How To Open The Airway

How to open the airway is an essential skill that every health provider should know. Of all the airway skills, it’s the easiest to master and the most likely to save lives in respiratory distress and failure. This article details recognizing airway obstruction, techniques to open the airway, and insertion of Read More …

Learning Intubation: A Beginners Guide

To learn intubation in addition to learning the physical steps, you need to understand why you’re doing those steps. This article will explain how to perform the steps of intubation, as well as the rationale behind them. Links to other articles on intubation technique appear both in the body of the text as well as repeated as a list at the end. Read More …

First Pass Intubation: When You Can’t See The Cords

Failure to see the cords on first pass intubation occurs about 10% of the time. This article describes the thought process behind the next steps for approaching the next intubation attempts. Read More …

Airway Management Review Article Published: 10 Common Pediatric Airway Problems — And Their Solutions

My review article has just been published in Anesthesiology News: 10 Common Pediatric airway Problems — And Their Solutions. The trend to only use pediatric providers has a seriously negative unintended consequence: It deprives other providers of routinely caring for children, making them less prepared for when they do inevitably have to care for a small child. This reviews the most important pediatric airway differences. Read More …

To Open The Airway, Optimally Position The Head and Neck

Discussion of how to open an airway using lateral neck X-rays to demonstrate how positioning the head and neck can either open or obstruct the airway. Read More …

Preventing Airway Emergencies

I’m in Egypt at the 35th International Conference Egyptian Anesthesia 2019. I was given the great honor of presenting my article on the 10 Rules For Approaching Difficult Intubation: Always Prepare For Failure. Preparation, Decision Making, Teamwork and Communication are key to preventing airway emergencies. Read More …

Pediatric Airway Risks: Inefficient Mechanics of Breathing

In many ways pediatric anatomy and physiology predisposes a child to respiratory distress and respiratory failure. Inefficient mechanics of breathing is one major risk factor for infants and young children. This article discusses the ways the anatomy of a child creates inefficient mechanics of breathing and predisposes to respiratory distress and failure. Read More …

ETCO2: Valuable Vital Sign To Assess Perfusion

We routinely use ETCO2 to provide information on ventilation. But ETCO2 can also provide valuable information on the adequacy of cardiac perfusion. It can be an essential tool in ensuring optimal, high quality chest compressions during cardiac resuscitation. Read More …

# 1 Review Article for Anesthesiology News 2018: 10 Rules for Approaching Difficult Intubation by Christine Whitten

And the numbers are in, my review article for Anesthesiology News was actually THE MOST viewed article on the site for the whole year! The link for the article is included. Please feel free to share.
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Conscious Sedation: Is Your Patient Breathing?

Conscious sedation can alter respiration, which can lead to the vicious cycle of hypoventilation, hypercarbia, and hypoxia. If you don’t recognize inadequate respiration —and treat it— the patient can suffer injury or die. This article discusses the continuum of sedation and its effect on consciousness and respiration. Read More …

The MAC Blade, The Vallecula, and the Hyoepiglottic Ligament

Intubation with the MAC blade requires precise placement of the tip of the blade in the vallecula in order to manipulate the hyoepiglottic ligament and lift the epiglottis. This discussion uses illustration, Xray, and video to demonstrate proper intubation technique. Read More …

Learning Intubation: Head Position Effects Laryngeal View

When first learning intubation,  a beginner often concentrates on memorizing the key laryngeal anatomy. This is important of course. If you can’t recognize the vocal cords, you will not be able to successfully intubate. However, even more important to learning intubation is understanding how the larynx relates to the other structures in the head and neck. In order to intubate you must manipulate those other structures to bring the larynx into view. This post uses lateral X-rays and CT scan images to help novice intubators master the anatomical relationships they must know to intubate. Read More …

Announcing My Latest Article Has Been Published: “10 Rules for Approaching Difficult Intubation”

I’m excited. My latest article, titled, “10 Rules for Approaching Difficult Intubation, Always Prepare for Failure” has just been released in the journal supplement Airway Management, published by Anesthesiology News. Managing the difficult airway is one of the most challenging, risk ridden, and downright scary clinical problems in anesthesia. The article makes the Read More …

Bilateral Tension Pneumothorax: Harder To Diagnose

Tension pneumothorax is a life-threatening emergency. This article discusses several iatrogenic bilateral tension pneumothoraces occurring during intubation and emergency airway management. Read More …

PostObstructive Pulmonary Edema

Patients with postobstructive pulmonary edema (or P.O.P.E.) develop sudden, unexpected and potentially life-threatening pulmonary edema after relief of airway obstruction.  It can be mild or severe. My first experience with it was in 1983. The Case In 1983, we didn’t have pulse oximetry, end-tidal carbon dioxide monitoring or even automated Read More …

Anatomic Dead Space Affects Hypoventilation

Having a tidal volume close to, or smaller than the patient’s dead space can lead to significant hypercarbia, hypoxia, and respiratory failure. This article discusses the concept of dead space and it’s clinical use in recognizing hypoventilation and preventing hypoxia and hypercarbia. Read More …

GlideScope Technique For Intubation In Small Mouths

The GlideScope can be difficult to use in a patient with a small, narrow mouth. This article discusses a technique for improving successful intubation in that type of patient. Read More …

Difficult Intubation In A Newborn

The unanticipated difficult neonatal intubation in L&D greatly complicates neonatal resuscitation. This discussion highlights the approach to difficult ventilation & intubation in the newborn. #FOAMED Read More …

Announcing My New Book: Pediatric Airway Management: A Step-by-Step Guide

At long last, after two years of writing (and rewriting),  illustrating, and  filming  on-line videos, I’m excited to announce the publication of my new book Pediatric Airway Management: A Step-by-Step Guide. Anyone who rarely cares for children tends to be anxious when faced with a small child’s airway. This is true even if they are comfortable with adult airway management.

My goal for this book is to demystify basic pediatric airway management. I want to give you the skills you need to recognize when a child is in trouble and act quickly to safeguard that child, including helping them breathe if necessary. My sincere wish is that this new book helps in the care of our littlest patients, no matter where they are. Read More …

NITROUS OXIDE: SHOULD WE USE IT?

When I was training, we used nitrous oxide on just about every anesthetic. It was easy to use. It was inexpensive. It didn’t tend to effect hemodynamics so it was useful in less stable patients when combined with an opioid. It helped speed induction through the second gas effect. It was not metabolized so renal and liver insufficiency were of less concern.

However, a lot more is now known about the pharmacologic disadvantages, and potential harm, of nitrous oxide in certain patients. N2O interferes with the B12/folate pathway and methylates DNA. This discussion reviews some of those patients at risk of harm from nitrous oxide exposure during anesthesia. Read More …