Life in the Fast Lane

Bronchoalveolar lavage (BAL) is a bronchoscopic sampling technique that instills sterile saline into a wedged distal airway and retrieves it for microbiological, cytological, and immunological analysis. It provides a direct window into the alveolar environment and outperforms proximal sampling techniques when distal pathology is suspected. BAL can be a useful diagnostic tool in critically ill patients for diagnosing pneumonia, diffuse infiltrates, alveolar haemorrhage, and immunocompromised hosts.

Flexible Nasopharyngolaryngoscopy is a rapid bedside assessment of the upper airway that can be used in critical care settings to clarify the cause of stridor, dysphonia, secretion clearance problems, and dysphagia, and as a decision tool for airway management.

Flexible bronchoscopy is first‑line in most adults (>90% success) for airway foreign body removal, while rigid bronchoscopy remains essential for large, sharp, proximal, or asphyxiating objects. See Airway Foreign Bodies for causes, pathophysiology, complications, clinical features, investigations, and management overview.

Airway foreign bodies (AFBs) are potentially life‑threatening AFBs predominantly affect children under 5 years and adults over 65 years – they are rare in other age groups A foreign body is any object or substance that is not naturally found in the body and is present where it does not belong. Presentations are often subtle – only ⅓ of FB aspirations are recalled by adults – and are misdiagnosed as asthma, COPD, pneumonia, or malignancy.

Editor’s note: This post is a follow up (apparently much requested!) to How to ace a consultant interview for early career medical officers. Hello everyone! It is amazing that I am still getting contacted with questions about this article over seven years since it was written. Thank you for your engagement. I feel incredibly privileged to be able to support colleagues through the interview process.

OVERVIEW Definitions VAFI is video-assisted flexible intubation, also termed FAVL or fiberoptic-assisted video laryngoscopy FARSI is flexiscope-assisted rapid sequence intubation Note that in clinical practice the terms flexiscope and flexible bronchoscopy are often used interchangeably with the older terminology of fiberoptic scope – most modern flexiscopes are not fiberoptic and use digital chip‑on‑tip cameras instead.

OVERVIEW Bronchoscopy is widely used during percutaneous dilatational tracheostomy (PDT) to improve safety and accuracy, and to facilitate procedural supervision. RATIONALE Bronchoscopy provides real‑time visual confirmation of key steps and hazards during PDT. As such it can provide answers to the following questions: Is ETT withdrawn adequately prior to commencing? Is the wire/sheath in the right place? Is the guide wire advancing correctly? Is it safe to commence ventilation?

Artificial intelligence (AI) is transforming cardiac CT from real-time coronary artery analysis and automated TAVI planning to detecting coronary inflammation invisible to the human eye. Panel discussion with Dr. Ronak Rajani exploring issues including AI hallucinations, accuracy, blackbox algorithms and clinician responsibility. Here we pick out a handful of highlights from a free full-length webinar on the topic. It probably is. You just might not realise it.

A 36-year-old woman presented with new irregular menstrual bleeding. An Implanon NXT device had been inserted into the medial aspect of her left upper arm 14 months earlier, after which she had experienced amenorrhoea. For the preceding month, she had been unable to palpate the implant and was concerned that it was no longer in situ. On examination, she was haemodynamically stable and systemically well. The implant was not palpable in the left upper arm.

Catalyst: Critical Care Ideas in Action fuses potent ideas with practical action. It is built for critical care clinicians of all stripes who want meaningful change to become reality. To make this all happen, we are bringing together an exceptional group of clinicians, thinkers, and educators. This includes Victoria Brazil, Eve Purdy, Brian Burns, Tom Evens, Neil Orford, and Shaun Greene among others.