Coding an Anesthesia medical simulator game: Narkosis. Testing preoxygenation, intravenous needle placement, sedation, tracheal intubation, vapor upkeep and extubation. Hopefully, our patient wakes up? (Flight analogy: Testing anesthesia take-off, flight and lading :D) youtu.be/IqEPUs55Lq8
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πŸ‘€︎ u/SputnikSK
πŸ“…︎ Apr 17 2021
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[Article][Supplementary appendix]Effect of a fluid bolus on cardiovascular collapse among critically ill adults undergoing tracheal intubation (PrePARE): a randomised controlled trial

I would like to access the supplementary material of following article; article itself is accessable through sci-hub. Thanks in advance!

  • DOI/PMID/ISBN: https://doi.org/10.1016/S2213-2600(19)30246-2

  • URL

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πŸ‘€︎ u/CaCD
πŸ“…︎ Feb 02 2021
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Tracheal Injury Post-Intubation

Hi there! I would like to share a brief clinical case. 56-year-old patient. Not relevant clinical history. She was admitted after 10 days of COVID pneumonia. She was with a mask reservoir bag at 15 L / min. She made her condition worse so the assistant did a quick intubation sequence (difficult airway). At 2 hours, the pt has entered refractory hypoxemia. Physical examination revealed subcutaneous emphysema on the chest and face. The chest radiograph revealed pneumo-mediastinum (not PTX). Endoscopy showed a tracheal lesion on the posterior wall, near the carina.

What would you do in this case? What treatment do you choose, open or endoscopic surgery?

What equipment do you often use in a difficult airway? Here we have supraglottic devices, stylet and FBC. We do not have a video laryngoscope.

https://preview.redd.it/b0mxep9m4cf61.jpg?width=2977&format=pjpg&auto=webp&s=02807bce46ffbd171434f873f795b37d9f148760

Anyway be careful with the wire and stylet. Specially in women with low height

Grettings (sorry the english), chau!

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πŸ‘€︎ u/awatsurra
πŸ“…︎ Feb 03 2021
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Steps to tracheal intubation (it hurts , don't go outside)
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πŸ‘€︎ u/FutureDr_
πŸ“…︎ Apr 01 2020
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A quantitative evaluation of aerosol generation during tracheal intubation and extubation associationofanaesthetist…
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πŸ‘€︎ u/PartyOperator
πŸ“…︎ Oct 06 2020
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Today's CT anatomy: The Epiglottic Vallecula is often used as a landmark in tracheal intubation for placement of the laryngoscope blade to optimize glottis visualization. It is a depression posterior to the tongue root between the epiglottic folds in the anterior wall of the oropharynx.
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πŸ‘€︎ u/FPIMD
πŸ“…︎ Mar 01 2021
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Risks to healthcare workers following tracheal intubation of patients with COVID‐19: a prospective international multicentre cohort study - El‐Boghdadly - - Anaesthesia - Wiley Online Library onlinelibrary.wiley.com/d…
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πŸ‘€︎ u/alfentazolam
πŸ“…︎ Jul 10 2020
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Difficult tracheal intubation resources.

Had a difficult airway the other day and tried every trick I knew and still was unsuccessful with intubation. MD used a fiber-optic bronchoscope with success.

Where can I find / what are some good resources on difficult tracheal intubation?

Thanks in advance!

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πŸ“…︎ Mar 12 2017
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[ARTICLE] Guidelines for the management of tracheal intubation in critically ill adults.
  • DOI: 10.1016/j.bja.2017.10.021.

  • URL

Please note: I am aware that the article is accessable through Sci-Hub. The version on Sci-Hub, however, is a temporary manuscript without some crucial information. A final version with graphics and tables included would be greatly appreciated. Thanks in advance!

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πŸ‘€︎ u/CaCD
πŸ“…︎ May 06 2018
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Trans-Tracheal intubation. Securing a difficult neonatal airway! twitter.com/j_a_porter/st…
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πŸ‘€︎ u/ENT-Paramedic
πŸ“…︎ Sep 19 2016
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Successful Tracheal Intubation In Children With Difficult Airways: Seven Secret Techniques Every Anesthesiologist Should Know prehospitalmed.com/2015/0…
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πŸ‘€︎ u/rhizomaticaxyz
πŸ“…︎ Aug 20 2015
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Comparison of McGrath Series 3 and Macintosh Laryngoscopes for Tracheal Intubation in Patients With Normal Airway by Inexperienced Anesthetists: A Randomized Study prehospitalmed.com/2016/0…
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πŸ‘€︎ u/rhizomaticaxyz
πŸ“…︎ Jan 21 2016
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MSCT to evaluate tracheal stenosis in intubated patient

It may sound dumb but to evaluate tracheal stenosis in an intubated patient with MSCT.

