Ooops, all those paragraph breaks got lost when hit 'post comment' - making the above comment look an incoherent rant rathe than a structured post. Minh can u patch it up?
Some good points Minh. Personal experience of 6/12 anaes rotation a decade ago when doing EM training, was that the exposure was lead by anaesthetists - who whilst expert did not appreciate the needs of an EM trainee. Approach to the difficult airway (then) invariably involved an AFOI. Going back to do a year of anaesthetic upskilling more recently, under the auspices of the JCCA in Oz in order to work as a rural GP-anaesthetist, I still struggled to get exposure to the necessary skill set from many anaesthetists - indeed, the only ones who 'got' what the needs of an isolated rural practitioner were likely to be were those who practiced retrieval medicine. This was in 2011...and ideas like apnoeic diffusion oxygenation, RSI checklists, sux vs roc and approaches to the surgical airway, let alone iLMAs were just off the radar of the majority of FANZCAs.
Speaking to FACEMs recently, they bemoan difficulty of accessing airway training for their registrars - all too often an EM trainee comes back from 6/12 of anaesthesia having mostly done elective ASA I/IIs on LMAs...plus ca change since my experience a decade ago!
We agree that the emergency airway is a very different beast. Is there scope to allow EM/ICU colleges to train in this arena? i think so. And I think core competencies need to be defined and tested.
Bottomline, I think that with DAS algorithms / Vortex and the emergence of affordable, robust equipment, then we can see a fairly standardised, teachable and assessable means of approaching the emergency airway, overlaid with not just sim but translation into the resus room, incorporating team work and checklists. Essentially a coming together of tall the airway FOAMed stuff we've been banging on about for past 2 years.
My thoughts on this are distilled in the 'difficult airway kit for remote/austere' talk - basically a toolkit for intubation out of the elective OT environment...which is entirely built upon DuCanto and your work.
Ooops, all those paragraph breaks got lost when hit 'post comment' - making the above comment look an incoherent rant rathe than a structured post. Minh can u patch it up?
Some good points Minh. Personal experience of 6/12 anaes rotation a decade ago when doing EM training, was that the exposure was lead by anaesthetists - who whilst expert did not appreciate the needs of an EM trainee. Approach to the difficult airway (then) invariably involved an AFOI. Going back to do a year of anaesthetic upskilling more recently, under the auspices of the JCCA in Oz in order to work as a rural GP-anaesthetist, I still struggled to get exposure to the necessary skill set from many anaesthetists - indeed, the only ones who 'got' what the needs of an isolated rural practitioner were likely to be were those who practiced retrieval medicine. This was in 2011...and ideas like apnoeic diffusion oxygenation, RSI checklists, sux vs roc and approaches to the surgical airway, let alone iLMAs were just off the radar of the majority of FANZCAs.
Speaking to FACEMs recently, they bemoan difficulty of accessing airway training for their registrars - all too often an EM trainee comes back from 6/12 of anaesthesia having mostly done elective ASA I/IIs on LMAs...plus ca change since my experience a decade ago!
We agree that the emergency airway is a very different beast. Is there scope to allow EM/ICU colleges to train in this arena? i think so. And I think core competencies need to be defined and tested.
Bottomline, I think that with DAS algorithms / Vortex and the emergence of affordable, robust equipment, then we can see a fairly standardised, teachable and assessable means of approaching the emergency airway, overlaid with not just sim but translation into the resus room, incorporating team work and checklists. Essentially a coming together of tall the airway FOAMed stuff we've been banging on about for past 2 years.
My thoughts on this are distilled in the 'difficult airway kit for remote/austere' talk - basically a toolkit for intubation out of the elective OT environment...which is entirely built upon DuCanto and your work.
http://kidocs.org/wp-content/uploads/2013/03/smacc2013-7-00-leeuwenburg.ppt
http://kidocs.org/wp-content/uploads/2012/09/plans-a-b-c-d-summary-ki-hospital.pdf
We need to train Docs to this sort of approach, wherever they will practice intubation - roadside, ED, ICU, rural etc