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A Message from the Founders of
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Dear Friends of Airway World,
We have discovered from years of teaching The Difficult Airway Courses that difficult airway management causes significant stress for many providers. After each course, we can almost hear a collective sigh of relief from the participants as they walk away more knowledgeable, skilled and confident.
But, not everyone is able to undertake such comprehensive hands-on training or refresh their skills as often as they wish. That's why Airway World is so important. By offering easy-to-access live and recorded webinars, educational videos and research papers, more people can access the important lessons we teach in The Difficult Airway Courses. We are working on providing CME credits for our webinars and plan to expand the types of on-line training that we do. We'll keep you posted as we make progress, but would appreciate hearing your ideas for new on-line programs. To share your ideas, please click here to send us an email. Thank you for your continued commitment to advancing the practice of airway management.
Ron M. Walls, MD Michael F. Murphy, MD Robert C. Luten, MD
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| The Collection | |
Visit The Collection in Airway World to see:
The Anesthesia
Collection
The Emergency Medicine Collection
The Critical Care Collection
The Pediatric Collection
The EMS Collection
The Journal Watch Collection
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| A Brief Note | |
Dear Airway World Members,
Just a quick note to let you know that you can get reminders of all of the Airway World events by following us on Twitter.
We also occassionally tweet interesting airway news. Recently, we tweeted about the release of a report on the first case of Tele-Intubation. John Sakles, MD (University of Arizona), a member of the National Airway Faculty, assisted in the intubation of a patient at a remote hospital. Using a GlideScope VL and the UA Telemedicine Network, Dr. Sakles guided the attending physician through a tough case. The intubation was a success!
Our last tweet was about the first intubation robot! Click on the Twitter button below to link to the article. This surely is a dynamic field of medicine!
Sincerely,
Terry T. Steele
Executive Director
(860) 679-9285
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| Airway World Update | | | Guest Program Extended |
Since so many have taken advantage of our guest log-in program, we have extended it until the end of May! To "test drive" Airway World before registering, we invite you to log in at www.airwayworld.com using these credentials:
Password: awguest
When you are ready to create your own account, you'll find that registration is easy (and free)! With your own account, you'll be able to identify your preferences, create a playlist, dowload documents to your briefcase, leave messages, chat and much more!
Passwords Simplified
You can now log into Airway World with a very simple password. Special characters are no longer needed. If you want to change your password to the simpler format, just click on "Forgot your password?" on the log in page. | |
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Schedule of Interactive Events |
| Save the date!
April 28, 2011 6:00 PM EST Airway World Auditorium Airway Management M&M (webinar) Join Calvin A. Brown, III, MD for a case-based review of difficult and failed airway management concepts. The four cases to be discussed will make you rethink your approach to the next difficult airway that comes through the door. Did your last difficult airway make you sweat? This webinar is all the anti-perspirant you'll need! Questions and comments can be submitted to Dr. Brown during and after the presentation (via a text box). Limit 100 participants. HOW TO PARTICIPATE: A link to this webinar is listed in the Airway World Auditorium. Click on the link when it becomes live 30 minutes before the start of the program. You will be taken to the webinar where you will enter your name and email address to join the session. Webinars Coming Soon... Telemedicine and Airway Management Intubating Stylets Obesity and Airway Management The Difficult Airway App (soon to be released to the App Store) |
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Why Not Just Take a Look?
An occassional blog posting by Ron Walls, MD |
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Recently, I was discussing a difficult airway case with a group of colleagues from emergency medicine and anesthesia. The patient in question had significant smoke inhalation, could not be intubated in the field (failed attempts with sedation but no neuromuscular blocking agent, NMBA) and had a functioning standard LMA in situ. Attempts to intubate through the LMA were unsuccessful, even using a bougie, although a fiberoptic scope was not tried. The patient was breathing spontaneously through the LMA.
The question is, what to do next?
One colleague suggested doing a difficult airway assessment and, if there were no markers of difficult airway, performing RSI. He advocated using a double set-up, though, because of the possibility that the intubation failure in the field was because of supra-glottic edema which might make oral intubation difficult or impossible. The set-up would involve having the patient's neck prepared, and the necessary equipment set up to perform emergency cricothyrotomy, if required.
Another colleague argued that the patient was breathing on his own, so why paralyze him? "Why not just take a look?" She advocated direct laryngoscopy, perhaps with IV sedation, but without NMBA. That way, you leave the patient breathing, so you do no harm, she posited.
So which method is right, RSI or an awake look?
The answer lies in the difficult assessment, as my first colleague suggested, and the intubator's level of confidence regarding oxygenation and intubation. The Difficult Airway Algorithm advises that if the intubator is confident that oxygenation using a bag/mask or extra-glottic device (like an LMA) will be possible, and that the likelihood of intubation success is reasonably high, then RSI is the recommended. If either of these requirements is not met, then an "awake" look is recommended. In this case, oxygenation essentially was assured, because the patient already was successfully oxygenating via the LMA. A difficult airway assessment didn't identify any other predictors of difficulty, other than the possibility of upper airway Obstruction (the O in LEMON). So, in this case, the argument for RSI, with or without a double set-up, agrees with the Difficult Airway Algorithm. Why not just do an awake look, anyway? The patient resists laryngoscopy, and can do so, because muscle tone is preserved. For the same reason, the patient can vomit (and aspirate). A proper awake look requires topical anesthesia and systemic sedation (often with analgesia), takes time to prepare, is relatively difficult, and less likely to be successful than an RSI. So, the right choice here was the RSI. What actually happened in this case? The physician tried an awake look, which was not successful, then did RSI, which was. No bad outcome here, but the patient was unnecessarily exposed to the risk of aspiration. That's the answer to the question, "why not just take a look?"
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Airway World Spotlight: The Auditorium |
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One of the first places Airway World visitors stop is the Auditorium. This is where you will find the most current recorded webinars and featured videos. Here's a partial list of the resources you'll find in the Auditorium:
Trauma Webinar Series: Trauma Airway Review (recorded webinar) Trauma Airways: Fact, Fiction or In Between (recorded webinar)
A Fiberoptic Tour of the Airway: the one and only Dr. Murphy narrating a tour of his own airway (video).
Never Forget Video Series: Emergency - an educational video featuring members of The Difficult Airway Course: Emergency focusing on the most critical lessons taught in this course (video).
Anesthesia - an educational video featuring members of The Difficult Airway Course: Anesthesia focusing on the most critical lessons taught in this course (video). Tour of the Difficult Airway Cart: a guided tour of the difficult airway cart designed by Ron M. Walls, MD and Calvin Brown, MD and used at Brigham and Women's Hosptial in Boston, MA (video). Quarterly Research Reviews (recorded webinars) The Auditorium is also the place you will find links to upcoming webinars. So, grab some popcorn and enjoy the show! |
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