Vortex Approach

 

Why Vortex?

 

Vortex approach

Other approaches

Simple enough for real life

Yes

No

Plan A

Anything

ETT only

Preparation for FONA

Early

Late

Target audience

Anaesthetists, nurses, ambos

Anaesthetists

 

Features of Vortex:

COMPONENTS:

·     Three lifelines

1.    Bag-mask

2.    LMA

3.    ETT

·     One CICO rescue

1.    FONA

·     Two zones:

1.   Green zone (out of vortex = safe)

2.   Blue zone (in vortex = spiral towards centre)

3.   No grey zone!

OPTIMISATION OF ATTEMPTS:

·     Max 3 attempts at each lifeline

o  Minimise trauma

o  Minimise delay

·     5 Categories of optimization

o  Consider all

o  Implement only if helpful

o  Don’t waste time here

SUCCESS:

·     If oxygenation ok: move to green zone

·     Optimise

o  Oxygenation

o  Circulation (e.g. address ignored hypotension)

·     Strategise

1.    Keep it (proceed vs wake up)

2.    Convert it (e.g. SGA -> ETT via aintree)

3.    Remove and replace it (= re-enter vortex)

·     Mobilise:

o  Personnel (e.g. 2nd anaes, ENT surg)

o  Equipment (e.g. fibreoptic bronchoscope)

o  Location (e.g. to theatre from ICU)

·     Considerations for next strategy:

o  Situation (e.g. urgency of surgery)

o  Patient factors (e.g. aspiration risk)

o  Team factors (i.e. skills)

o  Airway factors (e.g. pathology)

FAILURE BEST EFFORT:

·     If oxygenation not ok: continue through vortex

·     Travel in either direction

·     Spiral in towards CICO rescue

·     Can do parallel attempts (e.g. come out and bag-mask while awaiting video laryngoscope)

·     Must declare “Green zone” vs “Vortex” after each attempt

 

                  

CICO:

·     “CICO status”:

o  Ready: get kit

o  Set: open kit

o  Go: make cut

·     It’s not just about the SpO2

o  High sats but tried everything -> FONA

o  Low sats but haven’t tried LMA -> LMA
(more familiar technique)

·     Barriers to transition mindset:

o  ‘Flick of switch’ mentality vs ‘transitioning’

o  Don’t want a reputation for a weak stomach

o  Airway disasters are rare

o  Airway disasters are insidious

(not a Vortex drawing)

CRITICAL LANGUAGE:

·     CPR has standardized language, e.g.

o  Non-shockable rhythm

o  Stand clear

·     Vortex approach offers the same

o  Green zone

o  Vortex (blue zone)

o  Best effort

o  CICO status: ready, set, go

CLINICAL INTEGRATION:

·     Airway trolley should reflect vortex approach

 

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