This document outlines an upcoming advanced airway workshop hosted by airwaymanagement.dk. The workshop will cover various topics related to airway management including what is already known, developing an airway plan and predicting difficulty, awake intubation techniques, and new airway devices and techniques such as the LMA C-trach. It also introduces a presentation on tube tip in pharynx ventilation by Sandra Ellefsen that will be part of the workshop.
1) The patient presented unconscious with gurgling sounds and a head injury indicating a compromised airway.
2) Airway management takes priority over other injuries in this case.
3) Techniques for establishing a definitive airway include orotracheal intubation, nasotracheal intubation, or surgical cricothyroidotomy if other methods fail.
The document discusses the top five post-extubation emergencies: laryngospasm, laryngeal stridor, acute hypoxemia, acute respiratory failure, and neurologic pathology. It provides definitions and discusses how to potentially predict and treat each emergency. Key points include that extubations should not be treated as routine, extensive assessment is important, and having difficult intubation supplies available is critical in case re-intubation is needed. The document emphasizes being prepared for potential post-extubation complications.
This document discusses awake tracheal intubation in the emergency department. It provides a brief history of awake intubation and outlines its benefits over rapid sequence intubation, including maintaining protective airway reflexes and avoiding risks of induction agents. The document also summarizes guidelines for patient selection, preparation, equipment, and outcomes of awake intubation. Key considerations include thorough airway assessment, use of cognitive aids, positioning to optimize oxygenation, and video laryngoscopy as an effective tool.
This document discusses the management of pediatric spinal deformities such as early onset scoliosis, late onset scoliosis, congenital scoliosis, and neuromuscular scoliosis. It begins by classifying the different types of pediatric spinal deformities and then goes into further detail about the evaluation, treatment options including bracing, growing rod constructs, and fusion, as well as surgical techniques and outcomes for each condition. In particular, it focuses on the importance of allowing spinal growth and lung development in young children with spinal deformities through the use of growing rod constructs.
The document discusses anesthesia and resuscitation, covering topics like the ABCs of airway management, breathing, and circulation. It describes techniques for securing the airway like intubation, different types of anesthesia like general and regional, and considerations for special patient populations. Tracheal intubation is discussed in detail, outlining indications, equipment, positioning, techniques like rapid sequence induction, and ways to confirm proper tube placement.
A discription of chest wall trauma in a clinical settingAbdulelahMurshid
This document discusses chest wall trauma and injuries. It begins by describing the anatomy of the thorax and chest wall. It then covers mechanisms and types of chest trauma including penetrating injuries from stab wounds or gunshots and blunt injuries from falls or car accidents. Common injuries from chest trauma are discussed such as rib fractures, pneumothorax, hemothorax, lung contusions, and flail chest. Diagnosis involves imaging like chest x-rays or CT scans. Treatment depends on the specific injuries but may include chest tube insertion, ventilation support, pain management, and surgery in severe cases like flail chest. Complications are also reviewed.
Angioplasty is a minimally invasive procedure used to open blocked blood vessels by inserting a balloon catheter and inflating the balloon to compress plaque and widen the vessel. It is commonly used to treat coronary artery disease and heart attacks. During angioplasty, a balloon is guided to the blockage where it is inflated to open the artery. Sometimes a stent is placed to keep the artery open. Angioplasty allows faster treatment of heart attacks with good long-term outcomes and is generally safer than alternative procedures like bypass surgery.
Thoracic Cavity Case Study 1 lesson slides v2.pptxKentSmith70
This is part of a slide show I use to lead students through a case study on two patients with traumatic thoracic cavity injuries. We use the cases to explore the anatomy and physiology of this region.
This is just the respiratory system portion of the larger lesson.
1) The patient presented unconscious with gurgling sounds and a head injury indicating a compromised airway.
2) Airway management takes priority over other injuries in this case.
3) Techniques for establishing a definitive airway include orotracheal intubation, nasotracheal intubation, or surgical cricothyroidotomy if other methods fail.
The document discusses the top five post-extubation emergencies: laryngospasm, laryngeal stridor, acute hypoxemia, acute respiratory failure, and neurologic pathology. It provides definitions and discusses how to potentially predict and treat each emergency. Key points include that extubations should not be treated as routine, extensive assessment is important, and having difficult intubation supplies available is critical in case re-intubation is needed. The document emphasizes being prepared for potential post-extubation complications.
This document discusses awake tracheal intubation in the emergency department. It provides a brief history of awake intubation and outlines its benefits over rapid sequence intubation, including maintaining protective airway reflexes and avoiding risks of induction agents. The document also summarizes guidelines for patient selection, preparation, equipment, and outcomes of awake intubation. Key considerations include thorough airway assessment, use of cognitive aids, positioning to optimize oxygenation, and video laryngoscopy as an effective tool.
This document discusses the management of pediatric spinal deformities such as early onset scoliosis, late onset scoliosis, congenital scoliosis, and neuromuscular scoliosis. It begins by classifying the different types of pediatric spinal deformities and then goes into further detail about the evaluation, treatment options including bracing, growing rod constructs, and fusion, as well as surgical techniques and outcomes for each condition. In particular, it focuses on the importance of allowing spinal growth and lung development in young children with spinal deformities through the use of growing rod constructs.
The document discusses anesthesia and resuscitation, covering topics like the ABCs of airway management, breathing, and circulation. It describes techniques for securing the airway like intubation, different types of anesthesia like general and regional, and considerations for special patient populations. Tracheal intubation is discussed in detail, outlining indications, equipment, positioning, techniques like rapid sequence induction, and ways to confirm proper tube placement.
A discription of chest wall trauma in a clinical settingAbdulelahMurshid
This document discusses chest wall trauma and injuries. It begins by describing the anatomy of the thorax and chest wall. It then covers mechanisms and types of chest trauma including penetrating injuries from stab wounds or gunshots and blunt injuries from falls or car accidents. Common injuries from chest trauma are discussed such as rib fractures, pneumothorax, hemothorax, lung contusions, and flail chest. Diagnosis involves imaging like chest x-rays or CT scans. Treatment depends on the specific injuries but may include chest tube insertion, ventilation support, pain management, and surgery in severe cases like flail chest. Complications are also reviewed.
Angioplasty is a minimally invasive procedure used to open blocked blood vessels by inserting a balloon catheter and inflating the balloon to compress plaque and widen the vessel. It is commonly used to treat coronary artery disease and heart attacks. During angioplasty, a balloon is guided to the blockage where it is inflated to open the artery. Sometimes a stent is placed to keep the artery open. Angioplasty allows faster treatment of heart attacks with good long-term outcomes and is generally safer than alternative procedures like bypass surgery.
Thoracic Cavity Case Study 1 lesson slides v2.pptxKentSmith70
This is part of a slide show I use to lead students through a case study on two patients with traumatic thoracic cavity injuries. We use the cases to explore the anatomy and physiology of this region.
This is just the respiratory system portion of the larger lesson.
The document summarizes a hospital's venous thromboembolism (VTE) prophylaxis program over 7 years. It shows that the program reduced hospital-acquired deep vein thrombosis and pulmonary embolism by over two-thirds, saving over $6 million in costs. Moving forward, the hospital aims to further improve prophylaxis practices by focusing on areas like daily ambulation and administering prophylaxis in the emergency department and throughout a patient's care. The goal is continuous quality improvement to help more patients and potentially achieve outcomes like preventing all hospital-acquired infections.
The document discusses identifying and managing difficult airways in emergency situations. It emphasizes the importance of predicting potential airway issues based on a patient's history and physical exam findings. Specific tests and factors that can help identify a difficult airway are described. The document also stresses having alternative plans for airway management if intubation is unsuccessful, such as using different techniques, devices, or establishing a surgical airway. Being prepared to promptly implement backup plans is key to managing life-threatening cannot intubate, cannot ventilate scenarios.
This document outlines Advanced Trauma Life Support (ATLS) guidelines. It covers the initial assessment and management of trauma patients, including the primary and secondary surveys, as well as specific treatments for injuries like airway management, shock, head trauma, spinal trauma, thoracic trauma, abdominal trauma, burns, pediatric trauma, and geriatric trauma. It emphasizes the need for a systematic approach to rapidly triage and stabilize injured patients before transferring them to definitive care facilities.
The document provides an introduction to SNOMED CT, which is described as the most comprehensive, multilingual clinical healthcare terminology in the world. It allows for very granular data capture and powerful analytics and decision support. The document traces the history and development of SNOMED CT and compares it to other clinical coding systems such as ICD-10, noting advantages such as having no limit on the number of codes and concepts with multiple relationships that enable more flexible querying.
This document discusses strategies for managing difficult airways in emergency situations. It begins by outlining goals of predicting difficult airways, having appropriate plans, and confidence in "can't intubate, can't ventilate" situations. It then discusses factors that can help identify difficult airways through past medical history, physical exam findings like thyromental distance, and classifications like Mallampati. The document emphasizes having alternative plans for airway management if intubation fails, such as BVM ventilation, supraglottic airways, or surgical techniques. It stresses the importance of paramedics feeling prepared with multiple airway options when facing emergent difficult airway scenarios.
1. The Advanced Trauma Life Support (ATLS) protocol focuses on simultaneously identifying and treating life-threatening injuries within the crucial "Golden Hour" period after trauma.
2. The ATLS protocol involves two surveys - the Primary Survey to address airway, breathing, circulation, disability, and exposure issues, and the Secondary Survey for a full history and physical exam after initial resuscitation is complete.
