Emilie Martinoni Hoogenboom

Emilie Martinoni Hoogenboom

Emilie is a consultant in anaesthesia at UCLH, and an honorary senior clinical teaching fellow at UCL, with a special interest in airway management, teaching and education.

Location London

Activity

  • Hi Jon, this is an example from a theatre setting, where the items you mention are available separately.

  • Thank you for sharing your experience James.

  • Great tool to help with cognitive load!

  • Sorry to hear that Julie. It is working for me, but I paste the link here. Please try and let me know. https://padlet.com/AirwayMatters/tal8jte2j07k

  • Thank you for your feedback. The video was filmed taking into consideration the COVID-19 guidance at the time. Can you see if you can activate the caption/subtitles in the bottom right quadrant of the video? That should make it easier.

  • I think introductions by name is such an important step when working in a team - remember that was mentioned in the human factors experts top tips in Week 1!

  • I like it too Jordan and find that in the hospital environment where I work it's not used as often as it could be.

  • Hi @AlisonBlake-Reed can you see if it is possible for you to switch on the English caption/subtitles in the video? It should be in the bottom left corner

  • Well done for getting to Week 6! I have enjoyed reading your experience of pre-hospital medicine in the previous weeks and have been very impressed by your engagement.

  • Well done on completing Week 3! It is very rewarding to read how you are applying the knowledge from the course to your practice! Keep the examples coming.

  • Thank you for sharing your experience, sounds like a very stressful situation was handled promptly and swiftly by the team.

  • Thank you for sharing! I think your intervention to call for extra help was absolutely correct! Well done!

  • Thank you for sharing this resource

  • Yes, I would agree with you Stephanie. The daily team brief is an excellent opportunity to discuss proceeding in a MDT setting and to bring everyone on the same page "sharing the same mental model".

  • Multidisciplinary education makes a lot of sense: training together when working together, sharing a similar “mental model”. Have you been back on LW afte the teaching and noticed any changes?

  • Hi @KyranThomas auscultation is very useful and is good practice, you may be able to pick up problems like end-bronchial intubation or bronchospasm. Capnography tells you that the ETT is in the airway or that the airway is open if the patient is breathing spontaneously or has a supraglottic airway in situ.

  • Congratulations to achieving the end of Week 2! I am so impressed with your engagement and all your comments showing lots of insight. I am learning a lot from all your experiences. Thank you! Please stay with us for the rest of the course, lots of very exciting content to come :)

  • @KarenW I think 14G cannulae have a high risk of kinking, and then still need to provide oxygenation and also a way for insufflated gas to escape. ETT are widely available and are pieces of equipment we are all familiar with. The stress is also on training. Whichever technique is adopted, the skill needs to be rehearsed again and again so that it happens...

  • I think the vortex is a nice complement to the DAS guidelines. What I like in particular is the "Stay in the green zone" concept, highlighting the importance of oxygenation, rather than intubation at all costs. If oxygenation is not provided by any of the three methods (FMV, tube, SGA), then we start to fall into the vortex, with a final commitment to...

  • Thank you @CherylBurton , it's so helpful especially in emergency situation to have things clearly labelled and visible

  • Hi Mark, I really like the concept of "surgically inevitable airway" - eFONA is a very stressful situation for all involved and addressing the concept of "failure" can help.

  • Hi Peter, thank you for sharing this harrowing story. What do you think were the factors that made the procedure work well?

  • We have VLs widely available in our Trust and we encourage everyone to get familiar with their set up and using them at all opportunities. It is tool that can be very helpful in difficult airway, but requires slightly different skills than direct laryngoscopy.

  • Radiotherapy is one big "red flag" for difficult airway.

  • Welcome to Week 2!
    We will build up on the knowledge from Week 1 and see how Human Factors and Ergonomics are applied in emergency situations.

  • Congratulations on completing Week 1!

  • Hi Jessica, the 2015 guidelines are the most recent ones. In Week 2 we will be discussing them in more details.

  • Thanks you for all your comments, here is a summary of the main points from the discussion below:

    - PREPAREDNESS: taking a history and examining the patient helps with making a plan. We will discuss this at the start of Week 2. Some special patient circumstances will be discussed later in Weeks 4 and 5, such as the critically ill patient, pregnant women,...

  • Great summary

  • Thank you for sharing this video and for your summary.

  • Thanks Kevin for your comment. Some your points relate very much to system design, that we will explore next, in steps on ergonomics, it is important to ensure that the system is designed to make things as easy and comfortable as possible for practitioners. Thisinclude space configuration, but also rostering, flattening of the hierarchy, and generally...

  • Thank you Natalie, all these points are true. We will discuss them in details in Week 6 - do stay with us!

  • Welcome everyone! We are delighted to start this new Run of Airway Matters with you! We started the course in 2020 and for this run, we are particularly excited about the new content that's available in Week6, all about pre-hospital airway management. I hope you will stay with us! The facilitators and educators will be active during the corresponding week of...

  • That is a useful set up that certainly decreases cognitive load! Well done

  • Well done for making it this far in the course!
    Two more weeks to go, do stay with us!

  • Thank you for your questions. I think the plan will have to be changed according to the patients characteristics, the skill mix of the staff present and also the location. It requires advanced decision making. Different management for example for a patient in ED who is very compromised in the middle of the night to a patient in theatres for an elective...

  • Sounds very stressful indeed! I think in circumstances when the patient is able to dislodge the FB by their own efforts that should be encouraged!

  • Great summary Kate!

  • Thanks @ChrisConnolly for sharing this resource

  • Must have been very difficult and traumatic for all involved. Sounds like you have now changed your practice. Were the learning points from the case shared with others?

