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Course Review: Advanced Airway Management Course Refresher

Beginnings of my difficult airway kit: Melker cricothyrodotomy 4.0 kit, 14G Cannula, 5ml Syringe

I am fresh from the Advanced Airway Management Refresher Course in Melbourne last week. It was an excellent educational event and I couldn’t recommend it more to any doctor involved in airway management. There are a few other courses around Australia which are also run by members of the Australian and New Zealand College of Anaesthetist Special Interest Group in Airway Management.

The course organisers have designed a contemporary curriculum instep with the recent NAP4 findings and sought to give airway doctors confidence in the dreaded can’t intubate, can’t oxygen situation (CICO). They have also acknowledged the rapidly advancing importance of video laryngoscopy in difficult airway management.

There is an anaesthetic focus and the course is heavily populated by anaesthetic registrars, consultants and fellows but there was a fair sprinlking of ED & ICU doctors.

The subtle touches such as an all-day barista (unlimited coffee!), excellent food, great venue and enthusiastic faculty made this $900 well spent.

The day consisted of four main areas with practical stations:

CICO -> Dr. Andy Heard gave an excellent lecture outlining a clear and simple approach, why this approach works, their experience from the wet lab in over 3000 CICO scenarios!. The techniques described were a 14G Cannula and Scalpel/bougie approach which we were able to practice on models. This is a link to a series of extremely useful videos produced by Andy on Youtube.

Simulation session -> 8 scenarios run in excellent facilities with realistic tension and equipment. Each participant took park in an individual CICO scenario with an airway nurse and senior registrar!

Video Laryngoscope session -> Short and sharp lecture on how, what and why we use these, the increasing evidence behind its use and common issues faced. The VL’s presented and available to use were Glidescope, Mcgrath, King vision, Storz CMAC and Airtraq. My favourite for institutional use is the Storz Cmac but am strongly considering buying the King Vision for my personal anaesthetic kit.

Fiber-optic and airway topicalisation -> All airway doctors should be familiar with the fiberoptic scope and its use even if it doesn’t appear daily in their work. This station was completely hands on and fun! There were great practical tips on how to topicalise an airway and approaches to an awake fiber optic intubation.

So what am I taking away from this course as a GP Anaesthetist?

  1. CICO techniques – what they are, clear algorithm on when to use it, when to move on, developing my own difficult airway kit
  2. Extubation planning – Having a plan is important as this is a high risk time for airway complications.
  3. Solidification of the role of VL’s in modern anaesthetic practice
  4. Topicalisation for AFOI but more pertinent is topicalisation for awake intubation with laryngoscope, have a look with a breathing patient
  5. Networking, learning from others experience!
  6. Introduction to the fiberoptic scope and familiarity of its use if I need to use it

 

So in summary, it is well recommended for GP anaesthetists as it teaches some essential techniques and gives you an opportunity to ask heaps of questions from the best airway people in the country!

Scalpel bougie technique

 

 

 

Comments

  1. minh le cong says:

    great review JR!
    whats your mailing address? will send you the latest Vividtrac for your testing and opinion.
    you already got my email I think..
    disposable CMAC like VL USB POwered for under $100 is coming
    iPad WiFi VL testing soon in Oz..

  2. Long way to travel from Broome!

    But this is the sort of thing that is needed, not just for FANZCAs and FACEMs and their senior trainees, but also for established rural docs

    I reckon the all day barista would be the clincher! I did the Paul Baker airway course last year in Sydney – similar topics, and I think NAP4 guiding the profession is vital

    Of course, Minh le Cong’s prehospital courses sound like da’ bomb…my only hesitation is whether they are designed for the prehospitalist or the rural generalist…

    High fidelity sim is very useful…as is chance to network and think though capabilities/what if’s for your own institution

    But wouldn;t it be great if we could have a roadshow of similar course content, delivered locally to rural docs?

  3. Jonathan Ramachenderan says:

    Thanks Minh. Would love to give them a go.

    TIm, I live in Albany! I think there are direct flights from Broome.

    I absolutely agree about an airway roadshow, maybe we can ask Minh to help assemble an all star team!

    I am learning so much this year doing solo anaesthetics. I am so keen on doing any airway course as I know I will pick up some tips on how to become a safer anaesthetist. As we aren’t surrounded in that rich tertiary atmosphere anymore, I will take all I can!

    I am pretty keen on the Prehospital course, great to learn another dimension on airway management.