Do I need to extubate him/her for more accurary. Provided that a physician is there to intubate him/her right away after the scan ?

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πŸ‘€︎ u/wanincoco
πŸ“…︎ Feb 26 2019
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A sobering read for anybody who is on the fence about getting vaccinated reddit.com/r/nursing/comm…
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πŸ‘€︎ u/Therkster
πŸ“…︎ Oct 13 2021
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pylori's Physiology Bites - The physiology of ageing and illness, and its impact on critical care decision making

Welcome!

This is a series I am going to be working on where I endeavour to cover various topics in physiology intermixed with clinical pearls to impart some knowledge that doctors of most specialties and grades will hopefully find useful when looking after acutely unwell patients. Join me as we dredge through the depths of anaesthetic exam revision to answer important questions like "why do CT ask for a pink cannula", "why frusemide is okay to give in AKI", "why is hypoxic drive a bunch of horse manure" and many more. Pick up some of this material and you'll be well on your way to becoming a pernickety anaesthetist, whether you like it or not!

Questions, comments, feedback, and suggestions are both encouraged and welcome.


Previous installments:


The physiology of ageing and illness, and its impact on critical care decision making

Decision making regarding escalation to critical care is often something that confuses and frustrates many, on both sides of the aisle. There is no hard and fast rule, no recipe to follow. This should serve more as an insight into the minds of intensivists and what we try to weigh up when deciding on what to do, as opposed to a rule book that rules in (or out) admission to intensive care. Perhaps the most important lesson to takeaway from this is that decision making is necessarily subjective. Truthfully, we don't know what we're doing, we're at best guessing, and ITU consultants frequently disagree with each other on admissions (other things too). If you genuinely think escalation to ITU is appropriate, refer away. I apologise in advance if you are (or have been) met with hostility or anger, I can't control other people! Ultimately I can't fault doctors for wanting what they think is the best care for their patients no matter how judgemental I end up being internally.

Physiology of ageing

This is an important thing to consider because age isn't just a number. Independent, fit and well Bernard at 70 is not the same as 40 year old Oliver, even if they have the same exercise tolerance. Whilst there is no age that makes you automatically ineligible for ITU, we do have to understand and appreciate that the body changes as it ages, and consequently your ability to deal with and recover from criti

... keep reading on reddit ➑

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πŸ‘€︎ u/pylori
πŸ“…︎ Oct 27 2021
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Intubation during arrest

What is your practice for intubation during arrest. At out institution we still do, although generally never pause for compressions.

It seems a move among a lot of ER blogs and ER, Nurse, RT tiktok influencers to say stop intubating. To my knowledge most of that data is for out of hospital arrest where EMS doesn’t have great rates of getting tracheal intubation on first try and pause for long times. In fairness its likely hard to intubate out of hospital. So I buy using and LMA. Though lots of rct have found no difference.

But there are very few in-hospital studies. No studies for zero pause compressions intubation with DL or VL.

To me the out of hospital isn’t necessarily able to be extrapolated, but makes me think more about how long we pause during intubation more than just saying β€œintubation bad.” It seems like the medical community lately is so willing to totally abandon practices in the face of like a handful of inconclusive data in order to be cutting edge. But is less willing to actually interpret data.

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πŸ‘€︎ u/MetabolicMadness
πŸ“…︎ Oct 24 2021
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I thought I was going to have to have to body bag a coworker yesterday.

ER paramedic is intubated in the ICU currently. She’s in her fifties, healthy. Exercises daily, eats organic, takes herbal supplements. If she caught COVID, she’s healthy right? Who needs an β€œexperimental” vaccine. She told people she’d take her chances with the virus.

