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

Dr Andrew Weatherall returns to stuff about paediatric airways, a bit of a companion to an earlier post with some practical tips. 

There are some things you’re taught from a very young age to believe in. Then it turns out it’s just plain wrong. Santa Claus. The Tooth Fairy. The Public Holiday Numbat. (Well, the last one might be specific to my upbringing.)

And in medicine there are plenty of examples those too. Oxygen is always good. You can’t manage trauma without a cervical collar. Then of course there’s pretty much everything about the paediatric airway. As if managing kids didn’t come with challenges anyway, we all get to work with information that is just plain wrong.

And there’s no mistaking that clinicians find paediatric airways difficult. The staff from Royal Children’s Hospital Melbourne have recently published a sizeable prospective study of emergency department intubations. This is from a big, clinically…

Helicopter Emergency Medicine Service (HEMS)

Fellow position – 6 month fixed term (ACEM accredited special skill term in Air Ambulance)

June 2015 – December 2015

Auckland City Hospital is the largest public Hospital in New Zealand and one of the best trauma centres in the country .The Emergency department is a modern purpose built, world class facility that opened in 2003. We have an enthusiastic team of clinicians who have expertise in resuscitation, ultrasound, simulation, toxicology and retrieval medicine. The closely knit team consists of  FACEM’s, Medical officers and Resident Medical Officers. The department sees about 60,000 adult patients annually with a high patient acuity.

The department in conjunction with the Auckland Rescue Helicopter trust run the Helicopter Emergency Medical service (HEMS) which has been successful in providing fully integrated care for trauma patients. The department is also active in research and is currently involved…

A debate is ongoing among #FOAMED social media about increasing first passage rate in tracheal intubation and some difficulties when using VL.

At the beginning of my experience with VL I experienced some difficulties, but with a radical change in technical approach I reached a good security on first pass success.

Here are my consideration and I hope will be useful for anyone is starting using VL

 

There are some fundamental differences in VL technique respect to DL, that makes the DL more easy and intuitive to pass the tube trough the cords.

The 3 axys theory for airway management

“Sniffing position” align the pharyngeal axis with the laryngeal one

Sniffing position

Perfoming Direct Laryngoscopy with the laryngoscope we align the mouth axis to have a direct view of the cords.

DL VIEW

 

 

 

 

 

 

 

 

 

 

This view coincide with the route…

At CareFlight another round of training many people is about to come up so it seemed like a good chance to ask Dr Sam Bendall for her first contribution. 

Sam is an Emergency Physician who is passionate about education, particularly all things simulation. She works half-time at Royal Prince Alfred Hospital in Sydney in the Emergency Department where she helped develop and teaches the RPA Trauma Team Training program, teaches on the CIN nurses programs and helped develop the ED Essentials program. 

At CareFlight she is a retrieval doc (the other half-time) and the Deputy Director of Education. The CareFlight Education Team are always up to interesting things – from training the Australian Defence Force medical on how to look after all things ballistic, medical, surgical and paediatric, to running the Pre-Hospital Trauma Course both in Sydney and other locations (Malaysia, anyone?), to running Trauma Care Workshops all over the country. Oh…