3. Key components of the Primary Survey include assessing the airway, identifying tension pneumothorax and hemorrhage, and providing spinal immobilization, followed by full exposure to identify all injuries.
1. The document provides information on basic life support (BLS) training, including the key components of BLS, the chain of survival, sudden cardiac arrest, anatomy and physiology related to cardiovascular and respiratory systems, adult CPR procedures, use of an automated external defibrillator, management of foreign body airway obstruction, and terminology.
2. It outlines the steps for performing high-quality chest compressions, rescue breathing, using an AED, providing care for an obstructed airway, and terminating CPR.
3. Tables and diagrams are provided to illustrate procedures like two-rescuer CPR, checking responsiveness during CPR, and algorithms for managing an obstructed airway in conscious and unconscious
Head injuries can range from mild to severe based on factors like loss of consciousness and Glasgow Coma Scale. The primary goals of management are to stabilize the patient by protecting the airway and maintaining adequate oxygenation, ventilation, and circulation to prevent secondary brain injury. Imaging with CT scan is important to identify fractures and intracranial bleeding like extradural and subdural hematomas that may require neurosurgery. Ongoing monitoring of things like neurological status and intracranial pressure is also important for managing head injuries.
Medical emergencies in the dental operatoryAditi Singh
The document discusses how to avoid medical emergencies in the dental office by being prepared through training and equipment, properly diagnosing issues through medical history review and vital signs monitoring, treating emergencies effectively and immediately, and preventing issues through patient evaluation, stress reduction, and confirming medications. It covers common emergencies like airway obstruction, asthma, hyperventilation, hypertensive crisis, syncope, seizure, and allergic reactions, outlining risk factors, diagnosis, treatment, and prevention for each.
Management of severe traumatic brain injury evidence, tricks, and pitfallTláloc Estrada
This document provides an overview of the management of severe traumatic brain injury. It is edited by Terje Sundstrøm and others, and covers topics from epidemiology to rehabilitation. The editors are from various hospitals and universities in Scandinavia. The document aims to provide evidence-based guidelines and recommendations for treating severe traumatic brain injury, while also highlighting practical tips, tricks, and potential pitfalls. It serves as a comprehensive reference for medical professionals involved in traumatic brain injury management and treatment.
Management of severe traumatic brain injury evidence, tricks, and pitfallTláloc Estrada
This document provides an overview of the management of severe traumatic brain injury. It discusses epidemiology, classification, clinical assessment, prehospital management, admission and diagnostics, acute surgical treatment, peroperative anesthesia, and monitoring in neurointensive care. The editors are experts in neurosurgery, anesthesia, and intensive care from universities and hospitals in Norway, Sweden, Denmark. It aims to provide evidence-based guidelines on the management of severe traumatic brain injury.
Assessment and management of major injuries and advancedKCMCOT
The document provides an overview of the Advanced Trauma Life Support (ATLS) program for assessing and managing major injuries. It describes the sequential approach of the primary and secondary surveys following the ABCDE mnemonic. The primary survey focuses on establishing airway, breathing, circulation, disability assessment and environmental control/exposure. Key injuries like tension pneumothorax require immediate attention. The secondary survey involves a full head-to-toe examination, repeated vital sign checks, and ordering of radiological tests. Special populations like children and the elderly require modified approaches. Hemorrhage control is crucial to manage circulation issues.
This document provides information on traumatic brain injury (TBI) and its critical care management. It begins with definitions of TBI and classifications based on Glasgow Coma Scale. It then discusses the epidemiology of TBI and types of brain injuries that can occur. The remainder of the document covers assessment, monitoring of vital signs and intracranial pressure, treatment goals and interventions to prevent secondary brain injury, common complications, nursing care and rehabilitation.
Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery week 1Sean M. Fox
Drs. Potter and Richardson are interested in education and Pediatric Emergency Medicine. Follow along with the EMGuideWire.com team as they post these weekly educational, self-guided radiology slides on Pediatric Emergency Medicine Radiology Topics!
1) The document discusses unconsciousness in dentistry, including general causes, predisposing factors, prevention, clinical manifestations, and management.
2) Important causes of unconsciousness discussed include neurogenic syncope, postural hypotension, cardiogenic issues, failed oxygenation, drugs, and acute adrenal insufficiency.
3) The basic steps for management of unconsciousness are: recognition (R), termination of the dental procedure (T), positioning the patient supine with feet elevated (P), then addressing airway (A), breathing (B), and circulation (C). Definitive care then depends on the underlying cause.
This patient was in a motorcycle accident without a helmet and presented with an active seizure and head trauma. The initial assessment found unequal and sluggish pupils, ineffective breathing, and a depressed skull fracture. The patient received spinal immobilization, oxygen, airway support, full body immobilization after seizure cessation, IV access, and rapid transport. Head injuries require careful monitoring of airway, breathing, circulation, and mental status for signs of deterioration or herniation.
Reframing shock physiology - a tale of 3 pressures - Sara Crager - TBS24scanFOAM
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive function. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms.
Manual pressure augmentation in OHCA - David Anderson - TBS24scanFOAM
This document summarizes a presentation on manual pressure augmentation (MPA) for out-of-hospital cardiac arrest. MPA involves a paramedic applying firm, even pressure over electrode pads or paddles during defibrillation attempts to potentially improve current delivery to the heart. The presentation reviewed prior studies showing MPA improved defibrillation success for atrial fibrillation. It proposed a new study called AUGMENT-VA to evaluate if MPA could also benefit patients in ventricular fibrillation/ventricular tachycardia. The trial would randomize paramedics to provide standard care or MPA in addition to standard care during cardiac arrest resuscitation efforts, with the goal of improving survival to hospital discharge rates.
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Similar to Airway Session | Michael Selz and friends at TBS23
The document summarizes a hospital's venous thromboembolism (VTE) prophylaxis program over 7 years. It shows that the program reduced hospital-acquired deep vein thrombosis and pulmonary embolism by over two-thirds, saving over $6 million in costs. Moving forward, the hospital aims to further improve prophylaxis practices by focusing on areas like daily ambulation and administering prophylaxis in the emergency department and throughout a patient's care. The goal is continuous quality improvement to help more patients and potentially achieve outcomes like preventing all hospital-acquired infections.
The document discusses identifying and managing difficult airways in emergency situations. It emphasizes the importance of predicting potential airway issues based on a patient's history and physical exam findings. Specific tests and factors that can help identify a difficult airway are described. The document also stresses having alternative plans for airway management if intubation is unsuccessful, such as using different techniques, devices, or establishing a surgical airway. Being prepared to promptly implement backup plans is key to managing life-threatening cannot intubate, cannot ventilate scenarios.
This document outlines Advanced Trauma Life Support (ATLS) guidelines. It covers the initial assessment and management of trauma patients, including the primary and secondary surveys, as well as specific treatments for injuries like airway management, shock, head trauma, spinal trauma, thoracic trauma, abdominal trauma, burns, pediatric trauma, and geriatric trauma. It emphasizes the need for a systematic approach to rapidly triage and stabilize injured patients before transferring them to definitive care facilities.
The document provides an introduction to SNOMED CT, which is described as the most comprehensive, multilingual clinical healthcare terminology in the world. It allows for very granular data capture and powerful analytics and decision support. The document traces the history and development of SNOMED CT and compares it to other clinical coding systems such as ICD-10, noting advantages such as having no limit on the number of codes and concepts with multiple relationships that enable more flexible querying.
This document discusses strategies for managing difficult airways in emergency situations. It begins by outlining goals of predicting difficult airways, having appropriate plans, and confidence in "can't intubate, can't ventilate" situations. It then discusses factors that can help identify difficult airways through past medical history, physical exam findings like thyromental distance, and classifications like Mallampati. The document emphasizes having alternative plans for airway management if intubation fails, such as BVM ventilation, supraglottic airways, or surgical techniques. It stresses the importance of paramedics feeling prepared with multiple airway options when facing emergent difficult airway scenarios.
1. The Advanced Trauma Life Support (ATLS) protocol focuses on simultaneously identifying and treating life-threatening injuries within the crucial "Golden Hour" period after trauma.
2. The ATLS protocol involves two surveys - the Primary Survey to address airway, breathing, circulation, disability, and exposure issues, and the Secondary Survey for a full history and physical exam after initial resuscitation is complete.
3. Key components of the Primary Survey include assessing the airway, identifying tension pneumothorax and hemorrhage, and providing spinal immobilization, followed by full exposure to identify all injuries.
1. The document provides information on basic life support (BLS) training, including the key components of BLS, the chain of survival, sudden cardiac arrest, anatomy and physiology related to cardiovascular and respiratory systems, adult CPR procedures, use of an automated external defibrillator, management of foreign body airway obstruction, and terminology.
2. It outlines the steps for performing high-quality chest compressions, rescue breathing, using an AED, providing care for an obstructed airway, and terminating CPR.
3. Tables and diagrams are provided to illustrate procedures like two-rescuer CPR, checking responsiveness during CPR, and algorithms for managing an obstructed airway in conscious and unconscious
Head injuries can range from mild to severe based on factors like loss of consciousness and Glasgow Coma Scale. The primary goals of management are to stabilize the patient by protecting the airway and maintaining adequate oxygenation, ventilation, and circulation to prevent secondary brain injury. Imaging with CT scan is important to identify fractures and intracranial bleeding like extradural and subdural hematomas that may require neurosurgery. Ongoing monitoring of things like neurological status and intracranial pressure is also important for managing head injuries.
