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From BURP to BILP: backwards internal laryngeal pressure

A burns patient whose tracheal tube was accidentally dislodged and ended up placed in the oesophagus on day 2 of his ICU stay continued to spontaneously ventilate and maintain saturations on a...

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Don’t bronchodilators work in infants?

Inpatient paediatric teams can be scornful when bronchodilators are given by ED staff to wheezing infants, correctly referring to the lack of evidence of clinical benefit(1). There is however a...

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Transtracheal airways in kids. Well, pigs’ kids anyway

Ever had to do a surgical airway in a child? Thought not. They’re pretty rare. Bill Heegaard MD from Henepin County Medical Center taught me a few approaches (with the help of an anaesthetised rabbit)...

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Reassurance: difficult laryngoscopy in children remains rare

I was taught a useful principle by a paediatric anaesthetist 10 years ago which has proven true in my experience and has contributed to keeping me calm when intubating sick kids. Unlike adults, in whom...

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Lifting the Fogg on ED Intubaton

Fellow retrieval specialist and Royal North Shore Hospital emergency physician Dr Toby Fogg and coauthors have published their audit of intubations in an Australian Emergency Department(1). More...

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Advanced airways and worse outcomes in cardiac arrest

A new study demonstrates an association between advanced prehospital airway management and worse clinical outcomes in patients with cardiac arrest. Done in Japan, the numbers of patients included are...

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Ketamine & cardiovascular stability

I ‘jumped ship’ from etomidate to ketamine for rapid sequence intubation (RSI) in sick patients about seven years ago. Good thing too, since I later moved to Australia where we don’t have etomidate....

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Updated Difficult Airway Guidelines

The American Society of Anesthesiologists has published an update to its Practice Guidelines for Management of the Difficult Airway. You can get the full PDF for free. I’m linking to it for interest,...

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The importance of first pass success

A large single-centre study in an academic tertiary care center emergency department (where residents perform most of the intubations) examined 1,828 orotracheal intubations, of which 1,333 were...

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Save a life by watching telly?

If you’re in the United Kingdom on Thursday 21st March please consider watching BBC’s Horizon program at 9pm on BBC2. I’m in Australia so I’ll miss it, but I’m moved by the whole background to this...

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Lateral chest thrusts for choking

An interesting animal study examined the techniques recommended in basic choking management algorithms for foreign body airway obstruction (chest and abdominal thrusts). In terms of the pressures...

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Cricoid can worsen VL View

It is known that cricoid pressure can hinder laryngoscopic view of the cords during direct laryngoscopy. Using a Pentax-AWS Video laryngoscope, these authors have demonstrated that cricoid pressure can...

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Difficult intubation on ICU

A score to predict difficulty of intubation in ICU patients underwent derivation and validation in French ICUs. The main predictors included Mallampati score III or IV, obstructive sleep apnoea...

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Awake intubation

I had some fun today getting intubated. We used the Ambu aScope 2 and the Greater Sydney Area HEMS equipment and approach to airway management. I didn’t receive an antisialogogue or any analgesia or...

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RSI haemodynamics in the field

The noxious stimulus of laryngoscopy & tracheal intubation can precipitate hypertension, tachycardia, and intracranial pressure elevation, risking exacerbation of brain injury or haemorrhage....

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Thenar eminence based medicine

A recent study showed superior effectiveness of one bag-mask ventilation style over another in novice providers. The technique recommended is the thenar eminence grip, in which downward pressure is...

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The non-intubation checklist

Scenario: A 79 year old previously well female presents with loss of consciousness, having been found unresponsive by her daughter who saw her well one hour previously. Examination reveals a GCS of...

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Even the dead exhale CO2

Cardiac arrest patients sometimes have unrecognised oesophageal intubations because clinicians omit capnography, based on the assumption that circulatory arrest leads to an absence of exhaled CO2. This...

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Guidelines on prehospital drug-assisted LMA insertion

The UK’s Faculty of Prehospital Care has published a number of consensus guidelines in this month’s EMJ Dr Minh Le Cong‘s PHARM blog has summaries of three of them: The prehospital management of pelvic...

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London Trauma Conference Day 3

Dr Louisa Chan reports on Day 3 of the London Trauma Conference There was a jam-packed line up for the Pre-hospital and Air Ambulance Day which was Co-hosted by the Norwegian Air Ambulance Foundation....

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