The Vortex Approach

Implementation tool for airway Mx by @NicholasChrimes. Addresses human factors considerations to facilitate real time use by teams during a crisis.

[Project for Universal Management of Airways @UniversalAirway]

This PUMA foundation guidelines rec facilitates implementation of a rec made by ALL guidelines: to limit the number of attempts at ETT & SGA

Reliably doing this reqs counting them out loud in real time

“1st attempt at intubation”

In @Anaes_Journal

https://t.co/LqzCV3Etqx

[Project for Universal Management of Airways @UniversalAirway]

The PUMA Foundation guideline recommends all in-hospital airway practitioners should be able to intubate a patient awake.

It doesn’t have to be with a FB; it can be w VL, using a SGA conduit or via the neck.

Free full text in @Anaes_Journal

https://t.co/LqzCV3Etqx

[Difficult Airway Society (DAS) @dasairway]

A message from DAS President Prof Alistair McNarry @altgm

Wondering why you should be at #DASWales26? Al has a few very good reasons..

📅 11–13 November 2026
📍 ICC Wales

Please visit
https://t.co/dbp7gGSAAH for further details and to register

[Dr Rani Chahal @DrRaniChahal]

@DrHuw @davetheraw @AirwayMxAcademy Our job as experts is to unpack intuition: What are we seeing? What patterns are we recognising? What makes us change course?

The ultimate demonstration of mastery is not knowing what to do, it’s being able to explain why, and teach someone else to do it.

[Dr Rani Chahal @DrRaniChahal]

@DrHuw @davetheraw @AirwayMxAcademy Calling expertise a “sixth sense” or “muscle memory” risks turning mastery into mystique.

Yes, complex airway management demands experience. But expertise that cannot be articulated cannot be reliably taught, examined—or improved.

[Project for Universal Management of Airways @UniversalAirway]

Technique for hyperangulated videolaryngoscopy.

From the PUMA guidelines for providing a foundation for airway management

Full free text in @Anaes_Journal
https://t.co/LqzCV3Etqx

[Project for Universal Management of Airways @UniversalAirway]

Neck rescue technique

Detailed instructions for training & an emergency guide to prompt implementation

From the PUMA guidelines for providing a foundation for airway management

Free full text forever in @Anaes_Journal

https://t.co/LqzCV3Etqx

[Project for Universal Management of Airways @UniversalAirway]

Extubation algorithm

Helps link evaluation to strategy

From the PUMA guidelines for tracheal extubation

Free full text forever in @Anaes_Journal at https://t.co/3DNPinhl3N

[Project for Universal Management of Airways @UniversalAirway]

Awake extubation sequence.

Provide trainees with a framework to approach extubation or use for potentially challenging extubations.

From the PUMA guidelines for tracheal extubation.

Free full text forever in @Anaes_Journal at https://t.co/3DNPinhl3N

[Project for Universal Management of Airways @UniversalAirway]

Airway exchange catheter user guide

From the PUMA guidelines for tracheal extubation.

Free full text forever in @Anaes_Journal at https://t.co/3DNPinhl3N

[Project for Universal Management of Airways @UniversalAirway]

Protective sequence extubation

Analogous to RSI at intubation this provides recommended precautions when extubating patients ‘at risk’ of aspiration.

From the PUMA guidelines for tracheal extubation

Free full text forever in @Anaes_Journal at https://t.co/3DNPinhl3N

[Project for Universal Management of Airways @UniversalAirway]

Management of laryngospasm

From the PUMA guidelines for tracheal extubation

Free full text forever in @Anaes_Journal

https://t.co/3DNPinhl3N

[The Vortex Approach @VortexApproach]

RT @UniversalAirway: Extubation checklist

From the PUMA guidelines for tracheal extubation

Free full text in @Anaes_Journal
https://t…

[Project for Universal Management of Airways @UniversalAirway]

Algorithm for troubleshooting inadequate ETCO2

From the PUMA guidelines for preventing unrecognised oesophageal intubation

Free full text forever in @Anaes_Journal

https://t.co/fcMbLTlJpB

[Project for Universal Management of Airways @UniversalAirway]

Criteria for ‘sustained exhaled CO2’

Provide a clear trigger for identifying when ETCO2 is ‘inadequate’

From the PUMA guidelines for preventing unrecognised oesophageal intubation

Free full text in @Anaes_Journal

https://t.co/fcMbLTlJpB

[Project for Universal Management of Airways @UniversalAirway]

Consensus guidelines for preventing unrecognised oesophageal intubation.

The most widely supported airway guidelines ever published.

Free full text in @Anaes_Journal

https://t.co/fcMbLTlJpB

[Nicholas Chrimes @NicholasChrimes]

@doctimcook @UniversalAirway @Anaes_Journal This line in the Foundation guideline (citing the same paper) paraphrases the comment you made to me that inspired me to lift my HAVL game!

[Nicholas Chrimes @NicholasChrimes]

@DrHuw @docmartin22 @AirwayMxAcademy @emedfocus @doctimcook Exactly why the @UniversalAirway guidelines ask you to instead make an individualised assessment of whether management will be ‘rapid & reliable’. The words ‘difficult airway’ do not appear in any of the guidelines.

[Project for Universal Management of Airways @UniversalAirway]

Technique for cricoid pressure

From the Guidelines for providing a foundation for airway management

Full free text forever in
@Anaes_Journal at https://t.co/LqzCV3Etqx

[Tim Cook @doctimcook]

@UniversalAirway @Anaes_Journal If I might also offer there is something that could be usefully added

-head and neck position

I believe a key reason folk go on about difficult intubation with good view and difficult tube delivery is failure to position H&N correctly

Flextension