoscope & leave in place! In my practice it doesn't come out until cuff inflated, vent is connected & continuous ETCO2 confirmed. Any problems I can reconfirm with direct visualization.
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Blood is always the hardest to simulate. On cadavers it’s not possible,but we created FONA trainers that simulate bleeding in our course.
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If you want to be successful with
#HAVL
, you need to be skilled with a second device that is often overlooked in its importance. HAVL may get you good views, but your facility with the
#rigidstylet
will help ensure consistent tracheal access and tube delivery. Get good at using…
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Okay?👍👍👍👍👍👍👍👍👍👍👍👍👍👍👍👍👍👍👍👍👍👍👍👍👍👍👍👍👍👍👍👍👍👍👍👍👍
#rigidstylet
#intubation
#hyperangulated
#videolaryngoscope
#clinicalskills
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Performing laryngoscopy can be experienced as a desperate & stressful search for the cords. Radically improve your success by slowing down the process. This thread explores the 3 steps of laryngoscopy & the concept of incrementalization pioneered by
@airwaycam
#protectedairway
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EPIGLOTTOSCOPY: A term created by
@airwaycam
is the key to intubation! 🔑 This requires that you SLOW DOWN 🦥⏱️and forget finding the cords as your first goal. Find EPIGLOTTIS & the rest will come. Here is everything you need to know about epiglottoscopy.
The key in being a great intubator:
1 Visualise the uvula
2 Epiglottoscopy
3 Laryngoscopy
4 Deliver the tube!
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All the right moves to build your airway mantra. Visit us at PAC for more.
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Do you understand the whole DL vs VL thing? It may seem obvious but there are a lot of misconceptions. This thread going to break down the some of the vital differences, benefits and issues with both.
#protectedairway
#FOAMed
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One ☝️ more time.
1. Thumbs pointed towards the feet
2. Palms pressed down
3. All four fingers do a jaw thrust
There you have it.
Photo courtesy of
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One attempt may be all you get in a pt with severe inhalation injury. Don't wait until you face a CICO situation to start preparing for FONA.
- Discuss FONA plan with team
- Prep your set-up BEFORE intubation
- Transition to eFONA EARLY.
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New additions to the FONA learning space. Click the link to see more.
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It's not about what tools you use, it's about how you use them. Understanding their benefits and limitations is the key. Learn more 👉
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A quick clinical pearl and a preview of the developing learning space on
#tracheostomy
emergencies by Dr Kelly Crane that every clinician should know.
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Remember🎗️FAILURE TO INTUBATE ISN’T FAILURE, FAILURE TO PLAN FOR FAILURE IS.
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You need an optimization plan for the FACE MASK VENTILATION if your initial efforts fail. Here's a simple step by step approach:
#protectedairway
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Hot off the press! 📰🗣️
@jducanto
captured in his natural habitat - teaching airway decon skills
@PAC22
This one is sure to become an instant classic👇
#YouTube
#Intubation
#laryngoscopy
#MedEd
#FOAMed
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GRADE YOUR VIEW: CORMACK – LEHANE:
Grade 1: full view of glottis
Grade 2a: partial view of glottis
Grade 2b: arytenoids only
Grade 3: epiglottis only
Grade 4:no glottis or epiglottis identified
It's nice to speak the same language. If not just describe your view! THAT'S OKAY TOO.
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The first rule of laryngoscopy? Don’t plunge and pray. If you dive in thinking that your goal is to find the cords, then you will overshoot important anatomic landmarks that can guide you safely to your target. Overshooting those landmarks in a moment of stress is all too easy,…
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Share your most memorable airway pearl or quote with us!!! We'll start. Make a long vertical incision of the neck when performing eFONA. "Because some people can have fat necks, but everyone has skinny cricothyroid membranes."
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@PACAirway
@jameshorowitzmd
@jducanto
@gueromedico
3-D printed Tracheas on their way thanks to James Shin!
