Tuesday, February 17, 2015

You think you can manage the airway ?

Airway management is core for an anaesthetist's practice. Nowadays, Emergency Physicians are expected to be competent at it too despite the reduced importance in the ALS or ACLS guidelines. It goes back to ABC, A=airway. When A is compromised one can in a way forget the others as the mishandling of A will go a looonngg way!

During my MOship, only when one is comfortable with managing straight forward airways, one would be allowed to be oncall. And this would be certified via peers working with one, never self assessment or presumption. This is the one subject where theoretical knowledge without the hands on experience would be useless. One can be really good at reckoning which is which and how to handle things in theory, but when it comes tho practice; its the years of experience will count for any mishaps or possible issues. There is no time to think, its just the output needed on managing the basic principles. 
More so if it is the paediatrics population. How time is of essence. Many anaesthetist would frown upon paediatrics cases when they are posted up. Its the fear of problems that can come and handling paediatrics especially the smaller ones can be really delicate. Its not just a small person but its a totally different population and universe! 
I have evolved from the first day i was asked to intubate electively. I did make numerous attempts in resuscitation during my medical days, but those were when we gung hoed and just shoved the laryngoscope in! It was later in anaesthesia i do really understand which views we were looking for and of course with supervision. One of the first few persons who taught me how to intubate was Tok Man, who later became our senior MO in Sungai Buloh. He did not pursue his post graduate studies but his experience was abundant that he trained from the start a specialist like me. 
Its easy to say relax and take your time when you were in the midst of completing the task. Preoxygenation is important as it gives us the time to take a step back and figure why things happen when you do not get to intubate the first time around. It must have been fun for my MOs and specialists then seeing me jittery and jumpy in managing the airway whilst observing me. The same fun i had when i was training my HOs and MOs to intubate! haha 
"Bang.. tak boleh intubate ni.." Young healthy ASA 1 with features as easy intubation. 
"Abis tu?"
"Abis tu.. camana ni bang.. tolonglah.."
"Boleh bag kan?"
"Boleh.. boleh.. try intubate 2 kali ni tak dapat?" 
"Pandai-pandailah kau.." and he left the room for coffee..

Haha similar story? :) 

No comments: