the airway is really practical section i care more about giving you frameworks and guidance
on how to make your rotation much better than actually obviously being able to do any of
this training on zoom c ico is kind intubate carnox j i want you guys to know just take 30
seconds and tell yourselves now when do you call something ico or carnegie can oxygen and call for
help so obviously when you're junior it happens straight away as soon as you can't do something
but as you get more senior i want you to be able to have very particular end points where you go
yep guys this is a cic situation let's get help let's get everything ready
i want you have some hard markers for that so take 30 seconds and make some rules up for yourself
you said a lot of really good things and part of it was mentioning that you're having
attempts at stuff and you failed with stuff so sometimes what happens is you might get you know
depending again depending on your seniority uh you may not be in the space of calling it cico
because you'll always have someone with you so as an advanced trainee this probably makes more
sense as well as when you're independent and so what they say is you had three attempts
at intubation and maybe failed oxygenation with a couple of techniques you're already on the way to
not being able to do the last technique so why not call it early and get mobilize all your resources
or maybe you've tried only one technique but the sats are already persistently no at night
low at 90 percent so you can whatever markers they are i need you to have some hard markers
where you go actually you know what i want to call cico early when i'm senior and practicing
independently because i don't need to get down that rabbit hole where things are already too late
so just have some really clear markers for me i've had you know i failed bag mask ventilation
and intubation i will call the cico whilst we've got some whilst i'm trying an lma intubation
it's important that this used to be something we didn't brand just like we branded anaphylaxis we
branded militant hypothermia had drills has a box for it this was a very late thing that
we took a long time to brand and that's what the culture of anesthesia is so i can imagine
that you'd be in a situation even now where you're tested on it maybe you're doing your
um interviews and they're asking you about this this becomes very relevant just to know what
cico is and how to brand it and when to call it that's probably the relevance right now for you
okay so my goals are maintaining oxygenation minimizing trauma to the airway and i'll give you
some resources talking about how we approach the surgical area but again not something i need to go
through now i just need to give you the structure knowing that also the easiest thing to perform
without failure and the easiest thing to explain in an exam situation or in one of your
assessments will be the scalpel bougie and size six intubate size six tube technique and i'll
again provide you the resources to learn that i'm just giving you the framework and the logic of it
the nap4 the national audit project from the uk showed that scalpel bougie had zero failures 100
success rate um and while the needle crike technique had some failures the reason we
teased the needle crank is because it's thought that we're far more familiar as an east list with
needles than with scalpels but i'd say that overall it's it's just one of those things
that you can have any preference you want but just trust me that it's far easier to
explain scalpel boozy techniques than explain needle crack techniques just from a practical
point of view and it has some good data to suggest that there's very low failure rates
just take a photo of this these are the resources that you'll end up reading when you
do your anaesthetic techniques and again i'll put it up on on youtube as well there's a lot
of advanced airway courses out there natcat and the ace course fantastic courses to learn the
practicalities of this and they will teach you a lot of this stuff be really great to do this in
practice but i say you know you're in theater as much as you can be to actually learn this as well
so the full airway summary of what i've taught you in the last you know 50 minutes or so
i want you to be able to assess and communicate the airway just like we did in those drills
if it's very difficult you've got advanced techniques like the awake fiber optic and
awake techniques if it's predictably difficult you'll really impress your bosses if you can plan
for each difficulty through those um steps that are outlined if it's unknown difficult you can
optimize your attempts and do those as drills to speed up your learning curve during your rotation
and finally being able to identify c ico practically means that you'll be able to
do that in your rotation in in an exam situation later on in real life as well and scalpel bougie
versus the needle technique scalpel bougie is far easy to explain and has zero failures you