rRob is back with another airway pearl!
hi folks
Remember that Dr Rob Bryant, the Kiwi Doc in Utah, with the Damned Sexy Intubation podcast and free downloads of protocols he helped develop? Here he is again! Thanks big guy, we love you!
From Rob’s email :
Minh,
Here is an analogy that I have been batting around for a while and wanted to share with you, if it seems useful, feel free to post it.
The oxy-hemocoaster analogy idea is mine, the ‘bad roller coaster buddy’ idea came from my colleague Mark Oraskovich, a local EMS medical director who works in my group, and is currently running a prehospital RSI study with a rapid response paramedic crew performing the intubations.
Here is my take on the oxyhemoglobin dissociation curve and the identification of difficult airways, or difficult physiological states.
This is the oxy-hemocoaster, or a roller coaster depiction of the oxyhemoglobin dissociation curve. Imagine the scariest roller coaster you have ever ridden, and that is what you are putting your sick patients on when you intubate them. I am not a fan of roller coasters, and never want the coaster to get to the steep part of the ride, hence, when I intubate, I try to keep my patients from the steep part of the curve with high flow O2, apneic oxygenation, and good positioning.
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Now, imagine you actually like roller coasters, and have a front row seat on your favorite roller coaster. The seat next to you is empty, and you are really looking forward to having the front row to yourself.
Who are the people you would least like to sit next to you?
The morbidly obese man that makes it impossible to close the safety bar.
A third trimester pregnant woman, same issue with the bar.
A very drunk man that is already vomiting.
A visible agitated man, talking to himself, that could jump from the coaster
Any child, especially a screaming one with increased oxygen consumption
The guy that just pounded 2 beers and a large pizza.
A COPD patient that looks like a walking cigarette, who is packing their own oxygen tank, and is breathless walking 3 feet.
Anyone you wouldn’t want to sit next to on a roller coaster is going to be someone that will present significant airway, or physiologic issues that will necessitate optimization of their pre oxygenation, and an ‘A-game’ intubation strategy.
Thanks for the great blog and podcast,
Rob
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Rob Bryant MD
Utah Emergency Physicians
Prehospital and Retrieval Medicine - THE PHARM dedicated to the memory of Dr John Hinds 
Great slide – reminds me of happy times at fairground as a k’
Next, who’s up for a ride on the ghost train?
Won’t be long before those LITFL crowd come along to do a similar version for the ‘tunnel of love’
Also, with the effect of pulse oximeter delay (As per Scott Weingart’s most recent podcast), you would feel like you are on the back of the roller coaster – in the “safe oxygenation zone”, whilst your patient is actually in the front of the roller coaster in the “critical hypoxaemia zone”!
Great way to attach pulse ox lag to the roller coaster analogy! I like it!