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Thanks to Alex Swain Director of Wodonga Emergency for inviting us up to Albury Wodonga to give an Advanced Airway Workshop. It was a great day and everyone played all out. It was a real treat to see the layered approach of teaching kick in and by the end of the day everyone could tube every mannequin repeatedly even the famous mannequin (dubbed this over several workshops) ‘Mr Evil’. This is even after I had changed all the anatomy i.e. tongue up and larynx partly swollen and vocal cords slammed shut!

What was also great was the discovery, as we called it, of the ‘Swain technique’. Alex thought about surgical airway and his solution was to make the cut in the cricothyroid membrane and then put a bougie in there, and railroad the tube over it. I LIKE IT!

Thanks again everyone. Airway is not difficult. It’s essential and with the right teaching you can learn how to establish an airway every time! You don’t need the fancy gadgets. You don’t need the thousands of dollars of equipment if you ‘cant afford it. All you need is:

-a curved blade laryngoscope (#3)

-a stylet in the endotracheal tube bent at 35 degrees i.e. ‘hockey stick’

-a bougie

If all else fails, then simple things  should be available, such as an intubating laryngeal mask or an ‘airtraq’ and have on standby  a 14# cannula and some tubing for jet insufflation or just a scalpel for the definitive surgical airway. Remember, the most difficult thing about the surgical airway is the decision to perform the surgical airway. As I’ve shown you, the technique takes only 20 seconds.

REMEMBER TO HAVE A PLAN. When will you decide to go to the next step. The definition of a failed intubation is 3 failed attempts at passing a tube by an experienced operator OR sats <90%. Know when you must make the decision to go to surgical airway. The most important thing about intubating is position and putting the blade in the right place i.e. the tip of the blade in the vallecula and  then pulling up in the direction of axis of the handle.

Make sure your basic techniques are sound. Practice those bag-valve-mask techniques as they may be what saves your patient in the end.

Well done guys and I look forward to catching up with the bunch that registered for RESUS 2010 at the conference in July.

Again, thank you all for your committment to learning.

Peter Kas


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