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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