Ben Porter

🇬🇧 ICM & Anaes working in 🇦🇺. Educator. ML. Complex Systems. Graphic Design. He/him.

[CICM @CICMANZ]

Are you a CICM Trainee or SOT in NSW?

John Hunter ICU are presenting our NSW ICU Trainee Education Day: ‘What we do matters’ from 20 - 21 Feb.

We will also be hosting a Trainee Formal Project Presentation - with prizes!

More info and to register: https://t.co/arNCwL4bXz

[Tim Cook @doctimcook]

Tim’s top tips for airway management
2013 to 2024 a 🧵

Was asked to discuss some top tips at @GAMCLondon
Let’s start in 2013

Was asked to write a paper on this for Anesthesiology News in 2013

I leant heavily on NAP4

Sadly no link to the article but you should be able to piece the article together from the pictures.

1/n

[Tim Cook @doctimcook]

Great thread Cliff

Please allow my minor pedantry & high geekery

The tip of the (standard) igel does not reach the top of the oesophagus

For most SGAs this is true but not for the igel. If you line up the airway orifices of a series of SGAs you’ll find the igel is shorter from airway orifices to tip. During development Mohammed Nasir intentionally shaved of the tip bit by bit. This was intended to reduce ingress of the tip into the upper oesophageal sphincter (ie the horizontal fibres of cricopharyngeus) with tube aim of reducing dysphagia & dysphonia after anaesthesia. It worked with igel having better oropharyngeal recovery characteristics than other SGAs.

However the downside was a poorer seal with the oesophagus.

So compared with the ProSeal LMA (oesophageal seal 70 cmH2O, airway seal median >32 cmH2O) the igel has lower seals (10 cmH2O, & 24-26 cmH2O respectively). It also has a small drain tube [ & please let’s not call it a gastric drain].

This leads to a theoretical increase risk of aspiration with igel ba other high performing 1nd gen SGAs. It’s theoretical, unproven & likely unprovable…..but might be important particularly with the important role of igel in resus and PHEM.

So now - if anyone’s left - we move to the igel plus. The redesign has reintroduced the longer tip so now IT WILL reach the upper oesophagus.

I was chatting to Dr Nasir yesterday who explained that longer tip allows for
-the ramp designed to facilitate intubation thru igel (FOB still recommended)
-a larger drain tube
-a perhaps unexpected increase in airway seal pressures

I look forward to the objective evaluation of the new device.

Some interesting things going on g on in the field of SGAs which has been a quiet area for a few years….

[NSW Health @NSWHealth]

Junior Medical Officer applications for 2024 are now open. @NSWHealth JMOs work with some of the most experienced and skilled medical professionals in Australia, across a wide range of specialties.

Applications close 8 August 2023: https://t.co/eCvA0lqjrM

[Stephen Hearns @StephenHearns1]

Fatigue severely compromises our ability to make decisions, communicate and work effectively in a team

A couple of Core Cognition infographics describing how our cognitive ability is affected and some tools to maintain performance

https://t.co/GjZyDlO1ch

[Tim Cook @doctimcook]

So the #NAP7 panel are deep diving into the enormous data on UK perioperative cardiac arrests collected in 2021-2

What would readers of this : patients, doctors, AHPs etc actually like us to include?

What questions might we answer that we’ve yet to think of?
@NAPs_RCoA

[ANZICS @anzics]

CPR in space? Fascinating talk from Gordon Cable ⁦@ANZICSACCCN_ASM⁩ ⁦@anzics⁩

[Cliff Reid @cliffreid]

In resuscitation, both efficiency (doing things right) and effectiveness (doing the right things) are important

It’s possible to do the right things wrong and the wrong things right

Often in the latter case there’s a lack of insight and inappropriate self congratulation

[Steve Mathieu @stevemathieu75]

A difficult story to read ⤵️

Intensive Care is an incredibly rewarding but sometimes gruelling specialty even in ‘normal’ times. The psychological impact of the pandemic on health care professionals must not be underestimated @ICS_updates @SteveBarclay

https://t.co/L4Ym7uCWEA

[Andrew Petrosoniak @petrosoniak]

How does @NASA think about decision making?

This podcast with Chief Knowledge Officer, Ed Rogers is outstanding.

Two themes that resonated

1. Hindsight is 20/20 BUT only for what actually happened

2. Learning occurs thru reflection

My thoughts🧵
1/

https://t.co/4tPWoHbEkW

[Ben Porter @biddaba]

On top of three concurrent directorships, setting up the ECMO service, establishing a local PICU and the overseeing the construction of a massive adult ICU expansion from 6 beds to 28 are a few of the many achievements of Dr Ken Havill’s incredible career. @NewcastleICU

[Ben Porter @biddaba]

Dr Jeram Hyde interviews critical care legend Dr Ken Havill as he reflects on a career in ICU in NSW after his recent retirement. Fascinating to hear how far ICU has come over the last 25 years…no more routine awake nasal intubations for all ICU patients! @NewcastleICU

[Newcastle ICU 🇦🇺 @NewcastleICU]

Want ICU education and lunch with a view like this? Come work at John Hunter Hospital ICU!

[Newcastle ICU 🇦🇺 @NewcastleICU]

We’re lucky enough to have A/Prof Patsy Tremayne come to talk to our ICU Registrars on succeeding in exams and training #icu

[Ben Porter @biddaba]

Dr Sarah Crosby telling us her inspirational and emotional story about returning to practice, not once but multiple times, and the challenge in rebuilding confidence. “Work out how to fill your bucket.” @NewcastleICU @NewcastleSim

[Newcastle Simulation @NewcastleSim]

We're looking for a colleague interested in #humanfactors and #simulationinhealthcare to join us as a researcher in 2023 @DrGetafix

[Ben Porter @biddaba]

Leaning about the ⁦@NewcastleICU⁩ mentorship program. “It’s a bit like mentor tinder!”

[Ben Porter @biddaba]

John Hunter ICU sustainability program champion Lauren Garrity talking about recycling in critical care. @NewcastleICU

[Ben Porter @biddaba]

Be signal and not noise for a family when breaking bad news: great advice from expert ICU social worker Kate Jordison. Silence is your friend.

[Ben Porter @biddaba]

Slaying sacred cows with @NewcastleICU social work team…not all ICU doctors are experts at breaking bad news…