Technique for cricoid pressure From PUMA Guidelines for providing a foundation for airway management Full free text forever in @anaesjournal.bsky.social at associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/...
Project for Universal Management of Airways
@universalairway.org
PUMA is a global collaboration to produce universal guidelines for airway management that can be applied independent of geography, discipline or context.
Technique for hyperangulated videolaryngoscopy. From PUMA Guidelines for providing a foundation for airway management 2nd page of graphic on next post Full free text of guideline in @anaesjournal.bsky.social at associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/...
Technique for neck rescue From the PUMA Foundation Guidelines Download high res images & more detailed description of tech at universalairway.org/downloads Full free text forever in @anaesjournal.bsky.social at associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/...
Universal guidelines for providing a foundation for airway management now available for download. Free full text forever in @anaesjournal.bsky.social 🔑🔓♾ associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/...
Project for Universal Management of Airways: guidelines for providing a foundation for airway management
Introduction Before commencing airway management in any individual patient, a foundation should be provided that establishes the capability of organisations, departments and practitioners to underta...
associationofanaesthetists-publications.onlinelibrary.wiley.com
Standardising capnograph & other monitoring also recommended by PUMA. associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/... 3 important points re capnograph specified in SALG recommendations. www.salg.ac.uk/salg-publica...
Anaesthesia@anaesjournal.bsky.social · 2y agoThe Safe Anaesthesia Liaison Group recommends standardising waveform capnography as a white solid filled-in graph at the bottom of the monitor display. Is there compliance with the SALG standard in the UK? #AnSky doi.org/10.1111/anae...
International Consensus Guidelines for Preventing Unrecognised Oesophageal Intubation. Free full text in @anaesjournal.bsky.social Supported by @dasairway.bsky.social @safeairwaysociety.org @asahq.bsky.social @rcoanews.bsky.social & many more… www.universalairway.org/puoi/support
Preventing unrecognised oesophageal intubation: a consensus guideline from the Project for Universal Management of Airways and international airway societies*
Across multiple disciplines undertaking airway management globally, preventable episodes of unrecognised oesophageal intubation result in profound hypoxaemia, brain injury and death. These events occ...
associationofanaesthetists-publications.onlinelibrary.wiley.com
Nicholas Chrimes@chrimesy.com · last yr.Yet another case of death from unrecognised oesophageal intubation. The circumstances of the case are tragically similar to previous cases: good clinicians succumbing to cognitive bias. Please familiarise yourself with the guidelines to avoid falling into the same trap. @anzca.bsky.social
The Safe Airway Liaison Group in the UK have released a statement on displaying the waveform capnography trace in line with the @universalairway.org recommendations. The CO2 trace should be: 1. The bottom trace 2. White 3. Shaded in www.salg.ac.uk/salg-publica...
SALG | SALG Statement on Waveform Capnography
salg.ac.uk
The @universalairway.org guidelines for preventing unrecognised oesophageal intubation are supported by @safeairwaysociety.org, @anzca.bsky.social & @dasairway.bsky.social VL should be used routinely whenever feasible. Clinical signs should not be used to exclude oesophageal intubation.
🚨We have retired "no trace, wrong place" to align with PUMA guidelines. Instead, with @assocanaes.bsky.social and @dasairway.bsky.social, our message is that if sustained exhaled CO2 is not detected, then oesophageal intubation must be ruled out. See our dedicated webpage👉 ow.ly/vOZs50WA03r
3-step guide to mastering #HAVL from @cliffreid.bsky.social 1. Watch the video m.youtube.com/watch?v=aYo7... 2. Read the stepwise guide drive.google.com/file/d/14r_W... 3. Deliberate team practice (rinse & repeat)
International consensus guidelines for preventing unrecognised oesophageal intubation from @universalairway.org
Preventing unrecognised oesophageal intubation: a consensus guideline from the Project for Universal Management of Airways and international airway societies*
Across multiple disciplines undertaking airway management globally, preventable episodes of unrecognised oesophageal intubation result in profound hypoxaemia, brain injury and death. These events occ...
associationofanaesthetists-publications.onlinelibrary.wiley.com
Airway assistant (ala airway ally) litfl.com/airway-assis... the forgotten role in airway management in ED, ICU, and the wards… but an important one! #foamed #foamcc
Airway Assistant
Description of the airway assistant role in the ANZ critical care setting: responsibilities, tips, pitfalls for newcomers to the role
litfl.com
Unrecognised esophageal intubation litfl.com/unrecognised... Largely derived from the superb PUMA guidelines by @chrimesy.com et al #foamed #foamcc
Unrecognised oesophageal intubation
Unrecognised oesophageal intubation: frequency, causes, prevention, recognition, actions, and confounders. Derived from PUMA guidelines.
litfl.com
Key points: 1. ALWAYS confirm criteria for sustained exhaled CO2 are satisfied. 2. NEVER use clinical signs to exclude oesophageal intubation 3. The fastest, simplest & most definitive way to exclude oesophageal intubation is to remove the tube AND ventilate with an alternate device.
Project for Universal Management of Airways@universalairway.org · last yr.Organisations supporting the 'Consensus guidelines for preventing unrecognised oesophageal intubation' incl both @anzca.bsky.social and @rcoanews.bsky.social. Guidelines free full text in @anaesjournal.bsky.social: associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/...
Organisations supporting the 'Consensus guidelines for preventing unrecognised oesophageal intubation' incl both @anzca.bsky.social and @rcoanews.bsky.social. Guidelines free full text in @anaesjournal.bsky.social: associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/...
