Nicholas Chrimes

@NicholasChrimes

Sydney, Australia VortexApproach.org Joined March 2009

123 Following 8K Followers 7.5K Posts

Latest posts 5

Nicholas Chrimes @NicholasChrimes Nov 4

Great stuff Rani. I think you're going to love the PUMA guidelines. As in the Extubation guideline, our Evaluation guideline focuses not on 'predicting difficult airways' but identifying 'at risk airway management' then linking identified challenges to targeted approaches.

Dr Rani Chahal @DrRaniChahal Nov 3

Publication day!

New editorial on the novel framework & upstream cognitive scaffold of “Risk-aligned” airway management.

Thanks to @STHJournalClub, @Anaes_Journal for the review.

…-publications.onlinelibrary.wiley.com/doi/10.1111/an…

@ANZCA @PeterMacCC @SafeAirway @NicholasChrimes @UniversalAirway

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Nicholas Chrimes @NicholasChrimes Oct 8

In this editorial @dr_imranahmad (who oddly has written the accompanying editorial for every PUMA guideline & is planning to lead the new @dasairway extubation guidelines - though he hasn't declared this!) tries desperately to make the PUMA extubation guidelines look confusing!

𝘈𝘯𝘢𝘦𝘴𝘵𝘩𝘦𝘴𝘪𝘢 Verified account @Anaes_Journal Oct 8

In this editorial, @dr_imranahmad & @doctimcook consider the PUMA tracheal extubation guidelines and ask - towards clarity or complexity?

"Should we continue to develop guidelines tailored to specific clinical scenarios, considering factors such as location, speciality and patient characteristics? Or is it possible for a single, universal guideline to be applied globally, like the PUMA group envisages?"

#anaesthesia @NicholasChrimes @UniversalAirway

doi.org/10.1111/anae.7…

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Nicholas Chrimes @NicholasChrimes Oct 7

Again, record effort/outcone/ease but stop trying to reduce it to a score.

It would be useful to understand why when POGO was >25%, intubation was considered difficult or failed.

I’d suggest that absent glottic/subglottic pathology this represents an operator skill problem.

𝘈𝘯𝘢𝘦𝘴𝘵𝘩𝘦𝘴𝘪𝘢 Verified account @Anaes_Journal Oct 7

There is a dissociation between visualisation of the glottis/a good POGO score and tracheal tube delivery.

This table shows the distribution of tracheal tube delivery according to percentage of glottic opening (POGO), based on airway operator assessments.

#anaesthesia #MedX #MedTwitter

doi.org/10.1111/anae.7…

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Nicholas Chrimes @NicholasChrimes Oct 7

This is why POGO should NEVER be used. POGO <25% can mean CL 2a,2b,3a,3b or 4. Even POGO 0% can’t discriminate bw CL 2b-4. Useless.

𝘈𝘯𝘢𝘦𝘴𝘵𝘩𝘦𝘴𝘪𝘢 Verified account @Anaes_Journal Oct 7

There is a dissociation between visualisation of the glottis/a good POGO score and tracheal tube delivery.

This table shows the distribution of tracheal tube delivery according to percentage of glottic opening (POGO), based on airway operator assessments.

#anaesthesia #MedX #MedTwitter

doi.org/10.1111/anae.7…

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Nicholas Chrimes @NicholasChrimes Oct 7

We don't need FMV described as a score. What we need is a description of effort, outcome and a subjective appraisal of easy/moderate/difficult.

I'd often use 2 hands + OPA but still describe FMV as easy based on achieving a good airway that could be reliably reproduced by others

𝘈𝘯𝘢𝘦𝘴𝘵𝘩𝘦𝘴𝘪𝘢 Verified account @Anaes_Journal Oct 6

Classifying mask ventilation: current evidence supports the MASCAN score, not capnography

#anaesthesia #MedTwitter #MedX

doi.org/10.1111/anae.7…

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