PS61 2017: CICO

 

List:

·        Background

·        Management

·        Prevention

 

Background:

Definition

·      Upper airway obstructed

·      Supraglottic techniques failed

·      SpO2 <90%

Significance

·      High mortality

·      More common in ICU and A&E

·      Research suggests our technical and non-technical preparation is poor

 

Management:

Oxygenation

·      Mask

·      LMA

·      ETT

·      Hole

Optimisation

·      General: positioning, suction, muscle relaxant

·      Bag-mask: different size mask, OPA, NPA, two hands, clear oropharynx

·      LMA x 2: different size or type

·      ETT x 3: BURP, bougie, different size direct laryngoscope, video laryngoscope, bronchoscope via ILMA

Transition

·      If fail at 1: declare problem + get help + consider wakeup (yeah, right)

·      If fail at 2: prepare for FONA

·      If fail at 3: declare CICO + do FONA

 

Prevention: technical aspects

Pre-assessment

·      Any red flags? (infection, cancer etc)

·      Expect difficult procedures (BMV, LMA, ETT, FONA, extubation)

·      What are the stakes? (fasting status, cardioresp status)

Consider options

·      AFBI

·      Awake tracheostomy

·      Regional

·      Postponement

Pre-oxygenation

·      Face mask

·      HFNP

 

Prevention: non-technical aspects

Organisation

·      Adherence to best practice guidelines

·      Standardised equipment

·      Airway registry and alerts

·      Letters for tricky patients

·      Checklists

·      Audit

·      Incident reporting

·      Safety culture

Team simulation

·      Application of cognitive aids

·      Emergency planning

·      Airway timeout

·      Allocation of roles

·      Procedural skills

·      Use of equipment

Individual habits

·      Leadership (mental models, role allocation, status update)

·      Communication (declare CICO, closed-loop)

·      Humility (call for help, invite suggestions)

·      Wisdom (self-awareness, prevent high task workload)

 

 

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