The virus almost won yesterday. Shift change, we’re giving report when we notice on the monitor her sats are in the sixties and dropping. We run in emergently and begin lavaging and suctioning. We think it’s another mucus plug. Sats still dropping. We notice tracheal deviation. Call the offsite intensivist, he says draw an ABG. Not helpful. No cardiac arrest, but we call a code blue anyway to get a doctor at the scene. Put a stat X-ray in. It takes more than five minutes for them to arrive. No pneumothorax, thank god. But tracheal deviation to the left, insert chest tube and fluid pours out. Sats increase as fluid is released. Patient stabilized.

Coworkers watch on in horror as they fear they about to lose one of their own. They’re friend. Someone who has worked at the hospital for over a decade.

This virus is not a joke people. It does not discriminate against the young or old. Healthy or sick. Get fucking vaccinated. Spare your loved ones that dreaded call.

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πŸ‘€︎ u/brwneyes_6579
πŸ“…︎ Aug 31 2021
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Resuscitation of the infant

During the delivery of an infant who has an estimated gestational age of 42 weeks, you note that the amniotic fluid looks like pea soup and contains thick particles of meconium.

Of the following, the MOST important initial step in the resuscitation of the infant is to

A. aspirate the gastric contents

B. determine the Apgar score

C. initiate tracheal intubation

D. provide positive pressure ventilation

E. suction the hypopharynx

A?

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πŸ‘€︎ u/ProDiJaiHD
πŸ“…︎ Nov 08 2021
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ACPs, our royal colleges, and HEE ​are active in researching standards of care in replacing us as medics

Whilst I'm trying not to be a broken record, I do think the point needs underlining. Especially to those who don't think there's risk of our jobs and roles being eroded by these ANP/ACP types.

https://doi.org/10.1016/j.ienj.2020.100879

> Productivity of Advanced Clinical Practitioners in Emergency Medicine: A 1-year dual-centre retrospective analysis > > ACP roles are increasingly prevalent in UK Emergency Medicine. > > There is currently little evidence evaluating their overall impact. > >This study of ACP productivity demonstrated rates of 1.03–1.53 PPH. [patient per hour]

https://www.magonlinelibrary.com/doi/abs/10.12968/bjon.2021.30.8.470

> Evaluation of the safety of inter-hospital transfers of critically ill patients led by advanced critical care practitioners > > This quality improvement project provides an example of safe and effective advanced practice in an area that is traditionally a medically led domain. ACCPs can provide an alternative process of care for critically ill adults who require external transfer, and a benchmark for audit and quality improvement.

https://twitter.com/DentonGavin/status/1276940954059132930/

> Our ACCP team meet with ICS transfer guidelines and are at least at parity in efficacy and safety with Dr led transfer.

https://journals.sagepub.com/doi/full/10.1177/1751143718772957

> Can Advanced Critical Care Practitioners provide safe advanced airway management? > > This audit of ACCP delivered tracheal intubation, qualified ACCPs working within a framework of appropriate clinical supervision, were found to be able to perform tracheal intubation to a comparable standard to doctors working in intensive care or emergency medicine.

RCEM are actively involved in supporting ACPs in EM. As demonstrated by the vice president of RCEM himself:

https://twitter.com/RCEMPolicyVP/status/1396462443736469508

> 2/2 RCEM ,unlike many Royal Colleges, is defined by the specialty 'Emergency Medicine,' not the profession (so not Royal College of Emergency Physicians) We embrace and value our ACP colleagues, who compliment our hard pressed workforce.

https://twitter.com/RCEMACPChair/status/1377696058340470792

> 8th July RCEM are holding a virtual study day on developing & sustaining an ACP service. Topics covered - pearls and pitfalls from well established services, governance issues , supporting trainee in difficult, role of supervisor and much more. Spread the word.

https://t

... keep reading on reddit ➑

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πŸ‘€︎ u/pylori
πŸ“…︎ May 22 2021
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Question about trauma scenario while waiting for EMS

Hi everyone!

I have a question I was thinking about that I wanted to try to get some input on. I am an RN but have no experience in trauma/ER (all labor and delivery and newborns here!) and recently I learned about a friend's family who got in a very severe car accident. As a result of the accident, a child around 10 years old had a trachea laceration from what I understand. Thankfully a nurse witnessed the accident and was able to provide help until EMS arrived and last I am aware the child has survived and is responsive even after a couple of strokes although there may be other long-term complications.

