Airway session 1 webinar completed

5/25/2019

We finished the first airway webinar today - I think it was fun - but the candidates preparing for the exam probably didn't share the exactly the same sentiment 😩

Key lessons discussed:

Decide if a CRASH airway is appropriate
Decide if a DIFFICULT airway is expected by reviewing :

Difficult Laryngoscopy ? - LEMON mnemonic
Difficult BVM - MOANS mnemonic
Difficult LMA - RODS mnemonic
Difficult Cricothyrotomy - SMART mnemonic

What is your standard RSI technique ?
mine is :

Preoxygenate / Denitrogenate
Position well - head elevated / ramped
CMAC for laryngoscopy with bougie and ETT
Suxamethonium 1.5mg/kg for NMB
Ketamine 2-4mg/kg for induction

What is your standard rescue technique?
mine is :
BAG V mask ----- spo2 >90%
intubating LMA ---- spo2 >90%

FAILED AIRWAY algorithm / options need to be ready to roll

Know the steps for Cricothyrotomy ( or needle cricothyrotomy in child <5 with jet insufflation)

Have a plan for AWAKE ORAL INTUBATION - indications ? - likely Ketamine dissociation with local anaesthetic and CMAC or fiberoptic option to 'have a look'
- chords seen - intubate or perform standard RSI
-chords not seen - 'have one go' at intubation - then proceed to surgical airway options

Have a look at the learning pack from Rosen's:

airway resource rosens.pdf
File Size:	5776 kb
File Type:	pdf

Download File

5 Comments

Pavel Mastik

6/1/2019 11:38:55 pm

Hello, the Airway session from a week ago was great, lots of learning points. Unfortunately I had to leave the session earlier and I would like to ask where I can find the recorded video from that session? Would that be "the course calendar" section or "the webinars and videos"section? Today's cardiology session was great too. Thank you for what you do. PM

Zaahid Pandie link

6/2/2019 01:37:13 am

Hi Pavel. Im so glad you found the airway and cardiology sessions useful.We appreciate any feedback that candidates can provide to help us improve the the program.

The video streaming options will be available a week or 2 after the live session because the files are very big and take time to edit. Unfortunately the streaming video will not contain all the information in the live version for copyright, intellectual property and privacy reasons. The video streaming option will also only be available for a short period of time for registered candidates to stream.

It has taken a significant amount of time to collate and organise the ACE the ACEM course and we humbly ask candidates to keep the passwords and video streaming confidential - we are happy to register any interested exam candidates or ED personnel into the free course.

ACE the ACEM is committed to keeping the course free and open to all candidates across Australasia particularly in remote and regional centres - the best learning from the course is in the interaction between candidates and lecturers and hearing how ED trainees and specialists are managing complicated scenarios in different and novel ways.

I look forward to seeing you on the next webinar.

Zaahid Pandie

6/3/2019 05:01:40 am

Hello,
I was reviewing the video of the Airway session and I have a question about the answers for the SAQ discussed in the 2nd ½ of the session - the ketamine sedation scenario.
What were the 4 causes of apnoea for this patient? I found 2 causes but not sure about 4 of them.
1.
A. severe laryngospasm with no air movement caused by ketamine
B. opioid induced apnoea, likely opioid was used as initial analgesia
C. ?
D. ?

2. question was about management of apnoea vs can’t ventilate scenario
a. call for help and stop procedure
b. airway potency with BVM 15l O2 and PEEP valve for PPV
c. suction airway prevent further irritation of A/w
d. trial of naloxone 200mcg iv stat if opioid was given prior procedural sedation
e. deepen sedation with propofol 0.5-1mg/kg of TBW iv stat
f. paralyze with suxamethonium 1.6mg/kg TBW and intubate

3. what was the answer for the last question? Was it the audit cirlce and the quality analysis?

Where do you want me to write this questions/comments?
I really like your webinars.
Thank you for help
Pavel M
This question emailed from Dr Pavel

6/3/2019 05:19:08 am

Hi Pavel. I pasted your question here on blog for all to benefit from. The question was a patient having ketamine sedation after a fall and fracture of ankle and then develops apnoea.

Approach:

Drug related

Incorrect dose eg induction dose
Anaphylaxis
Adverse rxn - laryngospasm most Likely
Previous opioid eg morphine / fentanyl

Patient factors

?head injury
Aspiration
Other illness eg resp illness

Equipment ? Getting oxygen

Your management answer is good but add

Adrenaline
Midazolam
Could just bvm until wakes up if oxygenation and co2 acceptable
Complete rsi and ct head an option

Last section - good approach -
Staff, patient, disease, equipment, drugs, systems, processes, environment

Open disclosure to patient and family
Apology
Critical Incident notification and investigation
Support to staff counseling
Credentialling

Hope that helps. As stated the video content won’t have all the info due to file size issues. Try to attend the live sessions.

I encourage others in program to share resources and concepts on the blog.

There will be a blog related to each session done.

Happy studying.
Zaahid Pandie

Pavel

6/5/2019 04:01:33 am

Thank you
PM

Airway session 1 webinar completed

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