Medical emergencies in the dental operatoryAditi Singh
The document discusses how to avoid medical emergencies in the dental office by being prepared through training and equipment, properly diagnosing issues through medical history review and vital signs monitoring, treating emergencies effectively and immediately, and preventing issues through patient evaluation, stress reduction, and confirming medications. It covers common emergencies like airway obstruction, asthma, hyperventilation, hypertensive crisis, syncope, seizure, and allergic reactions, outlining risk factors, diagnosis, treatment, and prevention for each.
Management of severe traumatic brain injury evidence, tricks, and pitfallTláloc Estrada
This document provides an overview of the management of severe traumatic brain injury. It is edited by Terje Sundstrøm and others, and covers topics from epidemiology to rehabilitation. The editors are from various hospitals and universities in Scandinavia. The document aims to provide evidence-based guidelines and recommendations for treating severe traumatic brain injury, while also highlighting practical tips, tricks, and potential pitfalls. It serves as a comprehensive reference for medical professionals involved in traumatic brain injury management and treatment.
Management of severe traumatic brain injury evidence, tricks, and pitfallTláloc Estrada
This document provides an overview of the management of severe traumatic brain injury. It discusses epidemiology, classification, clinical assessment, prehospital management, admission and diagnostics, acute surgical treatment, peroperative anesthesia, and monitoring in neurointensive care. The editors are experts in neurosurgery, anesthesia, and intensive care from universities and hospitals in Norway, Sweden, Denmark. It aims to provide evidence-based guidelines on the management of severe traumatic brain injury.
Assessment and management of major injuries and advancedKCMCOT
The document provides an overview of the Advanced Trauma Life Support (ATLS) program for assessing and managing major injuries. It describes the sequential approach of the primary and secondary surveys following the ABCDE mnemonic. The primary survey focuses on establishing airway, breathing, circulation, disability assessment and environmental control/exposure. Key injuries like tension pneumothorax require immediate attention. The secondary survey involves a full head-to-toe examination, repeated vital sign checks, and ordering of radiological tests. Special populations like children and the elderly require modified approaches. Hemorrhage control is crucial to manage circulation issues.
This document provides information on traumatic brain injury (TBI) and its critical care management. It begins with definitions of TBI and classifications based on Glasgow Coma Scale. It then discusses the epidemiology of TBI and types of brain injuries that can occur. The remainder of the document covers assessment, monitoring of vital signs and intracranial pressure, treatment goals and interventions to prevent secondary brain injury, common complications, nursing care and rehabilitation.
Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery week 1Sean M. Fox
Drs. Potter and Richardson are interested in education and Pediatric Emergency Medicine. Follow along with the EMGuideWire.com team as they post these weekly educational, self-guided radiology slides on Pediatric Emergency Medicine Radiology Topics!
1) The document discusses unconsciousness in dentistry, including general causes, predisposing factors, prevention, clinical manifestations, and management.
2) Important causes of unconsciousness discussed include neurogenic syncope, postural hypotension, cardiogenic issues, failed oxygenation, drugs, and acute adrenal insufficiency.
3) The basic steps for management of unconsciousness are: recognition (R), termination of the dental procedure (T), positioning the patient supine with feet elevated (P), then addressing airway (A), breathing (B), and circulation (C). Definitive care then depends on the underlying cause.
This patient was in a motorcycle accident without a helmet and presented with an active seizure and head trauma. The initial assessment found unequal and sluggish pupils, ineffective breathing, and a depressed skull fracture. The patient received spinal immobilization, oxygen, airway support, full body immobilization after seizure cessation, IV access, and rapid transport. Head injuries require careful monitoring of airway, breathing, circulation, and mental status for signs of deterioration or herniation.
Reframing shock physiology - a tale of 3 pressures - Sara Crager - TBS24scanFOAM
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive function. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms.
Manual pressure augmentation in OHCA - David Anderson - TBS24scanFOAM
This document summarizes a presentation on manual pressure augmentation (MPA) for out-of-hospital cardiac arrest. MPA involves a paramedic applying firm, even pressure over electrode pads or paddles during defibrillation attempts to potentially improve current delivery to the heart. The presentation reviewed prior studies showing MPA improved defibrillation success for atrial fibrillation. It proposed a new study called AUGMENT-VA to evaluate if MPA could also benefit patients in ventricular fibrillation/ventricular tachycardia. The trial would randomize paramedics to provide standard care or MPA in addition to standard care during cardiac arrest resuscitation efforts, with the goal of improving survival to hospital discharge rates.
Scalpels and Stories - rediscoverin narrative in medicinen - Matt Morgan - TBS24scanFOAM
This patient has a rare blood disorder called TTP and is at high risk of infection due to immunosuppressant treatments. While starting a new treatment, the medical team will closely monitor for infection given other health issues. A tracheostomy may be needed to help breathing but will only be considered carefully over the next week based on the patient's condition and risks versus benefits. The team is very concerned about the patient's frailty and limited chances of survival due to the disease and prior health.
Whole blood for trauma haemorrhage - UK experience - Laura Green - TBS24scanFOAM
Whole Blood for Trauma Haemorrhage: UK experience
1) A study in the UK found that using a component of red blood cells and plasma (RCP) in pre-hospital trauma patients reduced wastage and had similar clinical outcomes compared to separate red blood cells and plasma.
2) This led to the development of a whole blood program and component to evaluate the potential benefits of whole blood transfusion in the pre-hospital setting.
3) The SWIFT trial is now underway, randomly assigning severely injured trauma patients to receive either two units of whole blood or two units of red blood cells and plasma to determine if whole blood transfusion leads to reduced mortality or need for massive transfusion.
TBI and CV dysfunction - Flora Bird - TBS24scanFOAM
Traumatic brain injury (TBI) is a major global health problem and the leading cause of death and disability in people under 40 in many countries. Approximately 24% of patients with severe isolated TBI experience cardiovascular dysfunction prior to physician-led emergency helicopter assessment. These patients have lower GCS, higher heart rate and lactate, and worse coagulopathy compared to those without cardiovascular dysfunction. They also require more blood transfusions, have higher mortality, and are less likely to be discharged home. Further research is needed to better understand the pathophysiology of cardiovascular dysfunction following severe TBI in order to improve recognition and treatment in the critical hyperacute phase after injury.
The document appears to be a slide presentation on using point-of-care ultrasound (POCUS) in emergency settings. It includes multiple poll questions, ultrasound images, and case descriptions of various trauma and medical patients where POCUS could be used to aid in diagnosis and treatment. Key information discussed includes using POCUS to identify pneumothorax, pericardial effusions, aortic abnormalities, and free fluid in trauma and obstetric patients. The importance of POCUS for volume assessment, guiding procedures, and detecting complications is also highlighted through several case examples.
How kissing a frog can save your life - Matt Morgan - TBS24scanFOAM
This short document discusses how kissing a frog can save your life by encouraging learning in different departments and upholding one oath. It suggests that being open-minded and exploring new ideas, as the fairy tale implies by kissing the frog, can lead to personal growth and development across different areas of life and work.
Fully Automated CPR - van der Velde - TBS"4scanFOAM
Dr. Jason van der Velde conducted an observational study on advanced respiratory support techniques for managing hypoxia and hypercarbia during cardiac arrest situations. The objectives of his presentation were to provide excessive detail and promote his own findings, criticize current practices, add unnecessary complexity to guidelines, present opinions as facts, ignore best practices for presentations, and go significantly over time.
ECPR at the Roadside - Mamoun Abu-Habsa - TBS24scanFOAM
This document discusses expanding the use of extracorporeal cardiopulmonary resuscitation (ECPR) for cardiac arrest patients. It examines current guidelines on patient selection criteria and outlines a proposed collaborative model for pre-hospital ECPR delivery. This model involves advanced paramedics performing roadside cannulation to begin ECPR within 10 minutes of arrest. It also discusses developing common training standards, clinical governance structures, and telemedicine support to safely implement a pre-hospital ECPR system across multiple centers. The goal is to establish earlier ECPR access for select cardiac arrest patients.
Mechanical ventilation in PARDS - same as adults? - Demirakca - TBS24tion_in_...scanFOAM
This document discusses mechanical ventilation strategies for pediatric acute respiratory distress syndrome (PARDS). It provides definitions for mild, moderate, and severe PARDS based on oxygenation index (OI) and oxygen saturation index (OSI) values. It recommends using a lung protective ventilation bundle with low tidal volumes, plateau pressures below 28 cm H2O or 32 cm H2O in cases of reduced chest wall compliance, positive end-expiratory pressure (PEEP) according to a PEEP/FiO2 table, and limiting driving pressure to 15 cm H2O. The document also discusses challenges with adherence to these guidelines in clinical practice and potential solutions like computerized decision support tools.
Failure is an option - journey of an astronaut candidate - Matthieu Komorowsk...scanFOAM
This document summarizes the lengthy process to become an ESA astronaut candidate. It involves submitting an application with credentials and experience meeting strict criteria. If selected, candidates undergo psychological tests, medical tests, and technical and professional interviews. From the initial applicants, only about 17 are selected for the final training cohort. The document emphasizes that the role requires strong teamwork, risk tolerance, and emotional stability to handle the challenges of space travel.
Unmanned aerial systems "drones" - increasing SAR response capability - Will ...scanFOAM
Will Smith is an expert in unmanned aerial systems and their increasing role in search and rescue operations. He discussed terminology related to drones, different drone platforms that could be used for SAR including their capabilities and limitations. He covered regulations and certifications required as well as concepts for how drones could be deployed for various SAR missions like lost person searches, mass casualty incidents, and avalanches. Partnerships between SAR teams and those with drone expertise will be important to establish effective drone programs for improving SAR response capabilities.