  4. Absolutely. JR, you gonna be at the ACRRM conference in Freo this October?

  5. Thank you so much for your review of our annual advanced airway management refresher course and I am pleased you enjoyed it.

    The course is in its fourth year of running and my aim for this course was to address the needs of all those involved in the management of the airway and provide a forum for the participants to talk to experts in the field. That is why we aim to have so many well known instructors there to provide the more individualised discussion and demonstrations.

    The participants have always come from a range of specialities and for the first time this year we had a paramedic from the air ambulance. Specific topics covered were new technologies, CICO management, Extubation, Human factors, Topicalisation, Fibreoptics and conversion techniques.

    The instructors are drawn from around the country and we were fortunate to have Paul Baker , Keith Greenland, Andrew Heard, Gordon Chapman, Shannon Matzelle, Ed Debenham, Gerri Khong and Ernest Wong come from interstate to assist us. Unfortunate Minh wasn’t available. On the local front, we drew staff from all the major hospitals in Melbourne such as Reny Segal and his RMH team, Jon Graham from the Austin, Balan from Boxhill, as well as instructors from the Western, Peter Maccullum and Monash. Human factors experts Stuart Marshal and Tim Gray were available to run the simulation. In addition we also had a number of trainee instructors so ultimately ended up with an instructor to participant ratio of 25:40

    Certainly as course director and as Chair of the SIG I wish for greater interaction between us all, and believe events like this help engage people in the process. Hopefully we are in the process of arranging lecture course throughout australiasia for next year and I for one would be keep to have discussions about a roadshow. i will also add in a past preAlfred life I had the good fortune to dabble as a flight retrival and emergency department overseas so have an idea of the challenges you face at the coal front.

    Cheers
    Pierre

    • Jonathan Ramachenderan says:

      Hi Pierre

      Thank you so much for your comments, we are honoured to have your input on our blog.

      Wow! What a great day, I walked away more confident with a skill we merely talked about during my JCCA training.

      I do wish my GP Anaesthetic colleagues could have attended as they were extremely interested as I described the course to them.

      We are thrilled that there are discussions about roadshow as the different SIG’s could input into one amazing upskilling experience.

      Thanks again Pierre.

      Jonathan

  6. Nice one Pierre

    Seems to me that the needs of rural GPAs/ED docs and tertiary centre FANZCAs may be slightly different. I’m obviously keen to push the barrel for rural GPAs…and perhaps adding these sort of courses to each of the State-based GPA anaesthesia updates held annually would be the way to go…

  7. Reny Segal says:

    Hi all,

    Reny Segal here. Specialist Royal Melbourne Hospital, A/Prof at University of Melbourne and recent past chair Airway SIG. I instruct on Pierre’s course and we collaborate on all items airway. We’ve also established for some years now a much bigger airway teaching faculty which is now around 70 enthusiastic teachers strong. We’ve focused on teaching our juniors and seniors and I run a country wide program called NATCAT as well as our fibre-optic courses, College ASM’s and ASA ASM’s, overseas courses and so on. GP anaesthetists have been on the outer quadrants of our radar and discussion for a number of years now. Outer quadrants….not really by design, but rather by the fact that we’re up to our ears in work! Having said that, if we had to run a big all day event….A – Z of airway management for GP anaesthetist, retrieval docs, A & E docs, what do you estimate the demand to be? How many participants do you guys estimate would sign up for such a course? Keen to know.

    Anyway, I applaud your enthusiasm, your work and thank you for coming to play on Pierre’s outstanding course and making it such as success!

    All the best,

    Reny

    • Jonathan Ramachenderan says:

      Hi Reny, very privileged to have you comment on our post.

      Firstly I would say that the demand for an A-Z of airway management would be huge as most GP anaesthetists, ED docs and retrieval specialists are sponges for new advances and techniques. Futhermore a course directed towards us would gather momentum around the country especially being taught by your current airway faculty.

      As a rural GP and I believe running an Airway course at one of our Annual rural conferences (such as the upcoming Rural Medicine Australia Conference in Fremantle WA) would work well.
      This is because prior to the conference there are skill workshops and courses that are run for the rural GP’s which we get a federally funded upskilling allowance to attend.

      Apart from this running a travelling road show that Tim L mentioned would be an excellent idea. On our last Rural Health West Survey we had 95 practising GP anaesthetists in WA and in accordance with our CPD requirements, this would be an excellent way to maintain our skills.

      Lets keep this discussion going!

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