Jacob Wawryk

[Jacob Wawryk @warkwarkwark]

@vikaskansalHQ My family plan was working fine until this

[Jacob Wawryk @warkwarkwark]

@NicholasChrimes That's just a colloquial definition of difficult though - rather than the '>2 attempts at direct laryngoscopy to secure a tube' definition.

Who is formally assessing someone's airway, deciding they almost meet 'difficult airway' criteria and then doing nothing with that?

[Jacob Wawryk @warkwarkwark]

@NicholasChrimes Easy/hard and what was used is all that matters.

Is POGO even useful in research? Seems unlikely.

[Jacob Wawryk @warkwarkwark]

@qantas has taken a $6k payment from me and not made a flight booking. Repeated calls to them just need to be "raised to the relevant department" within 10 business days. But at least they ask if I'm okay being called by my first name every single call.

[Jacob Wawryk @warkwarkwark]

@AirwayMxAcademy @NicholasChrimes That...is just being early in the algorithm. They called for help too late in your scenario. If you hadn't turned up and been able to oxygenate the next step should have been neck rescue.

[Jacob Wawryk @warkwarkwark]

@bruceppdl @NicholasChrimes Having witnessed everything from straightforward cannulation to a severed spinal cord in attempted eFONA, I would suggest that your predicted success rate once you get to eFONA is irrelevant. You should try it anyway, as the final part of a robust airway management plan.

[Jacob Wawryk @warkwarkwark]

@NicholasChrimes @narkosepadawan Not if laryngospasm is the problem. Paralysis or deepening will fix that without removing the device. But I agree with your general point.

[Jacob Wawryk @warkwarkwark]

@UniversalAirway @MonashAnaes Schrödinger's endotracheal tube - it's both not in the trachea and protecting the trachea at the same time.

I can't help but feel this language around a tube being dangerous to remove is only detrimental.

[Jacob Wawryk @warkwarkwark]

@SpontVentGA @JordiShahab @precordialthump @drdavidbrewster @CCRJournal Interesting data. How representative do you think confidence is of ability in these contexts, and do you think it skews high or low? I know this wasn't what was studied.

[Jacob Wawryk @warkwarkwark]

@NicholasChrimes What's the thought behind the 'is removing the tube dangerous?' line in the algorithm?

With no CO2 the vast majority of likelihood sits with ETT being malpositioned - so is it not actually making things more dangerous for those 'is removing the tube dangerous' situations?

[Jacob Wawryk @warkwarkwark]

@NicholasChrimes If there's no benefit to mastering DL then I think this is fair. The 2 techniques are quite different so this may also be a reasonable premise.

[Jacob Wawryk @warkwarkwark]

@NicholasChrimes Do you think that teaches the same degree of troubleshooting? Or is that actually unnecessary now?

Not arguing for making things needlessly more difficult, but most difficult airway algorithms maintain some kind of phrase regarding attempts by 'most experienced laryngoscopist'.

[Jacob Wawryk @warkwarkwark]

@NicholasChrimes There's no clinically significant benefit in the vast majority of patients. In those 3SDs outside the mean that benefit becomes clinically significant, and anaesthesia is all about the significance of these edge cases.

Besides which, better solutions exist. Recapture and reuse.

[Jacob Wawryk @warkwarkwark]

@NicholasChrimes I'm 100% certain you've passed your pharmacology exams and know that isn't true - you would have given examples where desflurane was advantageous at the time, and I'd dare say could still do so.

Can you get by without? Sure. That's the Monash way.

[Jacob Wawryk @warkwarkwark]

@NicholasChrimes There's a difference between using it routinely and having it available for select cases - sometimes it is the best choice.

Any patient where failure to wake is a significant possibility is one example.

How many cars off the road was removing desflurane responsible for again?

[Jacob Wawryk @warkwarkwark]

@NicholasChrimes But that would be 𝘭𝘦𝘴𝘴 complicated.

[LilMoonLambo @LilMoonLambo]

BREAKING: SATOSHI IS BACK