Experience learning - lessons from 25 years of ATACC - Mark Forrest and Halde...scanFOAM
This document outlines an integrated emergency care simulation programme that uses immersive simulation to train healthcare professionals. It discusses using realistic scenarios, environments, equipment and live actors to create challenging simulations that move beyond traditional skills stations. The goal is to improve learners' technical skills as well as their non-technical skills like leadership, communication and emotional intelligence. Examples provided include simulations of trauma resuscitation, complex medical emergencies, and disaster scenarios to fully immerse learners in realistic high-pressure situations.
Groupthink - lessons from the Challenger disaster - Vahé Ender - TBS24scanFOAM
The document discusses a teleconference between NASA officials about whether to launch the Space Shuttle Challenger on January 27, 1986. It notes the timing of the teleconference and includes quotes from the discussion. It then analyzes why the decision was made to launch, despite concerns about the weather, citing issues like groupthink, desire for conformity, intolerance of dissent, and deference to perceived expertise. The document suggests these group dynamics may have prevented an objective evaluation of the risks.
Precision in neonatal transport - Ian Braithwaite - TBS24scanFOAM
This document discusses precision in neonatal transport. It notes that tight control of PaCO2 and oxygen saturation is important during transport. Data shows the percentage of transports where PaCO2 was outside the target range of 4-7 kPa has decreased in recent years. Medication delivery also requires precision, and various factors like pump orientation and syringe size can affect stability. The physical forces involved in transport like shocks, vibrations and accelerations are defined, and data shows ambulance transports experience more impulsive events than helicopters. Precision is important throughout the entire transport journey.
Mantas Okas - where do we come from and where can we go if we feel like?scanFOAM
This document discusses the importance of stress management training for medical students. It describes a 2-week course called "The Inevitable Stress" that teaches stress management through simulation exercises. The course focuses on developing emotional intelligence, awareness of one's stress responses, and practical skills to handle stress. Student feedback praised the highly relevant content, opportunity to strengthen skills, and safe learning environment. The document argues that stress management training should be a mandatory and ongoing part of the medical school curriculum to create doctors who can handle stress and work better, improving patient care.
The document discusses the benefits of exercise for both physical and mental health. It notes that regular exercise can reduce the risk of diseases like heart disease and diabetes, improve mood, and reduce feelings of stress and anxiety. Staying active also helps maintain a healthy weight and keeps muscles, bones, and joints healthy as we age.
A talk by Sara Crager at TBS24
Shock isn’t about hypotension, it’s about hypoperfusion. While we know this in theory, we don’t do a great job of applying it in practice. In order to move beyond our reliance on blood pressure to recognize shock at the bedside, we need to stop thinking about shock as a diagnosis and instead think about it as a continuum.
Fully Automated CPR | Jason van der Velde | TBS24scanFOAM
Embark on a fascinating exploration of Fully Automated Cardiac Arrest Management with Dr. Jason van der Velde, who’s been part of a team refining the FA-CPR algorithm since 2019. Gain unique insights into real-world applications and ongoing research opportunities in optimising the “Low Flow State” through innovative approaches like Chest Compression Synchronised Ventilation (CCSV). Dr. Van der Velde shares an iterative journey, supported by real-life data, underscoring the profound impact of personalised CPR tailored to individual patients in rural Ireland. The talk goes beyond conventional guidelines, delving into the intricate science and human factors essential for achieving substantial improvements in Return of Spontaneous Circulation (ROSC) rates. Attendees will leave with a deep understanding of the potential of Fully Automated CPR with CCSV as a dynamic and continually evolving strategy, acting as a strategic placeholder to buy essential time for comprehensive diagnostics and personalised interventions. The presentation hints at transformative possibilities in resuscitation science, featuring case studies that showcase the concept of bridging patients to definitive interventions such as cardiac angiography and Extracorporeal Membrane Oxygenation (ECMO).
The future of the emergency room | Jean-Louis Vincent at TBS23scanFOAM
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One health condition that is becoming more common day by day is diabetes.
According to research conducted by the National Family Health Survey of India, diabetic cases show a projection which might increase to 10.4% by 2030.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
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In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Airway Session | Michael Selz and friends at TBS23
1. The BIG SICK 2023
ADVANCED AIRWAY WORKSHOP
airwaymanagement.dk
Michael Seltz
Kristensen
Michael Friis
Tvede
Pims de
Ruijter
John Diaper
Tatjana
Dill
Anne Cath-
rine Haug
Heleen
Biersteker
Søren
Rudolph
Richard
Levitan
Sandra Ellefsen James ”Jim”
Ducanto
Anne-Sophie
Lynnerup
Joerg Helge
Junge
Kristian B.
Krogh
24. The BIG SICK 2023
ADVANCED AIRWAY WORKSHOP
airwaymanagement.dk
Michael Seltz
Kristensen
Michael Friis
Tvede
Pims de
Ruijter
John Diaper
Tatjana
Dill
Anne Cath-
rine Haug
Heleen
Biersteker
Søren
Rudolph
Richard
Levitan
Sandra Larssen
Clifford
James ”Jim”
Ducanto
Anne-Sophie
Lynnerup
Joerg Helge
Junge
Kristian B.
Krogh
25. What we already know:
www.airwaymanagement.dk
Disposition:
Save the saviour
Airway management what is it? – and why should that be important?
Plan, prediction, preparation, combinations and special cicumstances
Breaking news
The Future!
> Hands on !!
Airwaymanagement.dk
The BIG SICK 2023
ADVANCED AIRWAY WORKSHOP
26. What we already know:
www.airwaymanagement.dk
Disposition:
Save the saviour
Airway management what is it? – and why should that be important?
Plan, prediction, preparation, combinations and special cicumstances
Breaking news
The Future!
> Hands on !!
Airwaymanagement.dk
The BIG SICK 2023
ADVANCED AIRWAY WORKSHOP
27.
28.
29.
30.
31.
32. What we already know:
www.airwaymanagement.dk
Disposition:
Save the saviour
Airway management what is it? – and why should that be important?
Plan, prediction, preparation, combinations and special cicumstances
Breaking news
The Future!
> Hands on !!
Airwaymanagement.dk
The BIG SICK 2023
ADVANCED AIRWAY WORKSHOP
39. • Death
• Brain damage
• Emergency surgical airway
• ICU admission resulting from an airway
management complication
Cook TM, Woodall N et al. BJA 2011
40. • One year data collection
• 133 related to general anaesthesia
• 19 deaths/brain damage
• 36 in ICU
• 22 deaths/brain damage
• Poor care in three-quarters of cases
• ICU and emergency care HIGHLY over-represented!
• Only tip of the iceberg!
• = often PREVENTABLE !!!
Cook TM, Woodall N et al. BJA 2011
41. • One year data collection
• 133 related to general anaesthesia
• 19 deaths/brain damage
• 36 in ICU
• 22 deaths/brain damage
• Poor care in three-quarters of cases
• ICU and emergency care HIGHLY over-represented!
• Only tip of the iceberg!
• = often PREVENTABLE !!!
Cook TM, Woodall N et al. BJA 2011
42. • One year data collection
• 133 related to general anaesthesia
• 19 deaths/brain damage
• 36 in ICU
• 22 deaths/brain damage
• Poor care in three-quarters of cases
• ICU and emergency care HIGHLY over-represented!
• Only tip of the iceberg!
• = often PREVENTABLE !!!
Cook TM, Woodall N et al. BJA 2011
43. • One year data collection
• 133 related to general anaesthesia
• 19 deaths/brain damage
• 36 in ICU
• 22 deaths/brain damage
• Poor care in three-quarters of cases
• ICU and emergency care HIGHLY over-represented!
• Only tip of the iceberg!
Cook TM, Woodall N et al. BJA 2011
44. • One year data collection
• 133 related to general anaesthesia
• 19 deaths/brain damage
• 36 in ICU
• 22 deaths/brain damage
• Poor care in three-quarters of cases
• ICU and emergency care HIGHLY over-represented!
• Only tip of the iceberg!
• Most often PREVENTABLE !!!
Cook TM, Woodall N et al. BJA 2011
45. • What happened:
• Failure to plan
• ..and if planning: Failure to follow the
plan
Cook TM, Woodall N et al. BJA 2011
46. • What happened:
• Failure to plan
• ..and if planning: Failure to follow the
plan
Cook TM, Woodall N et al. BJA 2011
47. • What happened:
• Failure to plan
• ..and if planning: Failure to follow the
plan
Cook TM, Woodall N et al. BJA 2011
48. The 7 routes for oxygenation and CO2 removal in our patient
49. The 7 routes for oxygenation and CO2 removal in our patient
50. The 7 routes for oxygenation and CO2 removal in our patient
Awake /
Anaesthetised breathing spontaneously /
Anaesthetised apneic
52. What we already know:
www.airwaymanagement.dk
Disposition:
Save the saviour
Airway management what is it? – and why should that be important?
Plan, prediction, preparation, combinations and special cicumstances
Breaking news
The Future!
> Hands on !!
Airwaymanagement.dk
The BIG SICK 2023
ADVANCED AIRWAY WORKSHOP
54. Can J Anaesth. 2021 Sep;68(9):1373-1404
Can J Anaesth. 2021 Sep;68(9):1405-1436
55. Part 2 ..predicted difficulty
Findings and key recommendations:
”Prior to airway management,
a documented strategy should
be formulated for every
patient, based on airway
evaluation….”
