Are you an Occasional Intubator?
If you are a reader of our comments sectio, you will know about Dr Minh Le Cong – RFDS Doc from Cairns who is one of the most enthusiastic teachers I have come across in the ether. If you want a sample of his pearls of wisdom – go to my post on Preoxygenation Pearls and check out the comments section.
One of his passions is teaching airway skills to GPs / occasional intubators. He also loves debunking medical mythology and dogma – and he has taken aim at the classical Rapid Sequence Intubation (RSI) and cricoid pressure.
So if you are an occasional intubator, or just would like to know what all the controversy is about – Minh has allowed us to put up his lecture on the topic.
The Occasional Intubator for Broome Docs blog
Check it out – let me, and Minh know what you think. I am sure there are some Anaesthetists out there who have something to say? Casey
About The Author
Casey Parker
I am a GP working in Broome, NW of Western Australia. I work as a hospital DMO (District Med Officer) doing Emergency, Anaesthestics, some Obstetrics and a lot of miscellaneous primary care. Also on the web as @broomedocs | + Casey Parker | Contact
minh,
Fantastic talk. I wish I had this information when I went to work remotely. My intuabtion rate went from 1 a forthnight to 1 every year!
This is why I felt the need to go to every airway course I could and read about airway management.
The emergency airway is different to the “standard” anesthetic airway and is good that we are know starting to acknoweledge this.
thanks Ray. I know what you mean. I am definitely an occasional intubator..I average about one emergency airway/intubation every 2-3 months. IN fact tonight I have done a RSI on a retrieval for a guy in status epilepticus. IN doing it I broke a couple of laws of traditional anaesthesia, RSI and airway management. I gave BVM oxygenation during apnoea whilst waiting for sux to work. I did not use cricoid pressure. In fact first thing I did when I encountered the grade 3 laryngeal view was to use external laryngeal manipulation as Levitan taught me and bang the view was there and tube went in.
Its these simple things that are practical and effective that are not routinely taught in our hospital anaesthetic terms. Next RSI try the nasal cannula apnoeic oxygenation technique..it is a game changer yet it took an emergency physician to teach it to me not what I learnt in hospital terms during my training.
Minh,
Just a quick note. I had a head injured patient a couple of days ago GCS fluctuating between 3-6. Sats 99% on NRb but evidence of aspiration. Did the standard head injury intubation. Only difference I added the nasal cannula as described by levitan and weingart. Absoultely fantastic no desat what so ever the sats stayed at 99% the entire apnea period and the entire period that I was looking after the patient.
Ray