Erik Lichnovsky

[Tim Cook @doctimcook]

Are there enough awake intubations for all airway managers to become expert.

In UK
Around 2 million GAs per yr
Rate of ATI is probably below 1% but let’s peg it at 1%
Around 56% get intubated

So number of intubations available is
2,000,000 x 0.56 x 0.01
That’s 11,200

There are 16,000 anaesthetists in UK
Intubations per anaesthetist is well below 1 per anaesthetist per year

To me the idea that all anaesthetists can be trained in ATI & maintain skills fails because of simple maths….

In some centres, settings, theatres the % ATI will be much higher but overall 1% is a highish estimate

[Cliff Reid @cliffreid]

"I have colleagues who say you can intubate anyone with a size 4 blade so just always use a size 4 because you know you can do it. Well I can eat my breakfast with a spade, but I didn't"

😂😂😂😂

The inimitable @EMManchester via @scanfoam

https://t.co/ES1CsqLx4y

[Tim Cook @doctimcook]

The KEY point here is that the evidence review is not stating
“clinical examination is of no value”

What it DOES say is
“clinical examination is of no value in excluding oesophageal intubation”

Further, clinical examination can lead one down a path of misdirection that ends in patient harm

The mantra “I’ve got misting & chest rise & now I’m going to look at the capnograph” needs to be replaced by “what does the capnograph show?”

Once intubation is confurmed one can worry about endobronchial intubation.

Worth noting that with routine VL you also see exactly how far the tube passes the cords & endobronchsil intubation is very rare.

[Matt Green @mattgreencomedy]

Blitz Spirit!💥

[Matt Green @mattgreencomedy]

Liz Truss: human rights and authoritarianism

[Anton Spisak @AntonSpisak]

Wait until Moscow or Beijing invokes "the doctrine of necessity" to override its international obligations. The damage that UK ministers are doing with this bill - simply because they cannot accept their mistake and negotiate in good faith - goes far beyond Northern Ireland.

[Tim Cook @doctimcook]

@AirwayMxAcademy @NicholasChrimes @nosecglasses @docveall @jplomas @ketaminh @gaspasser The problem with bougie is it is either too straight from the outset or if curled up it unfurls (different rates for different bougies & temperatures) & only matches the curve needed very transiently.

This creates time pressure that is not there with the correct adjunct (stylet)

[nick abbot @NIAbbot]

All that red tape they're promising to get rid of? It's pesky rules that stop banks ripping you off, or industry polluting your air or pouring raw sewage into your river, or food companies using carcinogenic ingredients banned elsewhere. Freedom!

[Erik Lichnovsky @docski_el]

Great idea! @PeterMerjavy @LaureMartin13 @allieb0502

[Matthew Bigwood @MJTB1987]

The cool sticks arrived today! Time to ditch the ethyl chloride for something cheaper and more sustainable! #sustainable #coolstick

[Erik Lichnovsky @docski_el]

@johncampbell01 @dasairway @SouthernHSCT @DASDatabase @ATICS_SHSCT @LJMottram @LaureMartin13 @clmartian @derrygasman @MaryMolloy14 @COAIrl @setrust @dr_imranahmad @altgm @Sajay70 @NISAnaes @ObsAnaesNetwork @rosie_hogg @johnyholland @LloydTurbitt @kelly1_catriona @SOBAuk @OAAinfo @dastrainees @ProfEllenO That’s thanks to Dr Michael Jones; thanks to @dasairway for excellent safety project & @DASDatabase @Sajay70 for providing all the useful information and assistance to make joining process straightforward

[New York Times Opinion @nytopinion]

“Seriously I can just come out and say it? Call him a liar?” asks @JonathanPieNews, a fictional broadcast reporter created and performed by comedian Tom Walker, in a satirical video about Britain’s Prime Minister.
“God bless America.” https://t.co/Hu6Q6q8TBp

[hamish @CoomaDoc]

The identification and saline-solution concentrations provided by Becton Dickinson were:
2-methyl-2- propanol: 8.5 ppm;
2-methyl-2-butanol: 0.7 ppm;
ethyl-buthyl-ether: 0.4 ppm.

Sounds scary, and if you look them up they are used in various roles, including paint thinner

[hamish @CoomaDoc]

A patient asked me not to flush a PIVC with these, they hated the taste it caused. I was a bit dismissive, but then had the misfortune to need IV antibiotics. And I noticed that yes, a few seconds after they are used there is a volatile smell…….

[Tim Cook @doctimcook]

@AirwayHub @Fionafionakel @altgm @PeriopMedUCL @UCLDigiEd @uclh @vikimitchell @Kevin_Fong #AirwayMatters is a fabulous resource.

https://t.co/dYYxPTUJwI

If you've not looked at it...do look, join the more than 10,000 people from more than 140 countries who have already done the same.

[Nicholas Chrimes @NicholasChrimes]

Rethinking TT size selection in anaesthesia.

“Instead of opting for ‘the largest tube that the larynx will comfortably accommodate, we perhaps should consider using the smallest tube which permits the safe conduct of anaesthesia”

In @Anaes_Journal

https://t.co/yHEmDNQDKZ

[Adam Kucharski @adamjkucharski]

"This is a health issue with huge ramifications for social welfare and it's a welfare issue with huge ramifications for public health"

[Ross Hofmeyr @rosshofmeyr]

Well, If Nic agrees with me, we must be right!

These systems get in the way and do nothing for aerosols.

You can't use them in a distressed sick patient.

No coughing on intubation if you use appropriate drugs

A simple sheet to arrest droplets on extubation _might_ be useful.

[Jonathan Lis @jonlis1]

Never thought I’d see the day but kudos to Piers Morgan. Govt will do everything to scramble its way out of this but the evidence is mounting by the day: they catastrophically botched their response and hundreds of thousands may die needlessly as a result

[Anaesthesia @SouthernHSCT @ATICS_SHSCT]

Simulation training for the critically ill patient with #COVID19 today organised by @ATICS_SHSCT for theatre staff & some other specialties. All donned at beginning for training & reality check as they only doffed at the end. Not easy to wear & difficult to communicate!

[richard horton @richardhorton1]

Laura Kuenssberg says (BBC) that, “The science has changed.” This is not true. The science has been the same since January. What has changed is that govt advisors have at last understood what really took place in China and what is now taking place in Italy. It was there to see.