This situation got me thinking that I really would not have known what to do in that situation. I tried to do an internet search for guidance and everything brought up intubation/trach/etc, however, obviously, that is not something I could do. So, if I was in that nurse's place above what is the best thing I could do for the person while waiting for paramedics?

This is my thought process... apply pressure to the wound with whatever I have available to try to limit bleeding and sealing the outside wound as best as possible to allow for the patient to breathe assuming no other head/neck injuries and they are breathing spontaneously. I'm thinking this gives the best chance for oxygenation even with the risk of aspiration from the blood.

However, I was also thinking if there is other significant facial/neck trauma and the possibility no air exchange was occurring from the nose or mouth, would it be better to try to keep the tracheal lac clear to allow for breathing almost like a trach (assuming the patient is spontaneously breathing)?

I realize this is probably something that is going to be exceedingly rare to ever actually encounter, but, I would rather feel prepared and know what to do to give the patient the best chance possible. If this isn't allowed here, please let me know and I'll delete it, but I thought since y'all work in the field, y'all would be the best ones to help me with guidance and my thought process. Thanks!

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πŸ‘€︎ u/lexiegurl91
πŸ“…︎ Aug 04 2021
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Blind Girl Here. Give Me Your Best Blind Jokes!

Do your worst!

πŸ‘︎ 5k
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πŸ‘€︎ u/Leckzsluthor
πŸ“…︎ Jan 02 2022
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Dropped my best ever dad joke & no one was around to hear it

For context I'm a Refuse Driver (Garbage man) & today I was on food waste. After I'd tipped I was checking the wagon for any defects when I spotted a lone pea balanced on the lifts.

I said "hey look, an escaPEA"

No one near me but it didn't half make me laugh for a good hour or so!

Edit: I can't believe how much this has blown up. Thank you everyone I've had a blast reading through the replies πŸ˜‚

πŸ‘︎ 19k
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πŸ‘€︎ u/Vegetable-Acadia
πŸ“…︎ Jan 11 2022
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What is a a bisexual person doing when they’re not dating anybody?

They’re on standbi

πŸ‘︎ 11k
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πŸ‘€︎ u/Toby-the-Cactus
πŸ“…︎ Jan 12 2022
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Geddit? No? Only me?
πŸ‘︎ 6k
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πŸ‘€︎ u/shampy311
πŸ“…︎ Dec 28 2021
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What starts with a W and ends with a T

It really does, I swear!

πŸ‘︎ 4k
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πŸ‘€︎ u/PsychedeIic_Sheep
πŸ“…︎ Jan 13 2022
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I wanna hear your best airplane puns.

Pilot on me!!

πŸ‘︎ 3k
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πŸ‘€︎ u/Paulie_Felice
πŸ“…︎ Jan 07 2022
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E or ß?
πŸ‘︎ 9k
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πŸ‘€︎ u/Amazekam
πŸ“…︎ Jan 03 2022
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No spoilers
πŸ‘︎ 9k
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πŸ‘€︎ u/Onfour
πŸ“…︎ Jan 06 2022
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Covid problems
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πŸ‘€︎ u/theincrediblebou
πŸ“…︎ Jan 12 2022
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These aren't dad jokes...

Dad jokes are supposed to be jokes you can tell a kid and they will understand it and find it funny.

This sub is mostly just NSFW puns now.

If it needs a NSFW tag it's not a dad joke. There should just be a NSFW puns subreddit for that.

Edit* I'm not replying any longer and turning off notifications but to all those that say "no one cares", there sure are a lot of you arguing about it. Maybe I'm wrong but you people don't need to be rude about it. If you really don't care, don't comment.

πŸ‘︎ 12k
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πŸ‘€︎ u/Lance986
πŸ“…︎ Dec 15 2021
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Spi__
πŸ‘︎ 6k
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πŸ‘€︎ u/Fast_Echidna_8520
πŸ“…︎ Jan 11 2022
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What did 0 say to 8 ?

What did 0 say to 8 ?

" Nice Belt "

So What did 3 say to 8 ?

" Hey, you two stop making out "

πŸ‘︎ 9k
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πŸ‘€︎ u/designjeevan
πŸ“…︎ Jan 03 2022
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