Dennis Reichert

@EM_VATA @AirwayMxAcademy @EM_RESUS @AirwayLegend What are your thoughts on nebulised adrenaline in addition to Abx and i.v. Dex in cases like this?

@EM_RESUS @AirwayLegend @AirwayMxAcademy Was stable, talking, able to lie down 4CT. Sitting posn FNE, Tolerated well. No Anaesth with AFOI expertise. Called ENT at tertiary 30min away. Disc transfer without intervention. IV dex + Abx. Had AFOI in OT+drainage of abcess. I 2 think DL/VL potentially dangerous

@AirwayLegend @AirwayMxAcademy @EM_RESUS 37 yr old sore throat, dysphonia, speaking but with difficulty. CT suspicious of necrotising epiglottis.

Just nodding with every tweet of this thread.

@VirtueOfNothing @Anaes_Journal Yes that’s a good point.

@Robowski2000 @Anaes_Journal Valid consideration. However, it’s common practice to have a paeds nurse involved in a paediatric resuscitation, even outside of the paeds ward setting. Why should theatre be exempt from this?

Interesting. Whereas parental presence during resuscitative events in ED is common and embraced by paeds/EM teams, this good practice does not seem to extent to theatres? How does it differ? If the child arrests (or is at high risk of doing so), why not offer it?

@AirwayMxAcademy @AntonBooth_SAS @doctimcook Therefore, I would use HA-VL in patients with predictors of difficulty With a slightly lower threshold as I want to use it regularly to refine technique

Decisions about suitability of ICU admission are not about “extubation”. When there is doubt it’s usually about -whether the patient will benefit, long term, from the burden of treatment that ICU imposes -whether exposing the patient to risk of complications from both their disease and invasive critical care treatment is in their interests - whether this is also true taking into account the extraordinary deconditioning that occurs rapidly during critical illness - whether their condition is reversible or is part of their secular physiological decline towards the dying process - whether the worsened quality of life the patient may experience if they survive would be acceptable to them Critical care is more than organ support. Sadly, as we have so few beds compared to other high income country healthcare systems it’s also sometimes about whether there is space and how to best manage that. Although this article is about whether to operate it captures much of the nature of making these important difficult decisions …-publications.onlinelibrary.wiley.com/doi/abs/10.111…

Happy New Year all, here’s to accidentally writing “2024” in the notes until at least April.

@rejschaap @LowkoTV Very interesting. Thank you and a happy Christmas!

@Robowski2000 @LowkoTV For the kids Sinterklaas is still the most popular guy in December by far. For adults it's more about Christmas, but obviously less about Santa Claus. Christmas Eve was traditionally the time to visit church, the emphasis is more on 25th and 26th, which is when we visit family.

Nothing quite like making tiramisu at 8 am

@rejschaap @LowkoTV Really? Nothing on the 24th or 25th?

@Robowski2000 @LowkoTV On December 5th actually

Great to see a national process for this - I think the same in Scotland. Is that right @altgm? Funnily enough we’ve just got rid of ours…… We have all we need for emergencies on each airway trolley in theatre -routine VL -routine use of 2nd gen SGA -box with scalpel/bougie/tube So no clear need for a rescue cart Our excellent airway leads have replaced with an awake intubation cart @RUHAnaesthesia

@Robowski2000 @amit_pawa @RAPMOnline Call me old-fashioned if you will (and you will) but for painful lap surgery I tend to pop some diamorphine in the cerebrospinal fluid - it works terribly well.

@Robowski2000 @RAPMOnline You are not alone in this thought process- and between you and I - I agree! That’s kinda why I wanted to see an anterior QL arm as I wondered about visceral analgesia with that! Don’t tell @jeffgadsden !

@Yashas777 @amit_pawa @RAPMOnline I definitely think though that some form of RA (either local infiltration, abdominal wall blocks or QL blocks) is helpful for post operative analgesia.

@Yashas777 @amit_pawa @RAPMOnline Personally I don’t usually see a significant enough stress response in our patient population to warrant an abdominal wall block. But that’s also another question: do the abdominal wall block before or after the operation?

For Laparoscopic Abdo surgery- are you performing blocks? If so which? This study in @RAPMOnline compared TAP to Lateral QLB and noted a difference in dermatomal loss of sensation, but not analgesia. I’d love to see an arm with Anterior QLB. Thoughts? rapm.bmj.com/content/rapm/e…

@amit_pawa @RAPMOnline @jeffgadsden Thank you. Will try to stick to Bluesky. 🙂

pEEG and ketamine If youve spent any time around TIVA and EEG You'll know that ketamine can increase the BIS number - Perhaps you never use ketamine because every time you do your processed EEG keeps telling you the patient's 'awake' 1/12

@Anaes_Journal I’ll bite. That conclusion isn’t consistent with the data the paper presents. 👶🏼 HFNO isn’t used to keep oxygen levels high, it’s to stop oxygen levels getting low 👶🏼 the numbers are low - 60 patients in a study of uncommon events is inadequately powered. 1/3