#PAC19
#ProtectedAirway
#Cricothyrotomy
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Understand the importance of attaching that small little PEEP valve attached to your BVM. Remember it doesn't come with!!! So put it on yourself okay? 👍 🤓 🏥
#PAC20
#theprotectedairway
#PEEP
#emergencymedicine
#FOAMed
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A shout out to our PAC team who create a one of a kind anatomy lab experience with multiple specimens modified to simulate difficult airways scenarios in the most realistic way possible.
#PAC24
#anatomy
#JointhePAC
#difficultairway
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Design, test, repeat. Medical education creation the way it should be.
#MedEd
#FOAMed
#airwaytraining
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The Protected Airway Course includes a full day in the state-of-the-art anatomy lab at Weill Cornell Medicine. We have developed a curriculum that brings high-fidelity to the next level. Check out more here and register for PAC24 this March 2nd and 3rd.
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Are you an infrequent intubator? EM & CC docs aren't intubating all day in the OR & those at teaching hospitals who supervise residents often don't get opportunity to do as much as they teach. You need a strategy! Here is mine...
#infrequentintubator
#FOAMed
#protectedairway
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Teaching fiberoptic skills for four NYP residency programs at once! Using the PAC system 😀❤️👍
#fiberoptic
#intubation
#FOAMed
#airwaymanagement
#residency
#EmergencyMedicine
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Here's a self-guided visualization tools. Take a moment to listen & see yourself performing the procedure. Studies show
#guidedvisualizaton
works! That's why we integrate them into our
#protectedairway
learning spaces.
#meded
#FONA
#airwaytraining
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Sneak peek! The masterclass learning space on
#tracheostomy
tubes is coming soon! Anatomy essentials, detailed review of device types, what to do in an emergency and more coming your way this fall. Watch this space. 🚀👩🏫🔥
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Ketamine - .25 to .5 mg/kg in TITRATED DOSES. We go low to start to avoid hypotension and peri-intubation arrest but we WANT sedation BEFORE paralyzation. For a deep dive on the discussion go here by by
@srrezaie
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FONA pearl 👉Just one of those small little things that make performing
#FONA
faster, smoother, and easier. It’s all the little details that add up to a Fearless FONA Mindset
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Some bougie clinical pearls I snagged on our b-roll from the last
#MedEd
content creation day. 🎞
@AnesthesiaResus
@jducanto
@gueromedico
@jameshorowitzmd
@OrenFriedman
@ResusOnTheRoad
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Patient's jaw wired shut during an airway emergency. Visit our learning space at PAC on how to handle it.
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We love the potential for these 3D printed devices to make VL training more accessible for learners. The ability for someone to plug a low cost laryngoscope blade into their own mobile device makes them a game changer in airway training.
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FONA: procedure is easy, but acting and making the cut is hard. Fearless FONA is about learning to overcome all the barriers to acting BEFORE you need to act.
#meded
#foamed
#medical
#emergencymedicine
#learning
#residency
#intubation
#laryngoscope
#protectedairway
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Want all the airway content curated by our PAC faculty in one place. Get the flipboard app and follow us!
#PAC
#ProtectedAirwayCourse
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Why is an incremental "no rush" approach to laryngoscopy is essential? To help avoid esophageal intubation for one! Remember all 3 steps of laryngoscopy: 1.epiglottoscopy 2.laryngeal exp 3. tube delivery
#FOAMed
#PACAirway
#PAC
#protectedairway
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Choosing the right time to intubate is an airway skill that requires experience and expert timing. Every skilled clinician I know starts by asking themselves these 3 questions to help them decide.
#airwaymanagement
#intubation
#laryngoscopy
#meded
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What a wonderful
#FOAMed
resource! 👍🙏❤️
☑️50 short educational airway management films 👉 🎥 .
#airway
#intubation
#FOAmed
#medtwitter
#anaesthesia
#ED
#ICU
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⚡️ “Know Your Pressors - Deep Dive”
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Critical actions for the hypotensive patient before, during and after intubation? Learn what to do here.
