#JanuAirway Day 2. Yesterday highlighted the need for strategy, so let’s talk Airway Planning. Decision making = the true art of airway management! NAP4 @doctimcook showed that poor judgement is implicated in many airway complications. This #OnePager covers the major themes. 1/9
#JanuAirway What's the issue? We encounter difficult airways relatively infrequently, & complications are rare. Low exposure leads to high anxiety. Add in multiple options @huitink & Bouwman suggest >1mill combinations of options to oxygenate. More options = more anxiety 2/9
Cognitive load can lead to decision fatigue & increasing bias & poorer decisions. Metacognition can help debias. Chew et al’s (ncbi.nlm.nih.gov) came up with the TWED checklist which can help: -
3/9
3/9
#JanuAirway The Elaine Bromiley & Gordon Ewing cases = essential reading – highlight competing problems with task fixation / failure to accept safe (but not necessarily desirably situations). Here's how defining goals helps a decision cycle as a way of combating both 4/9
#JanuAirway Situational awareness is key. Define your thinking zones & the kind of situation you are in. Try to limit your options, but think holistically about the whole airway – @vapourologist uses the following three stage approach 5/9
#JanuAirway Don’t forget your surgical colleagues. Involve them early. BUT remember not all ENT / maxfax surgeons are equal (same as anaesthetists!) – we all have subspecialty interests – a rhinologist might not be comfortable doing FONA either! #FOAMed 6/9
#JanuAirway Putting it all together – consider an airway strategy sheet, like the this one that @vapourologist designed – define problems / limits up front, involve ENT early, define plans ABC&D – consider all options, but decide on a few
#FOAMed 7/9
#FOAMed 7/9
Here are some papers / links that you might find interesting: -
a. nationalauditprojects.org.uk
b. das.uk.com
c. vortexapproach.org
If you have any others of interest, tweet them to us for inclusion next time!
#JanuAirway 8/9
a. nationalauditprojects.org.uk
b. das.uk.com
c. vortexapproach.org
If you have any others of interest, tweet them to us for inclusion next time!
#JanuAirway 8/9
vortexapproach.org
The Vortex Approach
TO AIRWAY MANAGEMENT
das.uk.com/content/video/…
How to perform a nasendoscopy - Video by DAS members | Difficult Airway Society
DAS is pleased to share the video shown below which demonstrates an excellent technique to perform N...
nationalauditprojects.org.uk/NAP4_home
NAP4: Major Complications of Airway Management in the United Kingdom - The National Institute of Academic Anaesthesia
NIAA
Hope that helps. We’ll see you tomorrow for more Airway #FOAMed. See you then! #JanuAirway 9/9
*Disclaimer: Inclusion of content (equipment, techniques and scoring systems etc.) in #JanuAIRWAY does not constitute DAS endorsement
*Disclaimer: Inclusion of content (equipment, techniques and scoring systems etc.) in #JanuAIRWAY does not constitute DAS endorsement
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