Difficult Airway Cases: Letting the panel take us through scenarios.
Dec 15, 2023
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In this podcast, the panel discusses difficult airway scenarios including tracheostomy tube displacement, hypoxemic patient going into cardiac arrest. They also talk about topicalization techniques and compare video laryngoscopy and direct laryngoscopy for handling the soiled airway. The team reflects on the benefits of immersive experiences in difficult airway management and the importance of cognitive skills, team management, and situational awareness. The podcast covers managing difficult airway cases, maintaining airway skills, the use of lidocaine, and considerations for airway management and supraglottic airway. They also discuss options for difficult intubation and the importance of surgical rescue preparation.
When managing a difficult airway, it is important to intubate from above rather than blindly pushing the tube back in to avoid potential dangers and adequately assess the airway.
In cases of a hypoxemic patient going into cardiac arrest, prioritize chest compressions and consider the adequacy of mask ventilation using waveform capnography to guide the decision on re-intubation or using a supraglottic airway.
Deep dives
Importance of Intubating from Above
When faced with a trick falling out of the airway, it is crucial to intubate from above rather than blindly pushing the tube back in. This situational awareness is a key insight for airway management specialists, as blindly pushing the tube back can be dangerous without adequately assessing the airway. Calling for help and pre-oxygenating while having a plan A, B, and C in place is also emphasized.
Proper Approach to Airway Management
In cases where a patient vomits and arrests, the priority shifts to chest compressions. The use of cricoid pressure to prevent vomiting is discussed, highlighting the importance of a definitive airway. Depending on the adequacy of mask ventilation, waveform capnography can guide the decision to re-intubate or use a supraglottic airway. The technique and timing for switching out the supraglottic airway are nuanced, with factors like video scope, flexible endoscope, and patient condition playing a role in the approach taken.
Topicalization and Techniques for Difficult Airway
Topicalization using lidocaine is emphasized as an essential step in airway management, with a concentration of 2% recommended. The use of nebulized lidocaine is debated, with some experts cautioning against its effectiveness in delivering the medication to the desired areas. The importance of time and careful application of topicalization techniques, including targeting specific areas like the glottic opening and superior laryngeal, is highlighted. The significance of good coaching and verbal anesthesia to reduce anxiety is also mentioned.
Welcome back to our second podcast from sunny San Diego! Stay classy, San Diego! Peter and Leon are again joined by Matteo, Jarrod, and Calvin for rapid fire cases! In this episode they discuss approaches to:
Rapid Fire Scenario 1 - Tracheostomy tube displacement.
Rapid Fire Scenario 2 - Hypoxemic patient going into Cardiac arrest
Topicalization Techniques
Handling the Soiled Airway - Video Laryngoscopy vs. Direct Laryngoscopy.
Join us as the team reflects on the benefits of spending time immersed in difficult airway scenarios. Airway management goes beyond mere intubation and involves cognitive skills, team management, and situational awareness. The Difficult Airway Course is a valuable experience for those interested in enhancing their airway management skills.
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