Difficult intubation deliberation

Last week I posted on a tricky airway requiring AFOI (awake fibre-optic intubation) – see Awake Intubation Procrastination.

I got a bit of correspondence from the readers and a very special reader – Dr James DuCanto, M.D. from Milwaukee, Wisconsin, USA.  (yep, Happy days, the Fonz.. you know the place.)  You will recognize Jim D if you have seen the Emcrit or PHARM blogs – he pops up there with great airway demos on a regular basis.

Jim was keen to show me how he approaches the patient with a predicted “difficult tube” due to poor mouth opening – such as my patient in the above post.

Rather than just describe it – he has sent me (and you) a great demo video of his technique in action.  It is a nice trick – one that might come in handy if you are like me – a very amateur AFOI user, but often in “no-backout” situations. Click below for the multimedia, commentated video:

Recognised Difficult Airway (TMJ) Managed with Oxylator Air-Q and Optical Stylet

Now.  How cool was that – is that not the coolest thing out of Milwaukee since the Fonz?  A purist might say that AFOI is the gold standard, but this is “tiger terrritory” if you are not proficient with a scope and the topicalization involved.

Whilst we are discussing cool stuff (if you are on the nerdy side).  I have to mention my mate Dr Tim (KI Docs) has upgraded his site and gone to a new adress.  He is now at:   http://kidocs.wordpress.com/  (see Blog roll) – add it to your reading list.  Tim is nothing if no interesting, fearless campaigner for rural GPs lot and a major tech, anaesthesia geek.

Tim has just posted on Apps for Airways etc – his own review of a bunch of Apple Apps that come in handy in his practice as a small town GP-anaesthetist.  Check out his reviews – I think I might add a few to my pocket brain.

Amongst the apps was the ANZCA app for all things Anaesthesia – including topicalization of the airway.  I think this might be a way of saving a memory in my brain for the occasional moments when I need o know how to do this.

Dr DuCanto will be answering any questions and giving his time to you all – so watch the video, imagine yourself in your theatre and ask him what you think will be the stumbling block for your practice.  He is a seriously smart, and super nice guy – so get on to the comments and take this opportunity to learn from a master.  Casey


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