Nicholas Chrimes

@chrimesy.com

990 Followers 345 Following

Anaesthetist | Creator Vortex Approach | Co-founder Safe Airway Society | Director Universal Airway (PUMA) Guidelines | ANZCA/ASA/NZSA Airway SIG Executive Member VortexApproach.org UniversalAirway.org SafeAirwaySociety.org EZDrugID.org

More complex graphic showing cross reactivity of different NMBAs following previous allergic reaction.
Algorithm indicating safest NMBA following prior allergic reaction to NMBA.
Dictionary Definitions from Oxford Languages: virtue signalling noun DEROGATORY the public expression of opinions or sentiments intended to demonstrate one's good character or social conscience or the moral correctness of one's position on a particular issue.
Algorithm for the circumstance in which the criteria for sustained exhaled CO2 are unable to be satisfied. 4 questions: 1. Is removing the tube dangerous? 2. Is the SpO2 adequate? 3. Has oesophageal intubation been excluded? 4. Has sustained exhaled CO2 been restored? If answer to ANY question is ‘NO’ then remove tube & ventilate with an alternate device. If answer to ALL questions is ‘YES’ tube may be left in situ. DO NOT USE CLINICAL SIGNS TO EXCLUDE OESOPHAGEAL INTUBATION Criteria for sustained exhaled CO2: 1. Level rises during expiration & falls during inspiration 2. Consistent or increasing amplitude over at least 7 breaths 3. Peak amplitude > 1kPa (7.5mmHg) 4. Reading is clinically appropriate
Here, we assert that when proper consideration is given to the science of climate change, volatile anaesthetic gas emissions cannot be simply equated to real carbon dioxide emissions, and that their climate impact is vanishingly small
Incomprehensible AI generated “explanation” of the Vortex Approach to airway management. Meaningless graphic in which colour coding & labels in legend don’t match the colours & abbreviations on the graphic.
Merely giving the patient information, rather than expert guidance, may produce suboptimal decisions and unnecessary stress [21]. Preserving patient autonomy is achieved by ensuring a patient’s care aligns with their personal values. Whether any outcome constitutes a material risk to a particular individual is influenced by an array of factors, including personality; experience; culture; age; sex; career; and lifestyle. It is important that the anaesthetist has the ability to recognise when patient values and priorities differ from their own. Determining this essentially requires a reversal of the flow of information; rather than providing information so that the patient can make decisions, the emphasis should be on acquiring information so that the clinician can make management decisions in line with the patient’s stated values. This information may be derived during the consent process, elsewhere in the patient consultation or from other sources.
Table from ‘The paradox of informed consent’ providing descriptors for categorical incidence levels common/uncommon/rare based on how frequently they are encountered by anaesthetists.
Table showing 6 categories of potential harmful consequences from anaesthesia (adverse experiences, psychological injury, physical injury, disability/death, additional interventions & additional care) with examples of each.
Whiteboard showing results of measuring ETO2 following 3 mins of HFNO at 70L with mouth closed as 90% & mouth open as 53%.
Informed decisions about whether to accept or refuse an intervention require appreciation of the harmful consequences impacting patient experience (e.g. pain, disability, additional interventions, death) or patient values (whether explicitly stated, e.g. blood transfusion in a Jehovah’s Witness, or inferred from societal expectations, e.g. obtaining permission to insert a suppository), which could arise from these choices. In contrast, complications that are physiological disturbances (acidosis, hypoxaemia, hypotension); pathological processes (haemorrhage, anaphylaxis, aspiration); or technical issues (endobronchial intubation, equipment failure, drug error) represent mechanisms of harm rather than consequences for the patient. The nature of these mechanisms may not be understood by patients and their implications for outcome are highly variable, sometimes unknown, potentially insignificant and not necessarily intuitive. A patient’s acceptance of a given mechanism for harm, the consequences of which may range from nothing to severe disability or death, may result in significant over- or underestimation of risk, undermining decision-making and compromising autonomy. Conversely, unless it impacts their experience or values, it seems implausible that a patient would accept a given overall risk of a specific complication contributed to by one mechanism of harm but not another. Disclosing mechanisms of harm may at best be unnecessary, and at worst represent an overload of baffling technical information that the Montgomery ruling specifies does not fulfil the doctor’s duty of disclosure
Table showing categories of harmful outcome (adverse experiences, psychological injury, physical injury, disability/death, need for additional interventions & need for additional care) with examples of specific harms for each.
We found only fair agreement among anaesthetists in assigning ASA class to ten fictitious patients, which was no better than that observed in earlier studies. Further, the range of scores assigned to standard patients' histories by anaesthetists supports earlier concerns about the robustness of this classification.
Beautiful, beautiful Ella. A Doberman with her front legs so elegantly crossed.
27G Whitacre spinal needle
Algorithm to be used if criteria for ‘sustained exhaled carbon dioxide’ aren’t met. Features criteria for sustained exhaled CO2’, instructions not to use clinical signs to exclude oesophageal intubation & prompt to not only remove tube but also ventilate with a facemask or supraglottic airway as the default action if oesophageal intubation cannot be excluded.