Difficult airway alert letter

[panetrain]

Anyone out there in private practice using difficult airway alert letters?

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[VisionaryTics]

Anyone out there in private practice using difficult airway alert letters?

ENT resident, but a couple of my attendings do this. They hand it to the patient. We also have some patients who get "difficult intubation" medical alert bracelets.

 

[pjl]

We do. There is a plain talk 2 paragraphs in it, then I edit the last paragraph each time to say what I used/failed at, and what worked, and what I would recommend trying in the future.
For us, this last paragraph is becoming less of an issue with Epic conquering the world. I can just see the records from any of the hospitals within 50 miles, and most of the hospitals in the state.


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[AdmiralChz]

We add it as a flag in the electronic chart and in their PMH. You can print out a letter through the chart as well.

 

[Psai]

We do. There is a plain talk 2 paragraphs in it, then I edit the last paragraph each time to say what I used/failed at, and what worked, and what I would recommend trying in the future.
For us, this last paragraph is becoming less of an issue with Epic conquering the world. I can just see the records from any of the hospitals within 50 miles, and most of the hospitals in the state.


Sent from my iPad using SDN mobile app

Good, the other EMRs are ****ing terrible
I long for the time when I don't have to spend time on the phone with a dumb intern at a crappy community program who doesn't know how to use their emr and is pissy with me. Hey dude, I'm not the one who dumped a trainwreck 6 month hospital course patient on you after an iatrogenic injury.

 

[fakin' the funk]

Anyone out there in private practice using difficult airway alert letters?

In EPIC you can add difficult airway / difficult intubation as a "problem" or in the "history." That's what I do now, and before that, I used to add sevoflurane as an allergy

 

[WheezyBaby]

You can flag it in cerner as well (pops up when you open pt chart)

 

[sigrhoillusion]

It always blows my mind when I open an old record and there is not intubation note... That is literally the ONLY thing I care about unless I'm looking at it for a specific incident.

 

[sevoflurane]

Anyone out there in private practice using difficult airway alert letters?

Yes. Absolutely. That is a true patient care issue and I'm always glad to get one from any patient. At the very least, I may not get a letter but the patient has read the letter and knows to give us a heads up.

And nice upgrade to your avatar.

 

[sevoflurane]

In EPIC you can add difficult airway / difficult intubation as a "problem" or in the "history." That's what I do now, and before that, I used to add sevoflurane as an allergy

Wut??? That's ludicrous.

 

[ZzzPlz]

On Epic, instead of clicking upper and lower dentures, does anyone else just drag the "M" logo for missing teeth over the entire picture of the mouth? God I love doing that.

 

[sigrhoillusion]

On Epic, instead of clicking upper and lower dentures, does anyone else just drag the "M" logo for missing teeth over the entire picture of the mouth? God I love doing that.

I showed my colleagues the M drag my second week at my new job and they found it amusing. I don't do it for edentulous patients, but will use it for large gaps and i think most of them do that now as well. Before you'd see a tooth chart with 50 small Ms...

 

[PTPoeny]

The version of epic I am most familiar with we could put a difficult airway in as a banner on the patient summary page -we had other ones for chemo, pregnancy, clinical trials, stuff like that. Makes it very hard to miss even if you don't go looking for the information.

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[pjl]

The version of epic I am most familiar with we could put a difficult airway in as a banner on the patient summary page -we had other ones for chemo, pregnancy, clinical trials, stuff like that. Makes it very hard to miss even if you don't go looking for the information.

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Ours is set up to annoyingly pop a banner for every provider to enter a chart EXCEPT anesthesiologists.
I find it amusing, so havent fixed that particular issue with our Epic people yet.


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[Ipassgas]

I hand out these business card sized difficult airway cards. Lists our name, hospital phone number, what went badly, what went well, and why we think it was bad.

We give it to the patient or family member, tell them to put it in their wallet and give it to any anesthesiologist they ever meet again.

I've had a few filter back to me. I guess the patients actually listened.

 

[IDontKnowWhoIam]

i dunno. how useful do you guys find these letters? obviously depends on previous anesthesiologist's skills and if your airway exam appears "normal" are you still doing an afoi? with video laryngoscope, the incidence of unanticipated truly difficult airway is very very low.

 

[vector2]

i dunno. how useful do you guys find these letters? obviously depends on previous anesthesiologist's skills and if your airway exam appears "normal" are you still doing an afoi? with video laryngoscope, the incidence of unanticipated truly difficult airway is very very low.

Unless the patient with the letter comes in with a trach scar or explicitly says or looks like very difficult ventilation, I'm putting them to sleep with glidescope as first look and foi in room for backup.

 

[Ipassgas]

They help me, because the rare normal looking difficult airway doesn't go to sleep until the glidescope is available. It'll keep me from getting into a situation where the fiber scope isn't nearby/set up and Bob is using the glidescope in room 7; meanwhile my room is turning into a cluster.

 

[ZzzPlz]

Totally agree that these letters are/can be useful. But agree with above that my glide scope and bougie are always immediately available and after about 12 months of residency I felt comfortable knowing when this beautiful combo won't result in successful intubation.
Trach scar, severe facial abnormalities, limited mouth opening, hx of radiation or other airway compression etc will get a much more thorough evaluation.