56. Part 2 ..predicted difficulty
Findings and key recommendations:
”Prior to airway management,
a documented strategy should
be formulated for every
patient, based on airway
evaluation….”
57. Is evaluation and prediction useful?
1) Nørskov A et al. Unanticipated difficult tracheal intubation…..., BJA, 2016 ,
2) Teoh WH, Kristensen MS. Prediction in Airway management…… BJA, 2016
60. Is evaluation and prediction useful?
1) Nørskov A et al. Unanticipated difficult tracheal intubation…..., BJA, 2016 ,
2) Teoh WH, Kristensen MS. Prediction in Airway management…… BJA, 2016
With this or even less prediction effort:
>50% of difficult intubations predicted
61. Is evaluation and prediction useful?
1) Nørskov A et al. Unanticipated difficult tracheal intubation…..., BJA, 2016 ,
2) Teoh WH, Kristensen MS. Prediction in Airway management…… BJA, 2016
With this or even less prediction effort:
>50% of difficult intubations predicted
…and they are likely to be the most obvious and the most difficult patients that are
identified
63. Is evaluation and prediction useful?
1) Nørskov A et al. Unanticipated difficult tracheal intubation…..., BJA, 2016 ,
2) Teoh WH, Kristensen MS. Prediction in Airway management…… BJA, 2016
With this or even less prediction effort:
>50% of difficult intubations predicted
…and they are likely to be the most obvious and the most difficult patients that are
identified
Yes !!
64.
65.
66.
67.
68.
69.
70.
71.
72.
73.
74.
75.
76. What makes “awake” such a good approach?
www.airwaymanagement.dk
Aziz M, Kristensen MS, Anaesthesia 2020:
77. awake anaesthetised &
Paralyzed
Advantages
Open airway preserved Y n
Spontaneous breathing preserved Y n
Easier to localise glottic opening (air bubbles) Y n
Easier to intubate (oropharyngeal axis) Y n
The patient can help Y n
The patient can be sitting Y n
Some protection against aspiration Y n
Observing patients neurological status Y n
Allows decision making (intubate or not?) DURING the
endoscopy
y n
Avoid cardiovascular depression Y n
Dis-advantages
Airway narrowing due to local anaesthetics Y n
Cardiovascular stimulation Y n
Patient dis-comfort? ? n
More time consuming? ? n
Aziz M, Kristensen MS, Anaesthesia 2020:
78. awake anaesthetised &
Paralyzed
Advantages
Open airway preserved Y n
Spontaneous breathing preserved Y n
Easier to localise glottic opening (air bubbles) Y n
Easier to intubate (oropharyngeal axis) Y n
The patient can help Y n
The patient can be sitting Y n
Some protection against aspiration Y n
Observing patients neurological status Y n
Allows decision making (intubate or not?) DURING the
endoscopy
y n
Avoid cardiovascular depression Y n
Dis-advantages
Airway narrowing due to local anaesthetics Y n
Cardiovascular stimulation Y n
Patient dis-comfort? ? n
More time consuming? ? n
Aziz M, Kristensen MS, Anaesthesia 2020:
79. awake anaesthetised &
Paralyzed
Advantages
Open airway preserved Y n
Spontaneous breathing preserved Y n
Easier to localise glottic opening (air bubbles) Y n
Easier to intubate (oropharyngeal axis) Y n
The patient can help Y n
The patient can be sitting Y n
Some protection against aspiration Y n
Observing patients neurological status Y n
Allows decision making (intubate or not?) DURING the
endoscopy
y n
Avoid cardiovascular depression Y n
Dis-advantages
Airway narrowing due to local anaesthetics Y n
Cardiovascular stimulation Y n
Patient dis-comfort? ? n
More time consuming? ? n
Aziz M, Kristensen MS, Anaesthesia 2020:
80. awake anaesthetised &
Paralyzed
Advantages
Open airway preserved Y n
Spontaneous breathing preserved Y n
Easier to localise glottic opening (air bubbles) Y n
Easier to intubate (oropharyngeal axis) Y n
The patient can help Y n
The patient can be sitting Y n
Some protection against aspiration Y n
Observing patients neurological status Y n
Allows decision making (intubate or not?) DURING the
endoscopy
y n
Avoid cardiovascular depression Y n
Dis-advantages
Airway narrowing due to local anaesthetics Y n
Cardiovascular stimulation Y n
Patient dis-comfort? ? n
More time consuming? ? n
Aziz M, Kristensen MS, Anaesthesia 2020:
81.
82.
83.
84. awake anaesthetised &
Paralyzed
Advantages
Open airway preserved Y n
Spontaneous breathing preserved Y n
Easier to localise glottic opening (air bubbles) Y n
Easier to intubate (oropharyngeal axis) Y n
The patient can help Y n
The patient can be sitting Y n
Some protection against aspiration Y n
Observing patients neurological status Y n
Allows decision making (intubate or not?) DURING the
endoscopy
y n
Avoid cardiovascular depression Y n
Dis-advantages
Airway narrowing due to local anaesthetics Y n
Cardiovascular stimulation Y n
Patient dis-comfort? ? n
More time consuming? ? n
Aziz M, Kristensen MS, Anaesthesia 2020:
85. awake anaesthetised &
Paralyzed
Advantages
Open airway preserved Y n
Spontaneous breathing preserved Y n
Easier to localise glottic opening (air bubbles) Y n
Easier to intubate (oropharyngeal axis) Y n
The patient can help Y n
The patient can be sitting Y n
Some protection against aspiration Y n
Observing patients neurological status Y n
Allows decision making (intubate or not?) DURING the
endoscopy
y n
Avoid cardiovascular depression Y n
Dis-advantages
Airway narrowing due to local anaesthetics Y n
Cardiovascular stimulation Y n
Patient dis-comfort? ? n
More time consuming? ? n
Aziz M, Kristensen MS, Anaesthesia 2020:
86. awake anaesthetised &
Paralyzed
Advantages
Open airway preserved Y n
Spontaneous breathing preserved Y n
Easier to localise glottic opening (air bubbles) Y n
Easier to intubate (oropharyngeal axis) Y n
The patient can help Y n
The patient can be sitting Y n
Some protection against aspiration Y n
Observing patients neurological status Y n
Allows decision making (intubate or not?) DURING the
endoscopy
y n
Avoid cardiovascular depression Y n
Dis-advantages
Airway narrowing due to local anaesthetics Y n
Cardiovascular stimulation Y n
Patient dis-comfort? ? n
More time consuming? ? n
Aziz M, Kristensen MS, Anaesthesia 2020:
87. awake anaesthetised &
Paralyzed
Advantages
Open airway preserved Y n
Spontaneous breathing preserved Y n
Easier to localise glottic opening (air bubbles) Y n
Easier to intubate (oropharyngeal axis) Y n
The patient can help Y n
The patient can be sitting Y n
Some protection against aspiration Y n
Observing patients neurological status Y n
Allows decision making (intubate or not?) DURING the
endoscopy
y n
Avoid cardiovascular depression Y n
Dis-advantages
Airway narrowing due to local anaesthetics Y n
Cardiovascular stimulation Y n
Patient dis-comfort? ? n
More time consuming? ? n
Aziz M, Kristensen MS, Anaesthesia 2020:
88.
89.
90.
91.
92.
93.
94.
95. Can J Anaesth. 2021 Sep;68(9):1373-1404
Can J Anaesth. 2021 Sep;68(9):1405-1436
100. What we already know:
www.airwaymanagement.dk
Disposition:
Save the saviour
Airway management what is it? – and why should that be important?
Plan, prediction, preparation, combinations and special cicumstances
Breaking news
The Future!
> Hands on !!
Airwaymanagement.dk
The BIG SICK 2023
ADVANCED AIRWAY WORKSHOP
101. What we already know:
www.airwaymanagement.dk
Disposition:
Save the saviour
Airway management what is it? – and why should that be important?
Plan, prediction, preparation, combinations and special cicumstances
Breaking news
The Future!
> Hands on !!
Airwaymanagement.dk
The BIG SICK 2023
ADVANCED AIRWAY WORKSHOP
109. Tube Tip In Pharynx (TTIP) ventilation
A simple life-saving technique for emergency airway management
Sandra Ellefsen
Anesthesiology resident, Department of Anesthesia, Stavanger University Hospital
Assistant Professor, Faculty of Health Sciences, University of Stavanger
airwaymanagement.dk
110. Collaboration partners
Michael Seltz Kristensen
Department of Anaesthesia and Operating Theatre Services, Copenhagen University Hospital,
Rigshospitalet, Copenhagen, Denmark
Anja Stubager
Nurse Anesthetist
Department of Anaesthesia and Operating Theatre Services, Copenhagen University Hospital,
Rigshospitalet, Copenhagen, Denmark
Tube Tip In Pharynx (TTIP) ventilation – a case presentation
airwaymanagement.dk
111. Collaboration partners
Michael Seltz Kristensen
Department of Anaesthesia and Operating Theatre Services, Copenhagen University Hospital,
Rigshospitalet, Copenhagen, Denmark
Anja Stubager
Nurse Anesthetist
Department of Anaesthesia and Operating Theatre Services, Copenhagen University Hospital,
Rigshospitalet, Copenhagen, Denmark
No conflicts of interest
Tube Tip In Pharynx (TTIP) ventilation – a case presentation
airwaymanagement.dk
112. • Airway management and establishing airway patency: the cornerstone of
anesthetic practice
• We’ve had considerable advances and innovation in airway management
equipment in the past decades
→Nevertheless, these are not always at one’s disposal, particularly not in
austere and low-resource settings
Tube Tip In Pharynx (TTIP) ventilation – a case presentation
Background – Case Presentation – The TTIP technique - Discussion
113. Aim of this presentation:
Highlight the Tube Tip in Pharynx (TTIP) technique - a simple way of
solving a potentially life-threatening situation in a matter of seconds
→ Simple, singled-handed technique
→ Requires minimal and readily available equipment
Tube Tip In Pharynx (TTIP) ventilation – a case presentation
Background – Case Presentation – The TTIP technique - Discussion
airwaymanagement.dk
114. Background – Case Presentation – The TTIP technique - Discussion
Port Harcourt, Nigeria, Africa
airwaymanagement.dk
Tube Tip In Pharynx (TTIP) ventilation – a case presentation
115. Tube Tip In Pharynx (TTIP) ventilation – a case presentation
Background – Case Presentation – The TTIP technique - Discussion
airwaymanagement.dk
116. Tube Tip In Pharynx (TTIP) ventilation – a case presentation
Background – Case Presentation – The TTIP technique - Discussion
“Dear Michael,
You have indirectly contributed to saving the life of one of my patients tonight – here
in Africa. It is because you taught me the TTIP technique.
