This one’s for @drmikeclifford.bsky.social Cricoid pressure has been selectively vilified out of RSI in many settings, yet it has less risks, a better rationale & more evidence for efficacy than any other cited component of RSI Why aren’t we doing it routinely for all adult tracheal intubations?

Awful. I'm just going to leave this here: yes, bronchospasm can account for a flat capnograph, but no, you can't assume that's the reason and you must take the tube out or (if that's genuinely dangerous) exclude oesophageal intubation using a bronchoscope. onlinelibrary.wiley.com/share/author...

Safe Airway Society (a not-for-profit org. in Australia & New Zealand; aiming to optimize safe, effective patient care through a collaborative, multidisciplinary approach to airway management across different healthcare roles & settings) leaves X (3.699 followers) Bluesky: @safeairwaysociety.org

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

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 most important use of VL is engaging the team. They can see what is happening. Your assistant can see if their airway manoeuvres are helping or hindering. DL is a lonely game.

Absolutely massive crowd in Naarm/Melbourne today. From the river to the sea.

He’s wanted to declare martial law from day one. Bypass all checks and rule as a tyrant. Many have speculated how he’d do it. Now his gambit is clear. DC was a test. He’s using manufactured crime stats to send troops into blue states & cities. This is not a drill. Democracy is at defcon 1.

Oh..patients don’t complain when you don’t use LA they just accept it hurts! What I get is “Oh ..is it done?” Or “Wow..that was ok after all” Also they don’t move and , should you miss, they don’t get wound up if you have to redo!

This is the midweek #MedSkyDebate thanks to @pieterpeach.com Do you use LA for your cannula insertions?

Not doing the right thing bc it’s too hard is simply not caring enough.

If the argument for why something - literally anything - should not be done, is that it's complicated, and hard, and you don't understand, blah blah, but good on you for caring... that's literally never a good point. It's always a deflection and never engages. It's PR for inertia

While CL has its issues (mainly that no one remembers what the gradings mean) POGO is a completely useless classification system. It can only subclassify easy views (CL 1 -2a) but is unable to discriminate bw challenging views (CL 2b - 4 are all potentially POGO 0%).

Apart from my very niche case HOW LOW WILL YOU GO, or let BP go before you intervene? Thanks to @chrimesy.com for the topic.

Let’s keep up the #MedSkyDebate pace!! Weekend topic is from Nicholas Chrimes @chrimesy.com#MedSkyDebate “Permissive hypotension: how low will you go?” My personal low was a 8 hour AVM resection in a 30 year old, at 50 systolic throughout the resection Brilliant outcome, minimal deficit

You got away with it. I don’t believe hypotension is permissible. 20% drop of patient’s norm is fine, beyond that bad. “the purpose of anaesthesia is to keep everything as boring as possible” “boring” = physiological

Trump: "I was very happy to hear him say if I was president that war would've never happened." (Putin knows how to play Trump like a fiddle.)

The people who are crazy enough to think they can change the world are the ones who do.

If sustained exhaled CO2 is in doubt, oesophageal intubation must be ruled out!

The PUMA guidelines for preventing unrecognised oesophageal intubation are also supported by @rcoanews.bsky.social @assocsas.bsky.social & many other organisations internationally across anaesthesia, ICU, EM & prehospital Full list: www.universalairway.org/puoi/support @anaesjournal.bsky.social

Does attempting to meet legal requirements for informed consent have the potential to *undermine* patient autonomy? From me, @hypoxicchicken.medsky.social & @maryannturner.bsky.social. Free full text for a limited time i @anaesjournal.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...

🚨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

Following on from @sarahmd.bsky.social's discussion, the midweek #MedSkyDebate is what are the cultural work practices you find interesting in other countries. For me it's surgeons in the USA not putting their own surgical gloves on. That is just weird.

Was this the post you mentioned seeing a couple of weeks ago @chrimesy.com ? bsky.app/profile/anes...

