The Difficult Airway: Panel discussion with Faculty
Dec 8, 2023
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Drs. Jarrod Mosier, Calvin Brown, and Matteo Parotto, distinguished leaders from the Difficult Airway Course, share insights on assessing difficulty of the airway, optimal dosage for rachirondium, paralyzing patients during intubation, approach to intubating acidotic patients, and the importance of critical thinking in difficult airway situations.
Assessing anatomical difficulty in airways is crucial in airway management, and tests like the upper lip bite test and the Elgan Zuri score can aid in evaluating complexity and predicting difficulty.
Video laryngoscopy (VL) can offer better visualization and maneuverability in managing difficult airways, but it should not be solely relied upon for successful intubation, and waveform capnography is still considered the gold standard for confirming proper tube placement.
Deep dives
Importance of Tailored Airway Management in Emergency Medicine
Emergency medicine encounters unique airway challenges that require tailored approaches due to the instability and critical condition of patients. The goal is to teach emergency medical professionals how to perform effective airway assessments and safely intubate patients who may be in remote hospitals with limited support. The difficult airway course addresses not only anatomical and physiological challenges but also crisis management and human factors, providing comprehensive training for managing diverse airway situations.
Assessing Difficulty and Predicting Anatomically Difficult Airways
Assessing difficulty in airways is challenging due to the limitations of available assessment tools. However, a systematic approach to assessment is essential in identifying anatomically difficult airways. Tests like the upper lip bite test and the Elgan Zuri score can aid in evaluating complexity and predicting difficulty. The Elgan Zuri score, combining various tests, has shown promise in providing a more accurate assessment of difficulty. It is crucial to anticipate trouble and be prepared for unexpected challenges in airway management.
The Role of Video Laryngoscopy and Anatomically Difficult Airway Management
Video laryngoscopy (VL) has gained popularity as a tool for managing difficult airways, although its effectiveness in predicting difficulty is still debated. Hyperangulated VL blades can offer a better view of the airway, but it's important to avoid placing the blade directly on top of the glottic opening. Proper technique involves taking a step back and positioning the blade for a posterior view, enabling better visualization and maneuverability. VL should not be solely relied upon for successful intubation, and waveform capnography is still considered the gold standard for confirming proper tube placement.
Optimizing Pre-oxygenation and Paralytics in Airway Management
Pre-oxygenation plays a critical role in airway management, ensuring a safe period of apnea during intubation. Flush flow rate oxygen and apneic oxygenation techniques, such as the use of apnoeic oxygenation cannulas, can improve pre-oxygenation and extend safe apnea time. There is ongoing debate on the choice of paralytics in emergency airway management. Automatate is considered safe and suitable for most situations, while the selection between rocuronium and succinylcholine often depends on personal preference. Dosages of 1.5 milligrams per kilogram of rocuronium are recommended to prevent partial paralysis.
In this episode, we have the privilege of hosting three luminaries in the field of airway management: Drs. Jarrod Mosier, Calvin Brown, and Matteo Parotto.
As distinguished leaders from the Difficult Airway Course, they bring incredible insights to managing the acute care airway. Whether you're a seasoned practitioner or a healthcare enthusiast, their collective knowledge promises to deepen your understanding and appreciation for the art and science of airway management. Tune in as they share their experiences, innovations, and vision for the future of airway management.
https://www.theairwaysite.com/
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