The pre-hospital airway with John Chatterjee

In this session we will examine the fundamentals of the
pre-hospital airway from airway assessment all the way through to
the difficulties posed in practice. We will also look at the
management from a stepwise concept all the way through to the use
of invasive surgical techniques to manage the airway. We will
also examine some of the optimal methods used to monitor the
respiratory effort and when and when not to intervene. We will
also examine the current utility and debate around Direct
Laryngoscopy (DL) and Video Laryngoscopy (VL) and whether VL is
around to stay within practice. 


To do this I have with me John Chatterjee.  John is a
consultant anaesthetist with an interest in pre-hospital care and
difficult airway, thoracic and high-risk anaesthesia. He has
worked with and educated clinicians around the world in various
ambulance and hospital services including places like New
Zealand, Sydney, Liberia, Ethiopia, Ukraine and in the UK where
he has worked with HEMS and BASICS. John is as an anaesthetist at
Guys and St Thomas', and a Consultant with London's Air Ambulance
at the Royal London. In the episode we examine: 


The challenges of the pre-hospital airway

How to assesses the difficulty of an airway from sight and
brief assessment

Declaration of the findings and plan

VL vs DL and where VL is going from a SOP and utilisation
tool.

Stepwise management and understanding where to come in on the
management plan. 

Assessment of respiratory effort

Thoughts on RSI compared to retrospective practice.

Tips on surgical airways

Seminal airway research in the last 10 years – Impact Brain
Apnoea

Seminal cases that John has learnt a lot from 

Final thoughts from John and take-home messages.






John mentions these two papers within the conversation:


Difficult Airway Society (DAS) 2015 guidelines for
management of unanticipated difficult intubation in
adults:


https://aimeairway.ca/userfiles/26556848_Difficult_Airway_Society_2015_guidelines_for_management_of_unanticipated_difficult_intubation_in_adults.pdf





Observational study of the success rates of intubation
and failed intubation airway rescue techniques in 7256 attempted
intubations of trauma patients by pre-hospital
physicians


https://academic.oup.com/bja/article/113/2/220/1745948





My thanks to John for an insightful and engaging
conversation.