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Poor Kumar. Maybe he'd like the snooze at work!

Bei der rsi machst du keine maskenbeatmung. In dem Moment wenn der Tubus durch die stimmritze ist und geblockt wurde ist ja ein Aspirationsschutz gegeben und der cricoiddruck hinfällig. Ist aber wohl eher was für den Straßengraben als das sichere Umfeld in der Klinik

Habe ich ja geschrieben

Hi @xhisatank. Thanks for the comment. As I said in the video it's optional. If you never use it then I suggest carrying on that way. I don't use it either but this video is targeted at med students soon to be interns and if they're about to dive about in someones wrist and not get the sample on first stab then I think it's in the patient's best interest to have anaesthesia first. Sure it's a second stab of a needle and a sting of some lignocaine but that's preferable to the multiple approaches I sometimes see from people in the learning phase. It's a painful procedure for many people and patient comfort is highly important to me. So some local is very reasonable in some scenarios.

Thanks for the comment. No I never perform it nor do any of my intensivist or anaesthesiologist colleagues . It has repeatedly been shown to have very large inter-observer variability and very poor sensitivity (though higher specificity). Overall it’s diagnostic validity is poor and is not a good predictor of hand ischaemia and so should not be performed.

​@@doctoraoifebeeReally? We are still taught to do it at med school and for our OSCEs.

@@ItsJustAPlug Yea we are too and I know lots of the cardiothoracic surgeons still check it if they're planning to harvest the radial for bypass. But alas the evidence for it isn't there! It's a perfect little test for an OSCE as it's so quick and easy. I still teach it to the students but warn them that it isn't a perfect test.

Hi Amir 👋 Always nice to hear how things work and the challenges we have to overcome all around the world 🇮🇷 🇮🇪

Hi! Thanks for the comment. Indeed it was only a few mm deep though it of course varies with body habitus. Average depth is approximately 2.5 mm in adults so with angling the needle it only need to be inserted a few mm more than that. In patients with thicker arms it can approach 10 mm or more, and with cachexia it can be completely visible pulsating in the wrist. All easily checked with a quick ultrasound scan where available.

Hello. I looked for the information about the depth of the artery in many places. Can you recommend me a source to check this information?

@@doctoraoifebee.

I’m so sorry to hear that. It certainly can bruise quite badly, much worse than puncturing a vein as it’s under much greater pressure in the artery. It’s true not everyone numbs the skin and I wasn’t taught that way but it’s a sensitive part of the body so I like to make it nice and numb for my patients.

Thank you Sabelo! I certainly will. If you've topics you'd like covered please feel free to suggest.

It is painful cause of the pressure in the artery - it's not a normal blood draw. It's done after anaesthesia in the area.

@@Reticence9zen924 can you scale it from 1-10 ?? The pain level ?

@@wckdaintgood Never had it so can't comment.

It hurts and my pain tolerance sucks so around a 5 or 7 for me which depends on the site (radial: 7, brachial: 5).

In my case, it felt like they were sticking it through my wrist.

Hi Dylan. I didn’t mean to imply the full 5 ml is required. 5 ml is just the smallest vial of lidocaine we have in our institute. Of course very little is required for the small area above the artery or sometimes none at all for a very obvious artery. Thanks for your comment.

Hi Nathan. Thank you for your question. As someone with small hands, I know how you feel. It can certainly make things harder, particularly with patients with a larger, heavier mandible. Personally, I practiced having the best technique possible with every patient, working on stretching my fingers wide and getting my little finger behind the angle of the mandible on every single patient. The more you practice on the easier airways, the better you'll be placed to manage the more difficult ones. That and never being afraid to ask for a second pair of hands so you can get someone else to bag while you use both hands to hold the mask on the face. Sometimes juniors feel this is failing to manage the patient on their own but as we get more experienced we learn to use all our resources and that we must never ever let ego get in the way of something as important as maintaining the airway. I hope that helps and best of luck with it.

It can be quite different from hospital to hospital here depending on where they’ve bought their drugs from. Keeps you on your toes! Always checking and checking again and again. Some places use mostly vecuronium, older consultants use lots of atracurium, but most places it’s rocuronium.

@@doctoraoifebee Here it kinds of is a pick your poison thing- They will use Nimbex most places if they worry about metabolism- but between Vec. and Roc... I get the feeling they usually go for Roc. because they don't want to deal with re-constitution. Also Sux. is always on hand but the standards from place to place of when to use it are all over the place. Some people use it for all intubations- other people go right for the non-depolarizer. Some people always reverse even with a good train of four- others predect the end of the surgery and only reverse if they would still have partial paralysis by extubation.

@@DigitalAndInnovation We use cisatracurium almost exclusively for infusion in ICU here (we all dual train). Once place I worked here had two or three anaphylaxis reactions to roc and switched to using vec most of the time though I'm sure it was just an unfortunate coincidence that they'd a few reactions so close together. I have to say I've never worked with anyone that uses sux for all intubations - just the usual RSI indication and even with that younger anaesthetists will frequently use RSI doses of roc and keep the sugammadex to hand just in case. Personally I like to use sux for some RSIs and roc for others to make sure I continue to feel comfortable and fresh with both approaches. And same with the reversal - lots of different approaches here. In the hospital that I did my first year of training we did TOF on everyone and reversed everyone. The TOF was to determine whether you used neostigmine/glyco or sugammadex. Next hospital it was impossible to find a TOF machine so you frequently had to gauge on timings of doses. Personally I reverse everyone if I've given any muscle relaxant and try my best to time things well so that that relaxant is neo/glyco to keep costs down. Lovely to hear how it's done all over the world though.

Thanks for watching!

It would be frowned upon in the medical school to cannulate the arteries of our interns 😂 I hope to organise consent from a patient having one done someday once ethical approval and paperwork etc is in order.

Hey dont we need to carry abg syringes in ice bod to prevent errors jn readinh?

We do in the patient under GA but usually use local otherwise.

He must have no trust in Iarlaith! 😁

😂