Inserting a supraglottic airway in a failed airway emergency can rescue your patient and allow successful oxygenation and ventilation. management of failed airway, can’t intubate can’t ventilate discussed. #anesthesia, #FOAMED Read More …
Pulmonary aspiration in anesthesia can be life-threatening. Article discusses how to minimize risk with vigilance, good judgment, preparation, and quick actions. #anesthesia, #FOAMED Read More …
To be effective, cricoid pressure must be applied using the correct force, at the correct spot, using the correct angle. It therefore, requires good communication between intubator and the applier. Article discusses technique. #FOAMED Read More …
Dead space is the portion of the respiratory system where tidal volume doesn’t participate in gas exchange. We often worry about anatomic and physiologic dead space. We often forget equipment dead space, the dead space belongs to any airway equipment used to assist ventilation. Ignoring equipment dead space can lead Read More …
The ebook version of “Anyone Can Intubate: A Step By Step Guide to Intubation and Airway Management” is now available at cost on the Amazon.com platform during the COVID-19 pandemic. Read More …
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 …
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 …
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 …
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 …
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 …
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 …
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 …
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 …
Intubating patients during cardiac resuscitation is often challenging because of the circumstances surrounding the intubation. Excitement and apprehension accompany this life saving effort. In addition, The patient is often in a less than optimal position while chest compressions are in progress. You usually find the patient in one of two awkward positions: on the ground or in a bed. This article discusses techniques to better manage intubation during cardiac resuscitation, especially with the patient in an awkward position. Read More …
An emergency department physician I met the other day shared with me an experience from her hospital that offers a good example of the fact that there are many different ways of managing an airway emergency in a child that don’t involve intubation. Medical management can sometimes avoid some of the risks of losing the airway that intubation might impose. Read More …
While assisting ventilation and protecting the airway are first priorities to stabilize a patient, treating the cause of the respiratory failure may require more than just ventilation and/or intubation. In fact, treating the cause can sometimes help you avoid the progression of respiratory distress to respiratory failure. If you don’t consider a potential problem or cause, you’re not going to be able to diagnosis it. This is a case of respiratory failure caused by hypovolemic shock and hypoglycemia in a child. Read More …
One of my readers recently asked a very important question about ventilating a patient with a bag-valve-mask device: “Is there an outlet for the expired air of the patient?” The answer is yes. When ventilating a patient we are concentrating, and rightfully so, on watching the lungs expand and verifying that we hear breath sounds. It is just as important to verify that your patient can exhale. All ventilation devices have a built in pressure relief valve, also called a pop-off valve, which allows you to balance the force needed to expand the lungs with the ability to the patient to passively exhale. Failure to allow exhalation can lead to patient injury from barotrauma. Read More …
When I’m teaching airway management to my Perioperative/OR nurses, I often recount the story of management of a young child’s postoperative respiratory depression. In addition to illustrating the importance of evaluating ventilation in addition to oxygenation, this case shows how good communication makes management of a critical event more effective. Read More …
A case of “can’t intubate- can’t ventilate is discussed which illustrates the importance of always using good techniques of basic airway management. Read More …
During intubation, any liquid in the mouth that obscures the view of larynx not only hinders visualization, it risks aspiration. We’re used to being able to rapidly suction the mouth clear or secretions, blood, or vomit and then have a clear view of the larynx. But sometimes, either because of continued profuse bleeding or massive emesis, fluid continues to accumulate while we’re watching. How can you manage this situation and successfully intubate? This article discusses two prior cases and offers suggestions on intubation when massive emesis or blood interfere with visualization. Read More …