oral/nasal handed mask ventilation 3. unsuccessful VS: grade 4 view on direct Do not repeat failed ▪ ▪ ▪ intubation attempt BP 140/95, laryngoscopy x 1 technique-change HR 130, communicates grade 4 blades, optimize patient ▪ SaO2 84% view to team, requests position, etc trial 4 view on direct cricoid pressure without LMA as rescue device ▪ ▪ laryngoscopy, SaO2 improved view in difficult airway 80% requests and places algorithm ▪ if resident continues to LMA correctly discuss potential for ▪ ▪ to intubate SaO2 Recognizes rise, additional airway ▪ continues to fall to 60% fog in LMA, confirms trauma/fixation errors easy LMA placement breath sounds with multiple DL ▪ with adequate calls for attempts, consequences ▪ ventilation after anesthesiology and of delaying definitive placement surgical backup, prepare management of hypoxia SaO2 improves to 92% for cricothyroidotomy call for anesthesiology ▪ ▪ /tracheostomy if and possibly surgery necessary help in potential difficult airway situation 4. team planning for SaO2 92% with LMA assesses and consider alternatives to ▪ ▪ ▪ definitive airway in summarizes situation secure BP 115/56, HR 115 with ICU team blade, LMA ▪ calls for as intubating conduit, ▪ anesthesiology and FOB, etc surgical backup, prepare ensure optimal patient ▪ for cricothyroidotomy positioning /tracheostomy if leadership and ▪ necessary communication critical during management of airway call for help early with ▪ difficult airway, before problem becomes 5. secures airway SaO2 rises to 95%, BP communicates 3 inform team and write ▪ ▪ ▪ 125/65, HR 120 view to team with a detailed airway change to airway what was management (new effective for this patient blade/position, etc) call for help early with ▪ communicates difficult airway, before ▪ successful intubation to problem becomes team confirms ETCO2, ▪ +EBBS after intubation helps RT secure ETT ▪ and get patient on vent calls for ▪ anesthesiology and surgical backup, prepare for cricothyroidotomy /tracheostomy if necessary Debriefing Note
oral/nasal mask ventilation 3. unsuccessful intubation attempt ▪ VS: BP 140/95, HR 130, SaO2 84% ▪ 4 view on direct laryngoscopy, SaO2 80% ▪ if resident continues to to intubate SaO2 continues to fall to 60% ▪ easy LMA placement with adequate ventilation after placement ▪ SaO2 improves to 92% ▪ grade 4 view on direct laryngoscopy x 1 ▪ communicates grade 4 view to team, requests cricoid pressure without improved view ▪ requests and places LMA correctly ▪ Recognizes rise, fog in LMA, confirms breath sounds ▪ calls for anesthesiology and surgical backup, prepare for cricothyroidotomy /tracheostomy if necessary ▪ Do not repeat failed technique-change blades, optimize patient position, etc ▪ LMA as rescue device in difficult airway algorithm ▪ discuss potential for additional airway trauma/fixation errors with multiple DL attempts, consequences of delaying definitive management of hypoxia ▪ call for anesthesiology and possibly surgery help in potential difficult airway situation 4. team planning for definitive airway ▪ SaO2 92% with LMA in ▪ BP 115/56, HR 115 ▪ assesses and summarizes situation with ICU team ▪ calls for anesthesiology and surgical backup, prepare for cricothyroidotomy /tracheostomy if necessary ▪ consider alternatives to secure blade, LMA as intubating conduit, FOB, etc ▪ ensure optimal patient positioning ▪ leadership and communication critical during management of airway ▪ call for help early with difficult airway, before problem becomes 5. secures airway ▪ SaO2 rises to 95%, BP 125/65, HR 120 ▪ communicates 3 view to team with change to airway management (new blade/position, etc) ▪ communicates successful intubation to team ▪ confirms ETCO2, +EBBS after intubation ▪ helps RT secure ETT and get patient on vent ▪ calls for anesthesiology and surgical backup, prepare for cricothyroidotomy /tracheostomy if necessary ▪ inform team and write a detailed airway what was effective for this patient ▪ call for help early with difficult airway, before problem becomes Debriefing Note handed trial
ierc_simman_diff_airway.docx