Intubation via LMA

LMA insertion is a basic airway skill we should all possess and is covered in the online modules from ACEM.  You will also get some experience whilst in theatre inserting these devices.  The next step up from the LMA is the intubating LMA.  You will see these referenced in various difficult airway alogirthms and will find them in the lower drawers of difficult airway trolleys in most EDs. You should have some familiarity with them.

The two videos below show how to insert these devices and how to then go onto intubating through them.  If you ever get stuck in a tricky intubation scenario with a failed endotracheal intubation and you have no other help to call upon (remember – ALWAYS call for help early if you have it) then consider one of these LMAs.  If you can ventilate through the LMA easily then leave it be until you get your extra help – you don’t want to go from not being able to ventilate, to being able to ventilate through your LMA, only to lose ventilation because you thought you could go that extra step and secure an ETT in place.

If the extra help is an anesthetist they may be able to go on to complete endotracheal intubation via your intubating LMA.

Bradyarrhythmias

This is a great talk (with great ECGs) by Dr Lorrel Brown from the University of Louisville.  The initial summary of the cardiac electrical system and how abnormalities along it affect the ECG is very good.  The bulk of the talk covers the usual bradyarrhythmias we see in the ED, how to recognise them, and when to act.  Highly recommended viewing.

In addition to the above, Louisville Lectures provides other detailed talks on various internal medicine topics.