We were in a terrible cannot intubate – cannot ventilate situation with a man who
needed an urgent laparotomy. He was shot down in front of his house while his wife
and children were watching. Our challenge is that we can only give 5 liters of oxygen
per minute, and we have no nasal airway. This man was 100 kg (=220lbs), with a
short neck and a big belly.
airwaymanagement.dk
117. Tube Tip In Pharynx (TTIP) ventilation – a case presentation
Background – Case Presentation – The TTIP technique - Discussion
“Dear Michael,
You have indirectly contributed to saving the life of one of my patients tonight – here
in Africa. It is because you taught me the TTIP technique.
We were in a terrible cannot intubate – cannot ventilate situation with a man who
needed an urgent laparotomy. He was shot down in front of his house while his wife
and children were watching. Our challenge is that we can only give 5 liters of oxygen
per minute, and we have no nasal airway. This man was 100 kg (=220lbs), with a
short neck and a big belly.
Minutes post RSI Airway intervention Outcome
0 min. 1st intubation attempt Failed
2 min. Mask ventilation with guedel Failed
3 min. 1st TTIP - ventilation Successful
6 min. Spontanous ventilation, removal of tube Desaturation
8 min. 2nd TTIP - ventilation Successful
11 min. Tube removal, better positioning, halothane inhalation Desaturation
14 min. 3rd TTIP-ventilation Successful
18 min. 2nd Intubation attempt Failed
20 min. 3rd Intubation attempt, using a bougie Failed
22 min. 4th TTIP - ventilation Successful
26 min. Return of spontaneous ventilation while maintaining TTIP Patient awake and cooperative
35 min. Surgical airway under local anesthesia, with maintained spontaneous
ventilation via the TTIP
Successful
airwaymanagement.dk
118. Tube Tip In Pharynx (TTIP) ventilation – a case presentation
Background – Case Presentation – The TTIP technique - Discussion
“Dear Michael,
You have indirectly contributed to saving the life of one of my patients tonight – here
in Africa. It is because you taught me the TTIP technique.
We were in a terrible cannot intubate – cannot ventilate situation with a man who
needed an urgent laparotomy. He was shot down in front of his house while his wife
and children were watching. Our challenge is that we can only give 5 liters of oxygen
per minute, and we have no nasal airway. This man was 100 kg (=220lbs), with a
short neck and a big belly.
Minutes post RSI Airway intervention Outcome
0 min. 1st intubation attempt Failed
2 min. Mask ventilation with guedel Failed
3 min. 1st TTIP - ventilation Successful
6 min. Spontanous ventilation, removal of tube Desaturation
8 min. 2nd TTIP - ventilation Successful
11 min. Tube removal, better positioning, halothane inhalation Desaturation
14 min. 3rd TTIP-ventilation Successful
18 min. 2nd Intubation attempt Failed
20 min. 3rd Intubation attempt, using a bougie Failed
22 min. 4th TTIP - ventilation Successful
26 min. Return of spontaneous ventilation while maintaining TTIP Patient awake and cooperative
35 min. Surgical airway under local anesthesia, with maintained spontaneous
ventilation via the TTIP
Successful
airwaymanagement.dk
119. The TTIP technique
Tube Tip In Pharynx (TTIP) ventilation – a case presentation
Background – Case Presentation – The TTIP technique - Discussion
Relation of the tube-tip, cuff, epiglottis and the base of the tongue
in TTIP ventilation
Tube Tip In Pharynx (TTIP) ventilation – a case presentation
airwaymanagement.dk
120. Tube Tip In Pharynx (TTIP) ventilation – a case presentation
Background – Case Presentation – The TTIP technique - Discussion
airwaymanagement.dk
121. Background – Case Presentation – The TTIP technique - Discussion
Classic technique: Fast technique:
Kristensen MS. Tube tip in pharynx (TTIP) ventilation: simple establishment of ventilation in case of failed mask ventilation. Acta Anaesthesiol Scand 2005; 49: 252-6
Tube Tip In Pharynx (TTIP) ventilation – a case presentation
airwaymanagement.dk
122. Patient with a Body Mass Index (BMI) of 46
Background – Case Presentation – The TTIP technique - Discussion
Kristensen MS. Tube tip in pharynx (TTIP) ventilation: simple establishment of ventilation in case of failed mask ventilation. Acta Anaesthesiol Scand 2005; 49: 252-6
Tube Tip In Pharynx (TTIP) ventilation – a case presentation
airwaymanagement.dk
123. Possible indications:
• Difficult/impossible bag-mask ventilation
• Difficult/impossible LMA placement
• As a conduit for fiberoptic intubation
However:
• Not widely taught nor practiced
• Studies should be performed to
obtain precise indications and
limitations
Background – Case Presentation – The TTIP technique - Discussion
airwaymanagement.dk
Tube Tip In Pharynx (TTIP) ventilation – a case presentation
124. Take home messages
• Airway management does not have to be expensive to be effective
• Remember the TTIP technique (placed orally or nasally) as a potential
maneuver when encountering difficult/impossible ventilation
✓Simple
✓Single-handed
✓Minimal equipment required
Adventageous especially in austere
and/or low-resource settings
Tube Tip In Pharynx (TTIP) ventilation – a case presentation
airwaymanagement.dk
127. Ref: Mørkenborg M-L, Kristensen MS. Tube Tip in Pharynx – a conduit for awake oral intubation in
patients with extremely restricted mouth-opening. Can J Anaesth, accepted for publication, 2022
What if:
the mouth opening is so restricted that it precludes use of an oropharyngeal airway
128. Ref: Mørkenborg M-L, Kristensen MS. Tube Tip in Pharynx – a conduit for awake oral intubation in
patients with extremely restricted mouth-opening. Can J Anaesth, accepted for publication, 2022
What if:
the mouth opening is so restricted that it precludes use of an oropharyngeal airway
and
we cannot go via the nose.
?
X
129. Ref: Mørkenborg M-L, Kristensen MS. Tube Tip in Pharynx – a conduit for awake oral intubation in
patients with extremely restricted mouth-opening. Can J Anaesth, accepted for publication, 2022
What if:
the mouth opening is so restricted that it precludes use of an oropharyngeal airway
and
we cannot go via the nose.
?
X
130. Ref: Mørkenborg M-L, Kristensen MS. Tube Tip in Pharynx – a conduit for awake oral intubation in
patients with extremely restricted mouth-opening. Can J Anaesth accepted for publication, 2022
131. Ref: Mørkenborg M-L, Kristensen MS. Tube Tip in Pharynx – a conduit for awake oral intubation in
patients with extremely restricted mouth-opening. Can J Anaesth accepted for publication, 2022
132. What we already know:
www.airwaymanagement.dk
Disposition:
Save the saviour
Airway management what is it? – and why should that be important?
Plan, prediction, preparation, combinations and special cicumstances
Breaking news
The Future!
> Hands on !!
Airwaymanagement.dk
The BIG SICK 2023
ADVANCED AIRWAY WORKSHOP
147. Improving Emergency Airway Management with
Suction Assisted Laryngoscopy Airway
Decontamination Techniques
James DuCanto, M.D.
Staff Anesthesiologist Aurora Medical Group
Milwaukee, Wisconsin, USA
Twitter @jducanto
Facebook SALADSimulation
148. Financial Disclosures
Dr. DuCanto is the inventor of the Nasco SALAD Simulator and the
SSCOR DuCanto Catheter and receives royalties on these products.
sables/Accessories
149. Definition of SALAD:
Suction Assisted Laryngoscopy Airway
Decontamination
“An incremental step-wise approach to the
management of a massively contaminated
airway”
Resuscitation Plus
(2020): 100005.
150. Pathophysiology of Airway Contamination
Negates ventilation by mask or
supraglottic airway
Neutralizes apneic oxygenation
Negates all forms of endoscopy
151. SALAD manages airway contaminants while assisting the
rescuer in placing basic and advanced airways.
It proactively addresses the contaminated airway
while assisting insertion of airway adjuncts
157. 1. Opening jaw and compressing
tongue into floor of mouth—
while suctioning
Replaces the “Scissor Technique”
with a rigid tongue depressor
158. 2. Manipulation of tongue and pharyngeal tissues to maximize
the view and placement of a laryngoscope
159. 3. Provides continuous decontamination of the hypopharynx
during laryngoscopy
SALAD Park
Maneuver
RSC is repositioned to
the left of the
laryngoscope blade,
with its tip into the
upper esophagus.
