· Background
· Management
· Prevention
|
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 |
|
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 |
|
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 |
|
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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