  • @AaronLau I think that the short duration of action of suxamethonium may sometimes be a disadvantage. If the airway is really difficult or obstructed the patients spontaneous breathing efforts may not be sufficient if they have also been sedated with other drugs. Also if multiple attempts are needed sux would wear off, making the intubating conditikns even worse

  • I think you raise an important point regarding this individual patient circumstances and it’s down to the clinician’s judgement to decide what works best.

  • It sounds like a very difficult situation and you did what you thought was best for the patient taking the circumstances into consideration.

  • Thank you for sharing your experience, it’s great to hear that the technology maybe made available at lower costs so more people can benefit from it.

  • I would advise tape, as a tie directly around the neck circumference may cause other issues such as vascular compression. But as an interim measure, anything that would keep the tube in place! As soon as the patient is stable enough, the team may consider a more definitive airway such as a tracheostomy.

  • Great summary Greg, the prehospital setting certainly adds a lot of extra challenges especially as far as non-technical skills and other human factors are concerned! We are all really learning from your experience and that of other pre-hospital clinicians.

  • Great tips, thank you Jolene!

  • Hi Tunjai, we will look into tracheostomies in more details in Week 4! Stay with us :)

  • Hi William! Thank you for signing up!

  • Well done everyone for getting to the end of the first week and for actively contributing to the discussions! Really enjoyed reading all your comments and engaging in discussions! Keep up the good work for the rest of the course!

  • Thanks Wesam, we will come back to that toward the end of the course with an article by Chris Frerk

    (https://www.futurelearn.com/courses/airway-matters/5/steps/1160268).

    I hope you’ll stay with us until then!

  • Thank you Zainab, I still remember when CO2 monitoring was introduced widely in the UK after NAP4, it made a huge difference in terms of patient safety. Now I would feel a bit lost without it.

  • Interesting point @DavidMeek . In week two we will learn about the vortex model, which outlines another cognitive tool in difficult airway management, putting the focus on keeping the patient oxygenated.

  • @BenRiley thank you for highlighting the challenges in the pre-hospital environment. Definitively the uncertainty adds to the variability and therefore meticulous preparation and practice is of paramount importance.

  • Thank you Nantaba, we are well aware of these inequalities. We will discuss some of the global challenges in Week 5 of the course. I hope you'll stay with us until then.

  • Hi Kirsty, you are absolutely right, identifying and planning for difficulties is key. We will learn more details about that at the start of Week 2 of the course.

  • Hello Irina :)

  • Great to have you on the course, get well soon!

  • Absolutely. As we'll see in more details in the human factors section, system design is vital, and that includes having kit that makes it easy to locate the right tool in difficult circumstances, to decrease our cognitive load.

  • Welcome to the 5th Run of Airway Matters! It's great to see you are joining us from all corners of the planet and we hope you'll enjoy the course materials. The faculty will be with you for each week of the course - we always learn a lot ourselves from your experiences, and I am really looking forward to reading all your posts!

  • Thanks Sophie, we hope that everyone can find something useful for their practice in the course :)

  • Thank you Robert, I am glad to read that the course is a good refresher. We are in the process of developing a more extensive part dedicated to pre-hospital airway management as we realise it's a rare occurrence and so difficult to keep skills and knowledge up to date. Watch this space!

  • Indeed a very important ime with risks of complications, but often overlooked as it's at the end, when everyone's attention is already shifting to the next case.

  • Well done for reaching the end of week 2! I have thoroughly enjoyed reading your comments and I am amazed by the level of insight you are all demonstrating. Some really thought provoking comments have made me reflect on my own practice and thinking about how the future of airway assessment and airway management looks like?

  • You are making a really good point Luke. Despite the event being a rare occurrence, it is vital that the skills, including the equipment assembly are kept up to date, so that it can be performed with confidence in that event.

  • Every time I watch this video I get a little tachycardia myself and feel stressed, a good reminder of the emotional response that occurs when we are faced with a difficult situation and that can impair our ability to perform skills and give us a "tunnel vision". I find it very useful when the ODP makes suggestions for a piece of equipment or I get prompted to...

  • That's very kind of you Peter! Please feel free to share the love by recommending the course to your colleagues :)

  • Thank you Ram, glad to read that you are enjoying it

  • I think you describe a "pattern recognition" that you have developed with experience of having assessed and managed the airways of 10k patients. I wonder how soon technology will be available to integrate that amount of information looking at imaging of patients, other features etc that will help us to predict the best tool to use for each patient. Schoettker...

  • Thank you Federica for pointing that out. Looks like it isn't available anymore. I have now removed the link to it. Apologies for the inconvenience.

  • I hope you'll like it and you may recommend it further :)

  • Welcome to the course. You are absolutely spot on, head and neck surgery comes with a number of airway challenges. Later in Week 4 and 5 we will meet Jen Taylor, one of our patients who underwent head and neck surgery and has kindly agreed to tell us her story and experience of having a tracheostomy.

  • You are correct @MarukPaul - We will look at airway management from a global perspective in Week 5, I hope you will stay with us!

  • Thank you Michael, we will cover some of your points on the challenges of the prehospital arena in Week 4 https://www.futurelearn.com/courses/airway-matters/4/steps/1095580 and would be great if you could stay with us.

  • Thanks you for all your comments, here is a summary of the main points from the discussion below:

    - PREPAREDNESS: taking a history and examining the patient helps with making a plan. We will discuss this at the start of Week 2. Some special patient circumstances will be discussed later in Weeks 4 and 5, such as the critically ill patient, pregnant women,...

  • I also find it remarkable how Mr Bromiley managed to turn such a harrowing personal tragedy into raising awareness and teach about human factors and ergonomics. I think many lies have been saved thanks to Mr Bromiley efforts.

  • It is great that you have improved your practice based on the results from your data collection

  • Each time I watch these videos I pick up something new!