Prehospital and Retrieval Medicine – THE PHARM dedicated to the memory of Dr John Hinds

Below you can read the answer to my question (Cricoid pressure in new DAS (Difficult Airway Society) Guidelines: still on?) from Chris Frerk, Chair of DAS guidelines group:

“Mario

Thanks for your thoughtful comments

The website posting is necessarily brief and there will be more detail in the developing paper.

Your point is well made re cricoid pressure vs BURP and external laryngeal manipulation.

The paper is predominantly aimed at anaesthesia for surgery in the UK though we recognise that the existing 2004 guidelines are referred to in ED and ITU settings. Current UK practice does endorse cricoid pressure for RSI (which includes most ED intubations) though we are aware this is not the case in other countries – we’ve taken the stance so far that this paper isn’t the place to debate RSI techniques but we do have a developing section on RSI.

 I think we do…

The excellent Dr Paul Bailey returns to provide more practical insights from the bit of his work that involves coordination of international medical retrieval. This is the second in (we hope) a recurring series which started here. 

Greetings everyone, it’s a pleasure to be back for the long awaited second edition of this humble blog. Looking back at my first foray into this unfamiliar world I’m pretty happy with how it reads and I think that it worked out well. If any of you have questions, I’m happy to participate in a bit of to and fro in the comments section.

Where to from here? I thought we might talk about risk. It’s hard to know exactly where to start, but it is fair to say that there are clinical risks, aviation risks, environmental and political risks – and there are probably more but I can’t think of them right…

Background story:

This is the post I wrote about the DAS April 2015 draft on intubation Guidelines:

DAS (Difficult Airway Society) released a draft of its intubating Guidelines for evaluation and comment before definitive update.

Previuos 2007 Guidelines are available here DAS Intubation Guidelines

This is the link to download the Update (April 2015) on DAS intubation guidelines 2015

What’s new on this draft:

Plan A (face mask ventilation and intubation)

• Preoxygeneation is now included (to mantain even during the intubation, O2 nasal cannula).
• VL is considered as standard approach (same leve than DL).
• Cricoid pressure is no longer mentioned and replaced with BURP.
• BURP has to be released if difficult intubation(laryngoscopy is predicted.

The authors invite all to send suggestions and comments to intubation@das.uk.com.

Last night (Italy time at least) on Twitter a debate about the presence on less of cricoid pressure aroused:

23:06 @MyEmergencyMed: Difficult Airway Society 2015…

62 yrs old male found unconscious GCS 6 (E1,V1, P4). Sign of vomiting and inhalation. Profoundly hypoxic, hypertensive (BP 200 over 110). Pupils were miotic with anisocoria dx>sx.

The team, after aspiration of gastric material from the airway, decided for airway control, before transport. The patient is overweight with a “taurine” neck so VL was chosen as first choice for airway management.

RSI (Fentanyl. Midazolam, Sux) performed. In the video you can see a detailed explanation of the VL technique that is slightly different from DL technique.

 Post-intubation management included ventilation optimization (EtCO2 35-38 mmHg in suspected intracranial hypertension) oxygenation and haemodynamic management.