fakin' the funk

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In case any of you haven't seen this yet...

[YOUTUBE]http://www.youtube.com/watch?v=bDRTzmuwMnQ&feature=player_embedded[/YOUTUBE]

http://www.youtube.com/watch?v=bDRTzmuwMnQ&feature=player_embedded
Awesome, funny, a little weird, kind of unnecessary, and totally genius.

My question would be: is a topically anesthetized airway really a "secure" airway? Or am I too used to thinking of aspiration and obstruction as CHRONIC risks a la the gomers that I'm dealing with in internship?
 

Planktonmd

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Awesome, funny, a little weird, kind of unnecessary, and totally genius.

My question would be: is a topically anesthetized airway really a "secure" airway? Or am I too used to thinking of aspiration and obstruction as CHRONIC risks a la the gomers that I'm dealing with in internship?
Awake intubation with airway anesthesia (topical and nerve bocks) is not intended to prevent aspiration, and certainly not indicated in situations where your main concern is aspiratuion like in bowel obstruction or true full stomach.
An awake fiberoptic intubation with airway anesthesia is ideal IMHO in cases where you anticipate difficult intubation and difficult ventilation either because of some anatomical problem that you detect or because of a known previous history of difficult intubation and ventilation.
If you anticipate difficult intubation and also have increased risk of aspiration then you will need to design a plan that combines both concerns like maybe placing an NG tube and emptying the stomach prior to the awake intubation.
 

urge

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In Soviet Russia, we trach ourselves...
 

rsgillmd

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So how often do you guys use the cricothyroid local lidocaine approach? I have never seen that before.
I never did in residency because the attendings didn't let me. However, I have done it as an attending. Part of my initial hesitancy was how well the patient would tolerate it. So I got together with another colleague and he let me do it his way -- attach the syringe to a 20 ga. Jelco type catheter. When you are in, slide the catheter off and you can inject without fear of a needle causing any damage. The patient tolerated the procedure well -- just a little cough at the end. Absolutely no reaction to me going through the cords, or inserting the tube.

I've done it several times since then and love it.