PHARM June 2012 Competition

Hi folks. I got an email from an anaesthetist about DSI.

I want to post this as the first competition for PHARM. Send in your best response to this question below. Winner gets an autographed special edition RFDS mouse pad and copy of my Prehospital Anaesthesia syllabus.

Quote begins

“But I am a little sceptical of this DSI business. I can’t really see what is so ground-breaking about it. Isn’t it just a fancy name for adequate pre oxygenation, this time using BiPAP? 

I fear it is another example of how marketing is taking over the world 😉 Give it a brand name and now you can sell it as something new, even if it’s the same old shit as before”

Quote ends

Submit entries as comments on this post. Competition closes in 7days.


11 thoughts on “PHARM June 2012 Competition

  1. I think the novel points are the use of noninvasive ventilation (which can provide better preoxygenation in many patients) and the use of sedation to facilitate preoxygenation, rather than just jumping straight to intubation because the patient can’t tolerate noninvasive ventilation.

  2. I like the way this bloke thinks! DSI is differentiated from BPAP because it uses sedation to ensure the patient is tolerable to preoxygenation (important in an agitated, most likely dysoxaemic patient) and it uses standard oxygen delivery equipment which does not require a fancy BPAP machine or ventilator so can easily be preformed prehospital where they may not be available.

  3. The anesthesiologist is correct, we are ruthlessly marketing a technique to trick emergency medicine providers into safely pre-oxygenating their patients.
    The concept of providing sedation for pre-oxygenation is relatively novel. The concept of pre-oxygenation is not novel, but without this technique it can be challenging / impossible to safely pre-oxygenate this select population of patients, (the bad brain, good lungs patient / the good brain, bad lung hypoxic patients)
    “Marketing” generally implies some evil profit seeking behavior. The benefit we reap is a safe intubation in a controlled setting, with a benefitial side effect of preserving the scarce commidity of our patients neurons, and decreasing the likelihood of peri-intubation hypoxia related cardiovascular complications.
    If giving it a catchy name acheives this goal, so be it. I do not plan on writing a jingle.
    Rob Bryant

    1. As a Paramedic I can tell you that the goal in our education seems to have always been “securing the airway” rather than “ensuring appropriate ventilation and oxygenation.” Preoxygenation is a step we always verbalized during scenarios but never actually went through the motions.

      There has been a shift in education…but it’s not enough! EMS needs more focus on ventilation and oxygenation as a continuous therapy rather than the goal of a single procedure.

      Tools like DSI have the potential to change EMS airway management for the better (much like CPAP and SGA’s), but we’ve got a long road ahead.

  4. DSI is a practical application of the 6 P’s applied to Ventilation:

    Quite simply put, it’s “Patient Centered Ventilation.”

    As I mentioned in the podcast a couple weeks ago, I am of the opinion that most medical professionals do not really understand ventilation, that is, ventilation support during RSI, ventilation support during separation from mechanical ventilation, and much more. This is due to established practices, based upon dated information.

    I view this DSI technique as return to “Center” for Emergency Medicine. Anesthesiologists are starting to talk about using techniques like this (Chris Christodolou lectured on nasal cannula and apneic oxygenation at the 2010 Society for Airway Management Meeting), but are still behind the curve in my opinion to a great degree.

    Expecting a failing/dying patient to passively draw in adequate oxygen to tolerate RSI safely
    (with their rapidly deteriorating tidal volume and minute ventilation) is a product of past approaches and attitudes in medicine–it is dated, ineffective, and needs a total over-haul.

    DSI drew the attention of Dr. Bryant’s Nurses as “Damn Sexy Intubation” because the technique is patient-centered, that is, it puts the best interest of the patient first, above the needs of the treating caregivers. Nurses are naturally patient-centered, so they obviously applaud Dr Bryant for his efforts.

    “Patient Centered Airway Management” is the name of the game in this next decade as we all take massive steps forward in improving ventilation. Substantial upgrades in our understanding and abilities will occur as we all become thoroughly appraised of the technology in ventilation developed in the past 15 years. My two cents goes with the non-invasive ventilation technologies, and its counterparts, such as the Oxylator.




  6. DSI seems to be just a way to get the patient to tolerate oxygenation/preoxygenation that would not otherwise be tolerate without physical restraint (accelerated hypoxia).

    It does not appear to be complicated, or patented, or to even have a jingle.

    DSI could probably use a jungle, because it probably scares a lot of people, when the whole concept of wrestling with hypoxic patients is much more scary.

    All that matters is if it works better than prolonged wrestling with the hypoxic patient, making the patient more hypoxic, because the goal is to make the patient less hypoxic. This ranks up there with facial immersion in ice water for good airway management.


Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

%d bloggers like this: