so so quick summary you've assessed the airway you've identified the difficulty bagmask lma
or ett if it is if it's very difficult you do something and if it's manageable you then do
something else if you have a very difficult airway that you think is virtually impossible you've just
got these options here essentially they're all spontaneous ventilation techniques awake fiber
optics awake look so literally just having the patient awake topicalizing the airway you know
ask one of your consultants to explain this to you when you're in theater and you have a look with a
video laryngoscope to see what you can see you can use regional local but that's not perfect in case
the regional fails uh awake tracheostomy again in the most dire situations this is what you might do
say for a tracheal laceration and maybe an inhalational induction but that's also got its
problems you will hear these as a solution rock uranium and reversal with sugamonics or sucks and
waiting it to wear off or test ventilating these are not ideal for example if you reverse someone
muscle paralysis or the sucks wears off you still have might have propofol on board or fentanyl
on board so the patient still might not breathe adequately and test ventilation is again actually
fraught with complications because you may have a lot of false positives with that as well
so i just want you to take away the knowledge that these are the optimal
techniques and as you get more advanced in your in your practice these are the ones you'll use
so you predict difficulty with bag mask lma and intubation
the junior doctor just cracks on but i want you to think like a consultant from day one
and take it to the next step i want you to modify the plan to tackle the difficulty
so i'm just going to go through these because they're just an example of what you can do
and you'll have all of these on the slides to you know to them to look at on youtube
and which you can then note down in your textbooks so you want to prepare equipment and staff for a
difficult bag mask adele nasopharyngeal range of masks positioning the patient well shaving
the beard leaving the dentures in and then giving a tailored anaesthetic meticulous preoccupation
rapid illet relaxant and then just use the ett or lma immediately without persisting
with bag mask ventilation that's so you've now predicted difficult bag masks that's what you do
with difficult bag mask typical lma again same thing prepare equipment and staff different lmas
different size of lma fast track pro still has higher seal pressure have an ett ready leave the
get get a good position leave dentures in and again meticulous preoccupation
and use ett immediately without persisting with an lma if it's failing
predicted difficulty with intubation similar format get everything ready video links are
bougie make sure it's out smaller tubes different blades modify the patient so position the patient
well take dentures out because dentures out is good for intubation but not as good for bag mask
and then same thing as before meticulous preoccupation maybe get up near oxygenation
with the um optiflow thrive and then maybe sucks or hide as rock to get the best conditions rapidly
so just gone through that you'll have all of that data for yourself so you'll identify the typical
airway and then make the plan see ico is rare focused airway assessment know your very difficult
options and then plan for the predicted difficulty well what's the exact reason that it's easier to
back mask ventilate without dentures in oh sorry with the dentures in but then you take them out
yeah it just provides a bit of structure to the face um goodell's elements also sit better
with the with the um with the dentures in um but you know give it a go like next time you have a
patient with dentures leave them in bag mask take them out bagmas and you'll just see how the uh
all of this stuff here just falls away and just prevents that seal okay let's get back to it um so
you