#foamed
#MedEd
#intubation
#airwaymanagement
#criticalcare
#resuscitation
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@ResusOnTheRoad
@Sruby345
@jducanto
@UCAirCareDoc
@EM_RESUS
@heavyhelmet
@JohnCSakles
@AirwayMxAcademy
@PulmCrit
@jstgeorgemd
You mean the rapid response difficult airway roll that:
-uses vertical space ☑️
-is rapidly accessible ☑️
-provides plan A-B-C-D at your fingertips ☑️
-was highlighted in BMJ ☑️
Time to stop digging through boxes to find what you need...
#betterway
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Another AIR Time Video. Part of our airway stories project. Sharing our collective experience to improve what we do through storytelling.
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@EM_RESUS
Great video! To expand on this: Epiglottoscopy only 1/2 the equation. With VL tube delivery is the other half. Note at 1:22 how the tube wants to go posteriorly first? A sign laryngscope is too close. Give yourself more space. Don't let perfect (views) be the enemy of the good.
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Part of cultivating a Fearless FONA Mindset? Remember that failure to intubate is not failure, only a failure to oxygenate your patient by any means necessary is. Don’t make multiple attempts at intubation out of your own fear of failure, instead see this as an opportunity to…
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What happens when you combine 70’s sic-fi art, interactive posters, immersive learning spaces and amazing faculty coaches like
@RalphSlepian
@AnesthesiaResus
@RunnelsSean
@jducanto
to teach advanced airway skills? A great day of learning! Thanks to all our faculty for a great day
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Updating the website for the upcoming education season. Lots of new content and of course PAC23 is in the works!!
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Please help us grow!🌲 Follow us here & subscribe to our YouTube Channel for great airway education.
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Video laryngoscopes give you great views, but can cause the tube to get hung up on the anterior tracheal rings. To help with placement, get use your thumb to retract the stylet - facilitating placement.
#foamed
#meded
#emergencymedicine
#laryngoscope
#intubation
#medicaleducation
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One of our favorite moments from
@jducanto
at PAC20. We miss you Jim! Hope to see you in person soon!
#meded
#foamed
#medical
#medicine
#education
#learning
#design
#residency
#intubation
#laryngoscope
#protectedairway
#medicalknowledge
#airwaymanagement
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☝️Our podcast on the role of fiberoptic in the age of VL is only the beginning: don’t miss out on all the interactive content on
#fiberoptic
concepts, skills, and tools in our online masterclass like this one here. 👇
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Another reason to get vaccinated. Posterior Glottic Stenosis a complication of prolonged intubation
#covid
#intubation
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Is the patient you're about to intubate hypotensive?? Shock Index >0.8? Resuscitate BEFORE you intubate to avoid post-intubation hypotension & cardiac arrest 1. Give fluids 2. Start pressors 3. Have push-dose pressors ready.
#FOAMed
#protectedairway
#PAC
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Nasopharyngoscopy for assessing the airway? Yes! ☑️👍💪
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We need a word in our airway assessment language beyond difficult/complex to describe the airway that is so unlikely to succeed, that benefit tips in favor of an immediate or swift transition to FONA. Let's call it the "improbable" airway. More here👇
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Due to demand we've opened up a few more spots for the Protected Airway Course (PAC23). March 4th & 5th. Immersive design, high fidelity simulations & state of the art Anatomy Lab. Come join us!
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It's great to learn awake fiberoptic intubation skills, but is your patient outside the OR appropriate for AFOI? Know when it's a viable technique in the emergent setting & when it's not. (🔗 to the
#fiberoptic
skills masterclass in video show notes).
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Registration for PAC24 is NOW OPEN. Space is limited.
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This video by
@TBayEDguy
on the D-Grip Bougie is just loaded with great tips and tricks to handle this technque like a pro!
#FOAMed
#protectedairway
#bougiefirst
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