160. Immediately prior to tracheal tube delivery, the
index finger of the right hand is inserted into the
path of tracheal tube delivery alongside right
margin of laryngoscope blade.
SALAD Poke Maneuver
190. Step 5
www.airwaymanagement.dk
Teoh WH, Kristensen MS. Anaesthesia 2014
Kristensen MS, Teoh WH. British J Anaesth. 2021
Kristensen MS. Acta Anaesthesiol Scand 2011
Mark the longitudinal course of
the airway by placing a mark at
each end of transducer
191. Step 5
www.airwaymanagement.dk
Teoh WH, Kristensen MS. Anaesthesia 2014
Kristensen MS, Teoh WH. British J Anaesth. 2021
Kristensen MS. Acta Anaesthesiol Scand 2011
Shadow from the needle is
between the thyroid and the
cricoid cartilages
204. TTJV not Recommended in
Emergency CICO Situations
Transtracheal jet ventilation in the ‘can’t intubate can’t
oxygenate’ emergency: a systematic review.
L.V. Duggan, et al.
BJA, Volume 117, Supplement 1, 2016, Pages i28-i38.
Device failure
in 42% of
emergency
CICO cases
51% rate of
complications
in emergency
vs. 8% in
elective
anesthesia
Barotrauma in 32% of emergency cases
205. • “Failed Airway” phrase stigmatizes procedure
• The surgical airway—a small neck incision—
should be viewed in larger context of patient
care issues
• “To save a life..sometimes you need a knife!”
• Attempt to oxygenate during procedure; 100
seconds to ventilation—must begin before
the patient is dead
Surgical Airway ≠ “Failed Airway”
Surgical Airway ≠ Rescue Airway
206. • Fluids are the enemy of everything
• High-volume fluids (blood, vomitus) can prevent
every means of visualization and oxygenation
• High-volume fluids make every means of
intubation—except cric—very challenging
• Distorted midface and upper airway may preclude
use of HFNC, mask, & SGA (supraglottic airway)
Surgical Airway NOW!
Dynamically Deteriorating with
Distorted Anatomy and Fluids
207. Common Misperceptions and
Errors with Surgical Cric
• Lack of anatomic insight creates fear about
using a scalpel—either cutting too deeply, or
too far laterally
• Operators are hesitant to start the procedure
if they haven’t identified the cricothyroid
membrane (misbelieving this is the 1st step)
• Misperception of surgical skill needed to do
the procedure causes delay in starting, and
makes many operators “more comfortable”
using a percutaneous technique
208. Operator Mindset
5 Mantras of a Surgical Cric
• “To save a life, I need to use a knife”
• “The laryngeal handshake will find midline”
• “I will find the CTM—after—the vertical,
midline skin incision”
• “I am not a surgeon, but I can stabilize my
hand on the patients sternum.”
• “The cartilaginous cage will protect.”
209. The Surgically Inevitable Airway
Distorted anatomy, high volume fluids, unable
to secure tracheal tube to midface
BVM, SGA, HFNC cannot work
210. The Surgically Inevitable Airway
GSW: Successful RSI, immediate cric plan B
BVM, SGA, HFNC cannot work
211. Dynamically Deteriorating with
Distorted Anatomy
Lingual hematoma,
secondary to stab wound.
Courtesy Ed Dickinson, MD
Epiglottitis as seen on
suspension laryngoscopy,
following emergency cric.
Courtesy Mike Mallon, MD
212. inferior
cornu
Thyroid Cartilage is the Primary
Landmark of Surgical Airway
cricoid
hyoid
thyroid
superior
cornu
reaches
hyoid
Lower
thyroid
overlaps
cricoid
213. inferior
cornu
Thyroid Cartilage is the Primary
Landmark of Surgical Airway
Thyroid spans from hyoid
to cricoid (coronal CT)
cricoid
hyoid
thyroid
superior
cornu
lamina
notch
cricoid
hyoid
thyroid
214. Thyroid is the Primary Landmark
Cricoid Much Larger in Back
cricoid
hyoid
thyroid
spans
from hyoid
to cricoid
trachea
30 mm
posterior
wall
5 mm
anterior
ring
216. Mobility of Larynx: Important to
Stabilize the Larynx During Cric
lateral mobility vertical mobility
click for video click for video
217. Mobility of Larynx: Important to
Stabilize the Larynx During Cric
lateral mobility vertical mobility
click for video click for video
218. Mobility of Larynx: Important to
Stabilize the Larynx During Cric
lateral mobility vertical mobility
click for video click for video
219. Localizing CTM with fingertip
often fails, and delays start
Fingertip palpation is a
fine motor skill in
setting where most
operators will have
elevated heart rates
CTM identification is difficult
through skin and adipose
If operator cannot
locate CTM, they
are mentally
defeated
at outset
220. Female vs. Male Thyroid Cartilages
& Implications for Finding
Landmarks
120° 90°
Equal prominence
thyroid and cricoid
lateral and frontal
views
Obvious thyroid
prominence.
Larger, longer
neck.
Thyroid lamina
angles
221. Laryngeal Handshake
Applied to Thyroid, Moves
Rhomboid of Larynx
1st & 3rd digit
palpates and
then manipulates
thyroid to identify
midline
Recommended
in DAS
Guidelines
222. Laryngeal Handshake
• A Comparison of the Laryngeal Handshake Method Versus the Traditional Index
Finger Palpation Method in Identifying the Cricothyroid Membrane, When
Performed by Combat Medic Trainees. Moore A, et. al. J Spec Oper Med
2019;19(3):71-75.
• Utility of the laryngeal handshake method for identifying the cricothyroid membrane.
Oh H, et. al. Acta Anaesthesiol Scand. 2018 Oct;62(9):1223-1228.
• Laryngeal handshake technique in locating the cricothyroid membrane: a non-
randomised comparative study. Drew T, McCaul CL. Br J Anaesth . 2018
Nov;121(5):1173-1178.
223. Cartilaginous Cage Will Protect
Anterior
Lateral
Posterior
High
back
wall
cricoid
Small
anterior
ring cricoid
Thyroid
cricoid
overlap
CTM
227. • Dominant hand holds the scalpel; low grip on
scalpel, like holding a pencil
• Base of scalpel hand rests on patient’s sternum
throughout the entire procedure—making both
vertical skin and horizontal CTM incisions
• Operator should be
at the patient’s side,
at shoulder, on the same
side as operator’s
dominant hand
Ergnomics of Surgical Cric
Cutting hand
sternal
stabilization
Non-dominant hand
laryngeal handshake
from start to finish
228. • Always insert finger tip in the hole after CTM
incision
• Verifies entrance into airway
• Verifies size of hole is adequate for tube
• Some advocate bougie insertion alongside finger;
It’s OK to use bougie, but never omit finger tip
insertion to verify hole size
• Most common mistake in open cric procedure is too
small a hole, then passing a bougie or tube into
subcutaneous location (same error common with
chest tubes)
Scalpel > Finger > Tube
or Scalpel > Finger > Bougie > Tube
229. Non-Dominant Hand Position &
2nd Digit Movements
Fingertip verifies
CTM location after
vertical skin incision
1st & 3rd
digits grab
thyroid
Hand in
same
position
Verifies hole size
after horizontal
skin incision
230. Incrementalized Surgical Cric (1)
Dominant hand
laryngeal handshake
Non-dominant hand
laryngeal handshake
VERTICAL SKIN INCISION
STERNAL STABILIZATION
231. Incrementalized Surgical Cric (2)
Verify
CTM location
Stab incision
pull toward R
Blade flipped
push L
Finger in
hole
Tube held
at proper
point
~10 cm
HORIZONTAL INCISION
233. • Verify depth. Bifurcation
of trachea is ~ 11 cm from
cords—and insertion point
is below the cords to start
• Over-insertion causes
hyper-inflation, tension
physiology
• Tension pneumothorax
can occur from air
dissecting through tissue
planes
• Secure tube securely
Post-Surgical Cric:
Depth of Tube & Pneumothorax
234. Cadaveric Lab Case Example
Scalpel, Finger, Bougie
Incision is widened laterally to fit finger tip
Note: Better to keep finger out of hole using scalpel
click for video
235. Cadaveric Lab Case Example
Scalpel, Finger, Bougie
Incision is widened laterally to fit finger tip
Note: Better to keep finger out of hole using scalpel
click for video
242. “Blind” methods
– not dependent on visibility in the airway
– successfully used in the bleeding airway:
Blind oro-digital Intubation
Blind nasal Intubation
Transillumination
Intubation via Supraglottic Airway Device
Oesophageal Combitube
Ultrasound guided intubation
Retrograde Intubation
Cricothyroidotomy/tracheostomy
Cardiac assist/bypass/ECMO
+ combinations
Kristensen MS, McGuire B. Canadian Journal of Anesthesia, 2020
243. “Blind” methods
– not dependent on visibility in the airway
– successfully used in the bleeding airway:
Blind oro-digital Intubation
Blind nasal Intubation
Transillumination
Intubation via Supraglottic Airway Device
Oesophageal Combitube
Ultrasound guided intubation
Retrograde Intubation
Cricothyroidotomy/tracheostomy
Cardiac assist/bypass/ECMO
+ combinations
Kristensen MS, McGuire B. Canadian Journal of Anesthesia, 2020
244. “Blind” methods
– not dependent on visibility in the airway
– successfully used in the bleeding airway:
Blind oro-digital Intubation
Blind nasal Intubation
Transillumination
Intubation via Supraglottic Airway Device
Oesophageal Combitube
Ultrasound guided intubation
Retrograde Intubation
Cricothyroidotomy/tracheostomy
Cardiac assist/bypass/ECMO
+ combinations
Kristensen MS, McGuire B. Canadian Journal of Anesthesia, 2020
245.