Preventing unrecognised oesophageal intubation: a consensus guideline from the Project for Universal Management of Airways and international airway societies*
Across multiple disciplines undertaking airway management globally, preventable episodes of unrecognised oesophageal intubation result in profound hypoxaemia, brain injury and death. These events occ....
associationofanaesthetists-publications.onlinelibrary.wiley.com
But do patients at risk of aspiration need “a tube stuck in quickly”? It’s unlikely there’s actually a proportional incr in asp risk the longer the airway is unprotected. I’d suggest that regurg/asp mainly occurs w change in m tone at induction or w instrumentation while inadeq anaesthetised/relaxed
Aren’t there already things we would do when extubating a patient at incr risk of aspiration? Rather than being ‘rapid’ they relate to ensuring return of airway reflexes prior to removing tube (awake), potentially decreasing risk of regurg (gastric suction) & aspiration (lat position).
But what are the elements of intubation technique you’d encourage to reduce aspiration risk & do any of them relate to the components of RSI? I’d suggest that it’s more important that a patient is deeply anaesthetised/paralysed before the airway is instrumented than anything relating to rapidity.
Background reading for this week’s debate - this excellent editorial by @sthjournalclub.bsky.social & Craig Lyons in @anaesjournal.bsky.social associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/epdf/10....
Rapid sequence induction: a modern‐day example of Theseus' Paradox?
You have to enable JavaScript in your browser's settings in order to use the eReader.
associationofanaesthetists-publications.onlinelibrary.wiley.com
Dr Mary-Ann Fox BMBS FANZCA GChPOM@maffygirl.medsky.social · last yr.“The term & concept of RSI should be abandoned due to the simplistic rationale behind it, the absence of evidence to support it & its potential for harm.” #VortexDebate #AnSky #MedSky
Should we use universal videolaryngoscopy in real-world operating theatre settings? YES! ↑ rate of easy intubation ↑ rate successful first-attempt intubation ↓ incidence of difficult laryngoscopy ↓ complications related to intubation #AnSky #AirwaySky #MedSky doi.org/10.1111/anae...
In adult patients undergoing tracheal intubation in real-world operating theatre settings, universal VL showed clear advantages over direct laryngoscopy. This is the largest comparative analysis conducted to date! #AnSky #AirwaySky #MedSky doi.org/10.1111/anae...
Brilliant, provocative editorial from @sthjournalclub.bsky.social & Craig Lyons. While cricoid has been vilified out of existence in some areas by the EBM zealots, there's no evidence for benefit of any other aspect of RSI. Conversely CV compromise & use of rapid-onset NMBAs may cause harm.
Anaesthesia@anaesjournal.bsky.social · last yr.Editorial: Rapid sequence induction: a modern-day example of Theseus' Paradox? Stept and Safar described ‘rapid induction/intubation’ in 1970. PUMA recently issued a consensus statement on RSI. Let's compare. @sthjournalclub.bsky.social #AnSky #AirwaySky doi.org/10.1111/anae...
Important paper on Airway Leads and implementing comprehensive airway quality improvement process in the Emergency Department from @emcrit.bsky.social Whether or not you agree w the specific interventions, this should be the template for all airway management programs.
EMCrit Blog and Podcast@emcrit.bsky.social · last yr.
Thio sux is the only classic (but I've never seen it done one, hence all being mRSI). I think otherwise it ought to be fast acting hypnotic and 1/kg or more of sux or roc. Opioids seem reasonable but I'd be worried about that being your sole "relaxant" I love www.universalairway.org/rsi above
RSI — Project for Universal Management of Airways
universalairway.org
For exactly this reason the @universalairway.org guidelines have removed the term “modified RSI” in favour of a defined spectrum of variations that constitute RSI. Anything outside this is not RSI. www.universalairway.org/rsi
RSI — Project for Universal Management of Airways
universalairway.org
It’s extraordinary that this is a case report in 2025. It’s like publishing a case of a CVC wire being lost intravascularly in which the authors conclude that it might be a good idea to always hold onto the wire.
Anaesthesia Reports@anaesthesiareports.bsky.social · last yr.During hyperangulated #videolaryngoscopy #HAVL the ETT was passed through the soft palate The authors discuss a ‘blind spot’ of the oropharynx during videolaryngoscopy. Any thoughts? buff.ly/L50WWP4 #AnSky #MedSky #AirwaySky #SurgSky #ENTSky
“At least seven respondents reported in the free text comments that UOI could not happen to a competent anaesthetist and that further training was therefore not warranted” In my experience, the greatest barrier to uptake of the PUOI guidelines is getting clinicians to recognise they need them.
British Journal of Anaesthesia@bjajournals.bsky.social · last yr.Are we doing enough to reduce the risk of unrecognised oesophageal intubation? Majumdar et al discuss the results of a survey on #oesophagealintubation #capnography #airway #openaccess
But I'm sure you'd agree that's clearly outdated & something the majority of clinicians would disagree with. In the @universalairway.org guidelines we've defined RSI based on a spectrum of practice that adheres to specific principles. www.universalairway.org/rsi
RSI — Project for Universal Management of Airways
universalairway.org
The term "TIVA RSI" misrepresents the issue. All RSIs are IV. Whether it's a TIVA anaesthetic depends on whether the subseq maintenance agent is inhaled or IV (& irrelevant to the process of RSI). The question is whether IV induction agents should be administered by an infusion pump during RSI.
Anaesthesia@anaesjournal.bsky.social · last yr.Do you use TIVA when you are doing a rapid sequence induction in theatre? #AnSky #AirwaySky #MedSky doi.org/10.1111/anae...
I underwent explainaesthesia this week and emerged knowing a LOT more about hyperangulated videolaryngoscopy thanks to @chrimesy.com youtu.be/aYo7kqu9QpA
INCREDIBLE Deep Dive into Hyperangulated Videolaryngoscopy
YouTube video by Cliff Reid
youtu.be