I recently got an email from the creators of a new approach to airway management

What these two gentlemen have crafted is a paradigm called the vortex approach. It is best represented by this diagram:

And here are versions with even more information:

I could write about the method, but to do it true justice, it is better to watch this video:

The Shock Trauma Algorithm

Now you folks know I am partial to a modified-version of the Shock Trauma Algorithm for Failed Airway Management. It is bar none the simplest, most effective (and validated) algo I have come across. Or at least it was until I started parsing the Vortex Approach. The reason is that the Vortex Approach encompasses the STC algorithm in a way that is universal to all specialties and settings.

Ebook

Nicholas and Peter wrote a free ebook about the concept, which is available in a number of formats.

Websites

They also have a website set up for the Vortex Approach as well as other projects on their Clinical CrEd Site. The Vortex site also has videos demonstrating the approach in action in both an emergency department and operating theater intubation.

Podcast

Minh Le Cong did an interview with the two of them on his PHARM podcast site that is definitely worth a listen.

Apps I Liked

I was sent free evaluation copies of 2 IOS applications:

• The IOS version of PressorDex from the EMRA folks. The pocket-book was good; the app is even better.
• An application listing the most important critical care papers and a short summary of their impact. The app is called ICU Trials by Sean Kane. The link goes to the free lite version; if you like it buy the full version.

Now on to the Wee…

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The Conference

SMACC 2013 was, bar none, the best Critical Care Conference I have ever attended!

The People

I got to meet people like…

Doug Lynch (@thetopend)

Victoria Brazil (@SocraticEM)

and Most Importantly,

to all of the wonderful listeners that introduced themselves–I Love You!

Jetlag

Great Article (CLEVELAND CLINIC JOURNAL OF MEDICINE 2011;78(10):675)

SMACC-Backs are coming…

The Clinical Stuff

IVC Ultrasound

SIMWars

• BP Rep Time
• Drip Sheets – See the EHCED drip-sheet project
• Tension Pneumo
• Bind the Pelvis

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The MOPETT Trial took sub-massive PE patients and randomized them to half-dose tPA vs. standard care. No bleeds in either group. 41% ARR of pulmonary hypertension at 28 months.

Study Description from the Author

PDF of his MOPETT presentation slides

 Does this change your game?

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A comment by Sean Marshall (scroll all the way down) got me thinking about bimanual larygoscopy. I realized, when I am doing fiberoptic laryngoscopy, I don’t need to really perform too bimanual anymore. Big paradigm shift since I strongly espoused the virtues ever since I learned the technique from Rich Levitan.

I now outsource external laryngeal manipulation to my assistant; or I do it for the intubator when one of my residents is that intubator. This outsourcing concept was first introduced to me by my friend, Reuben Strayer. He realized you could outsource suctioning. It was a natural progression for me to start outsourcing thyroid manipulation and now tube-prepassage.

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