246.
247.
248. What we already know:
www.airwaymanagement.dk
Disposition:
Save the saviour
Airway management what is it? – and why should that be important?
Plan, prediction, preparation, combinations and special cicumstances
Breaking news
The Future!
> Hands on !!
Airwaymanagement.dk
The BIG SICK 2023
ADVANCED AIRWAY WORKSHOP
249. What we already know:
www.airwaymanagement.dk
Disposition:
Save the saviour
Airway management what is it? – and why should that be important?
Plan, prediction, preparation, combinations and special cicumstances
Breaking news
The Future!
> Hands on !!
Airwaymanagement.dk
The BIG SICK 2023
ADVANCED AIRWAY WORKSHOP
264. ”
…The currently available
evidence does not indicate
benefits of more invasive
airway approaches based on
survival, neurological
function, ROSC, or successful
airway insertion…”
265. ”
…The currently available
evidence does not indicate
benefits of more invasive
airway approaches based on
survival, neurological
function, ROSC, or successful
airway insertion…”
277. Preventing unrecognised oesophageal intubation: a consensus guideline from the Project for Universal
Management of Airways and international airway societies. Anaesthesia. 2022.
278. Preventing unrecognised oesophageal intubation: a consensus guideline from the Project for Universal
Management of Airways and international airway societies. Anaesthesia. 2022.
310. Intubation during a medevac flight: safety and effect on total prehospital time in the helicopter emergency
medical service system. Scand J Trauma Resusc Emerg Med 2020
311.
312.
313. What we already know:
www.airwaymanagement.dk
Disposition:
Save the saviour
Airway management what is it? – and why should that be important?
Plan, prediction, preparation, combinations and special cicumstances
Breaking news
The Future!
> Hands on !!
Airwaymanagement.dk
The BIG SICK 2023
ADVANCED AIRWAY WORKSHOP
314. www.airwaymanagement.dk
Kristensen MS, Hesselfeldt R, Brinkenfeldt HK…Acta Anaesthesiol Scand, January 23rd, 2023, ahead
of print
Infrared flashing light through the
cricothyroid membrane as guidance to
awake intubation with a flexible
bronchoscope -
A randomised cross-over study
326. Kristensen MS and co-workers.
Acta Anaesthesiol Scand 2018; 62: 19-25
327.
328.
329. Kristensen MS and co-workers. Acta Anaesthesiol Scand 2018; 62: 19-25
- hidden behind pathology
330. Kristensen MS and co-workers. Acta Anaesthesiol Scand 2018; 62: 19-25
- hidden behind pathology
331. Pre-anaesthetic nasendoscopy by the surgeon revealed:
”…inability to visualise the vocal cords due to a pronounced swelling”
332. www.airwaymanagement.dk
Kristensen MS, Hesselfeldt R, Brinkenfeldt HK…Acta Anaesthesiol Scand, January 23rd, 2023, ahead
of print
Infrared flashing light through the
cricothyroid membrane as guidance to
awake intubation with a flexible
bronchoscope -
A randomised cross-over study
333. Research question:
www.airwaymanagement.dk
Will Infrared guidance be helpful
as a standard?
..in daily clinical practice?
Kristensen MS, Hesselfeldt R, Brinkenfeldt HK…Acta Anaesthesiol Scand, January 23rd, 2023, ahead
of print
334. Inclusion:
Patients for oral awake intubation
with a flexible optical scope
Endoscopists:
The doctor allocated to the
operation room – both trainees and
consultants
www.airwaymanagement.dk
Kristensen MS, Hesselfeldt R, Brinkenfeldt HK…Acta Anaesthesiol Scand, January 23rd, 2023, ahead
of print
335. Inclusion:
Patients for oral awake intubation
with a flexible optical scope
Endoscopists:
The doctor allocated to the
operation room – both trainees and
consultants
www.airwaymanagement.dk
Kristensen MS, Hesselfeldt R, Brinkenfeldt HK…Acta Anaesthesiol Scand, January 23rd, 2023, ahead
of print
336. Methods:
Two (2) scope insertions in each patient
Randomised cross-over design:
Infrared first No infrared first
No infrared second Infrared second
Kristensen MS, Hesselfeldt R, Brinkenfeldt HK…Acta Anaesthesiol Scand, January 23rd, 2023, ahead
of print
337. Methods:
Two (2) scope insertions in each patient
Randomised cross-over design:
Infrared first No infrared first
No infrared second Infrared second
Kristensen MS, Hesselfeldt R, Brinkenfeldt HK…Acta Anaesthesiol Scand, January 23rd, 2023, ahead
of print
338. Methods:
Two (2) scope insertions in each patient
Randomised cross-over design:
Infrared first No infrared first
No infrared second Infrared second
Kristensen MS, Hesselfeldt R, Brinkenfeldt HK…Acta Anaesthesiol Scand, January 23rd, 2023, ahead
of print
339. Methods:
Two (2) scope insertions in each patient
Randomised cross-over design:
Infrared first No infrared first
No infrared second Infrared second
Kristensen MS, Hesselfeldt R, Brinkenfeldt HK…Acta Anaesthesiol Scand, January 23rd, 2023, ahead
of print
340. Methods:
Two (2) scope insertions in each patient
Randomised cross-over design:
Infrared first No infrared first
No infrared second Infrared second
Kristensen MS, Hesselfeldt R, Brinkenfeldt HK…Acta Anaesthesiol Scand, January 23rd, 2023, ahead
of print
343. Results:
44 insertions of the flexible scope in 22 patients
Kristensen MS, Hesselfeldt R, Brinkenfeldt HK…Acta Anaesthesiol Scand, January 23rd, 2023, ahead
of print
349. Results, Secondary endpoints:
The time until either the flashing light or the
vocal cords was seen, was :
21 S (22) (Infrared) versus 48 S (62) (no
infrared)
p = 0.005
Kristensen MS, Hesselfeldt R, Brinkenfeldt HK…Acta Anaesthesiol Scand, January 23rd, 2023, ahead
of print
350. How easy was it to perceive the entrance to the trachea ?
Results, Secondary endpoints:
351. How easy was it to perceive the entrance to the trachea ?
P
=
0.001
Results, Secondary endpoints:
352. How easy was it to perceive the entrance to the trachea ?
P
=
0.001
Results, Secondary endpoints:
353. Conclusion:
www.airwaymanagement.dk
Addition of trans-cricothyroid infrared flashing light…..:
resulted in:
Unequivocal, and
easier, identification of the pathway to the trachea at significantly
more proximal level within the airway.
…..this addition was highly beneficial for the entire airway
management procedure.
Kristensen MS, Hesselfeldt R, Brinkenfeldt HK…Acta Anaesthesiol Scand, January 23rd, 2023, ahead
of print
354. What we already know:
www.airwaymanagement.dk
Disposition:
Save the saviour
Airway management what is it? – and why should that be important?
Plan, prediction, preparation, combinations and special cicumstances
Breaking news
The Future!
> Hands on !!
Airwaymanagement.dk
The BIG SICK 2023
ADVANCED AIRWAY WORKSHOP
355. We would like at technique that works for..
• Awake and anaesthetised/musclerelaxed patients
• ..without any devices in the airway
• ..with FIO2 adjustable (for laser etc..)
• ..with a physiological /better hemodynamic profile
• ..
363. We would like at technique that works for..
• Awake and anaesthetised/musclerelaxed patients
• ..without any devices in the airway
• ..with FIO2 adjustable
• ..with a physiological /better hemodynamic profile
• ..
airwaymanagement.dk
380. But inside…
Chondrosarcoma + multiple lesions of unknown origin...
Previous:
Apnea + HFNO for short diagnostc procedure
Jet-ventilation resulting in difficult access
Now: Need for longer acces with various devise, including ”shaver” and possibly laser
airwaymanagement.dk
403. What we already know:
www.airwaymanagement.dk
Disposition:
Save the saviour
Airway management what is it? – and why should that be important?
Plan, prediction, preparation, combinations and special cicumstances
Breaking news
The Future!
> Hands on !!
Airwaymanagement.dk
The BIG SICK 2023
ADVANCED AIRWAY WORKSHOP
404. The BIG SICK 2023
ADVANCED AIRWAY WORKSHOP
airwaymanagement.dk
Michael Seltz
Kristensen
Michael Friis
Tvede
Pims de
Ruijter
John Diaper
Tatjana
Dill
Anne Cath-
rine Haug
Heleen
Biersteker
Søren
Rudolph
Richard
Levitan
Sandra Larssen
Clifford
James ”Jim”
Ducanto
Anne-Sophie
Lynnerup
Joerg Helge
Junge
Kristian B.
Krogh
405. The BIG SICK 2023
ADVANCED AIRWAY WORKSHOP
airwaymanagement.dk
Michael Seltz
Kristensen
Michael Friis
Tvede
Pims de
Ruijter
John Diaper
Tatjana
Dill
Anne Cath-
rine Haug
Heleen
Biersteker
Søren
Rudolph
Richard
Levitan
Sandra Larssen
Clifford
James ”Jim”
Ducanto
Anne-Sophie
Lynnerup
Joerg Helge
Junge
Kristian B.
Krogh