I have quite the topic for the #MedSkyDebate this weekend. Do you use Chat GTP and how has it affected your practise?? ChatGTP did this infographic. Is AI bad for us or can we use it to assist us? Pro’s and Con’s. This should be the best debate!!

Igel is the worst airway ever. The igel is a perfectly decent airway. Discuss. See if you can do it without SHOUTING like my most recent interaction 🙄 #ansky

This man is a danger to us all.

I hate this man. Why is he trying to kill all of us.

“Non maleficence “ or what some are now calling “benevolent materialism” In paediatrics - we call it putting on “the wooly cardigan “

It is more important than ever for the law to work collaboratively with clinicians to support a concept of futility... Clinicians must be empowered to hold onto professional responsibility and accountability for complex decision-making. #AnSky #ICUSky #MedSky #FreeForAWeek doi.org/10.1111/anae...

“Merely giving the patient information, rather than expert guidance, may produce suboptimal decisions & unnecessary stress” From me, @hypoxicchicken.medsky.social & @maryannturner.bsky.social. Free full text for a limited time in @anaesjournal.bsky.social 🔓🔑⏳

Get your applications in! This is a wonderful opportunity to work with our team at Anaesthesia Reports! Due 10 August

Trump saying he has the best poll numbers he’s ever had citing “Harry Emden” on CNN Harry Enten response: If we are comparing him to other presidents at this point in their presidencies, he is the second lowest on record compared only to himself.

The FBI released its Uniform Crime Report *today* showing that all categories of violent crime are down in Washington DC, returning to pre-2020 levels.

"The president usually has limited control over the economy, with downturns being caused by events beyond their control. In this case, however, Trump’s policies are directly responsible for job losses, rising prices, wavering confidence, and a speedrun toward what looks like stagflation."

“There is moderate evidence that intrathecal morphine does not increase rates of sedation or hypoxaemia after non-obstetric surgery. There is very low-quality evidence that intrathecal morphine might increase the rate of respiratory depression”

Intra-operative ketamine and delirium • Low-dose ketamine was associated with a LOWER risk of postoperative delirium. • High doses did not influence the risk. #AnSky #ketamine #FreeForAWeek #MedSky #PainSky doi.org/10.1111/anae...

“We acknowledge that economic & logistical factors may limit the universal implementation of VL in all settings. However, as pt safety is paramount, our findings suggest that investment in this technology may be justified, partic when considering the potential costs of failed tracheal intubation”

This planet is run by crazy people. Remember what they have to do to get where they are. Their perspective is so narrow, so...brief. A few years. In the best of them a few decades. They care only about the time they are in power. - Carl Sagan, Contact

NEW: Incredible scenes in Sydney, Australia today as tens of thousands march for Gaza, demanding an end to the genocide. #MarchForHumanity (🎥 Ema Franklin)

This shouldn’t be surprising. The only way to fight back is to… actually fight back. If Democrats want to improve their approval rating (or far more importantly, make actual change), we need real leadership to put up real resistance to authoritarianism. apnews.com/article/ap-p...

MSM be like - it wasn't THAT many people that it could represent a groundswell of public opinion but also it was such a dangerously large number of people for public safety

I just need one member of the media to ask Trump how much a $500 drug would cost after a 1500% discount.

Editorial: Understanding the role of medical futility in determining non-beneficial treatment at the end of life #AnSky #ICUSky #MedSky #futility #FreeForAWeek doi.org/10.1111/anae...

I don't routinely talk about AAGA but wonder if I should

One of the most baffling aspects of interacting regularly with "normal" suburban people who voted for Donald Trump is that they genuinely seem to be unaware of his explicit racism, and if challenged, either refuse to believe it or fall back into exactly what Mulvaney does here.

Revisions happen every month.

Maybe Summers read the new issue of my OUR LAND newsletter on "Donald Trump and the Deconstruction of America," which notes all the daily outrages from Trump distract from the grand master plan of MAGA to transform American society. The big-picture story of Trumpism isn't being told. Check it out.

Who routinely consents patients for the risk of awareness?