Tag Archives: Airway

MCSA/ICAR/WSAR Mountain Medicine Workshop 2016 Presentations

As promised, open access to my two talks from the Mountain Medicine Workshop hosted at the MCSA in Cape Town, 2 May 2016.  Please feel free to use for reference, or direct questions to me!

Austere & Confined Space Airway Management:

Practical Wilderness Analgesia:

Airway Pic-of-the-Week 2014_0825

Kudos to those that responded with answers to the last picture РI hope you found it stimulating!  Jesse Mumba gets the virtual prize (perhaps a sponsor of real prizes will manifest!) for sending in a complete and thorough answer first.  He correctly identified a tracheosophageal fistula on the Gross C (Voit 3B) type, which is the most common (about 86% of cases).  To be fair, it could be the much rarer Gross D, which features a proximal fistula with the oesophagus as well, but this is very unlikely.
 
TOF_Gross_C_Labelled
The main anaesthetic challenge (other than surgery in a small neonate with a significant chance of other, including cardiac, abnormalities) is the difficult in providing positive pressure ventilation, as the gas flows preferentially into the stomach via the fistula rather than the lungs.  The conventional technique is to maintain spontaneous ventilation through a gas induction until the fistula can be occluded.  We achieved this in the above case by passing a Fogarty balloon catheter into the fistula under vision with a 2mm rigid telescope and then intubating with a 2.5mm ETT.  Significant simultaneous tachycardia and sympathetic stimulation was noted in the anaesthetic personnel, but the infant did very well.
This week’s picture of the week comes with complements of the September edition of Anesthesiology:
Reproduced from Anaesthesiology online (article and image openly accessible by clicking the image above); credit to the authors, dos Reis Falc√£o et al.
Reproduced from Anaesthesiology online (article and image openly accessible by clicking the image above); credit to the authors, dos Reis Falc√£o et al.
Transorbital intubation!  Yip, you read that right.  The case report in the September 2014 edition of Anaesthesiology is accessible here and will fill in the details.  Remarkably, this is not the first time this technique has been described in the literature, although prior reports involved the use of a fibreoptic scope rather than direct laryngoscopy.  It goes a long way to illustrate that a good knowledge of the anatomy, technical skill with a wide variety of devices and a flexible approach are the cornerstones of excellence in airway management.
Eye can’t beat that this week…nor will anyone else around the globe.

Airway Pathology Pic-of-the-Week – 2014_0811

I got a good response to a missive sent out via email, so we are trying this again. This is what I sent previously:

Vocal cord papilloma

Numerous people responded correctly. It is indeed a papilloma, which was causing variable obstruction as it swung back and forth through the vocal cords on it’s pedicle. It was managed by videolaryngoscopic intubation with a microlaryngoscopy tube (MLT) followed by surgical debulking by the ENT. Here is a nice simple summary of MLTs and other special ETTs used in ENT surgery, although they erroneously attribute the acronym RAE. ¬†Click here for more about ETTS and to see the correct source.

Pic for this week:

AirwayPath_2014_0811
This is a bronchoscopic view from the mid-tracheal level in an infant. Can you tell:
A) What is going on here?
B) Is there a classification system for this pathology, and can you fit this case into it?
C) What is the main challenge and advised technique for dealing with this airway?

Let me know if this is interesting/useful ūüėČ

Airway presentation & page update

I have uploaded a new presentation titled ‘What I Am Thinking About When Working With Airways‘ which was created for our institution’s Anaesthetic Nurse Short Course. It’s a Prezified distillation of my thoughts, tips, tricks and tribulations; don’t expect a lot of text. The audience seemed to enjoy it – hopefully it is useful to stir some ideas. The link and a fully browsable window of the Preza are to be found on the Presentations page. Photos that aren’t mine are collected from Google. (Google is like a gum elastic bougie… your friend in times of need!)

I’ve also done some housekeeping on the page and made theme-sorted direct links immediately available. Check it out and feel free to comment.

The Prezi’s need some time to load all the images if you don’t have a fast connection. Please note that these presentations are intended for a medical audience and may contain images some individuals could find disturbing.