At 02:30 I triaged a 2.1 kg DSH with RR 64 and SpO2 82% on flow-by, paradoxical breathing, and audible crackles. We paused for TFAST and light sedation before intubation — would you have tubed immediately and started IPPV, or trialed nasal O2 and brief POCUS first to buy diagnostics? I’m tightening our red-tag algorithm and want concrete thresholds you use to skip workup and commit to airway/control.
, day 1–2 are brutal; after that “peak pressure around 24 hours,” I switch from cold sips to warm saltwater rinses and do brief chews on a bite wafer warmed in hot water — seems to boost circulation without overloading teeth.
I’ve had better luck swapping to OrthoDots CLEAR when drying is impossible — moisture-activated, they stay put even after a quick drink, @OP… After that “peak pressure around 24 hours,” I do a 60-second low-speed gum massage with an electric toothbrush to nudge blood flow; if it throbs, I switch back to cool sips for a bit.
We ditched our old AVID wand for the Datamars iMAX Black Label — reads Avid/FDX‑B fast and pairs over BLE so chip IDs drop right into our phone form; battery easily clears a “4-hour shift” in full sun, though the screen gets a bit squinty at noon, . If you want cheaper, the Halo works in a pinch but the Bluetooth can get flaky in heat. Do you need true Bluetooth text output, or is a post‑shift USB dump fine?
But what’s worked best for me is a ‘pop-on comfort cover’ over the front brackets for the first two nights; warm it under tap water, dry the brackets, then seat it so the cheeks don’t rub while things settle. Small caveat: it can trap plaque, so I have patients use it right after brushing and skip it during the day.
Quick tweak that’s helped me: have them do a 30‑second warm saltwater swish, then a cold sip, and at bedtime slide on a Comfort Cover strip over the front brackets — little raincoat for the cheeks. @brianW303 I like silicone pads for daytime too, but they don’t stay put as well overnight once saliva ramps up.
I’d pick the CBCT block — one tweak that cut repeats for us was a 60‑second weekly phantom scan with a 50 mm PMMA cylinder; when “PMMA >135 HU or air <‑980 HU” we reseat the detector ribbon and open a service ticket before artifacts show. If your crowd’s heavier on printing, a tighter resin‑validation session might land better, @victorHansen.
@OP With your 2.1 kg at 02:30 sitting at 82% on flow‑by with paradoxical effort, my red‑tag is “SpO2 <85% on flow‑by + paradoxical = tube now,” so I pre‑oxygenate 45–60 s, induce, intubate, and start IPPV without TFAST. If crackles aren’t obvious or the cat’s the quiet tachypneic type, I’ll allow a single 15‑second lung glide/B‑line sweep on POCUS in an O2 cage, but any struggle or desat aborts to the tube plan.
@OP 82% at 02:30: preoxygenate 60 s, tube, then POCUS; start PEEP 3–5 if crackles.