From Dr Fen Moy, FACEM and airway lead for AED, pre-reading documentation for registrar orientation:
Introduction to ED Airway Drugs
Other airway resources on this site can be found by clicking on the ‘airway’ tag in the lower left of the page.
Auckland ED is currently conducting usability testing of the Storz C-MAC video laryngoscope. Resources are found below:
<p><a href=”http://vimeo.com/40230198″>Introduction to the Storz/C-MAC Video Laryngoscope</a> from <a href=”http://vimeo.com/pemcincinnati”>Brad Sobolewski</a> on <a href=”https://vimeo.com”>Vimeo</a>.</p>Literature regarding C-MAC use in ED
Resources:
AED will shortly be transitioning from the venerable Oxylog 2000 to the Oxylog 3000 plus.
The video below is a superb introduction to the Oxylog 3000 series, covering anatomy, settings, and connections:
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The Oxylog 3000 plus has some additional features, including embedded capnography and a feature called Autoflow – you can read the official Draegar infomation about Autoflow HERE, or you can read the Sydney HEMS take on it HERE – ‘PRVC isn’t a country in Sout East Asia’.
Prior to testing your newfound knowledge on real live patients, you can have a go at the Draegar Oxylog Simulator by clicking HERE. (This page takes a while to load, select ‘manual simulation‘ from the ‘simulation‘ menu once the page has loaded)
George Douros (Emergency Physician from the Austin Hospital in Melbourne, ) has created these charts to help you ‘own the Oxylog 3000’ (sourced from the superb lifeinthefastlane.com) – click the images to enlarge:
As part of your AED orientation and departmental CME we will be running through basic airway survival skills on Tuesday the 10th December from 2pm to 4pm.
We will be covering
I have attached some links for pre-reading around the ED airway, RSI and checklists as below:
http://emcrit.org/podcasts/emcrit-intubation-checklist/
– This is a collection of airway based podcasts and resources from Scott Weingart on his EMCRIT blog, presented all on one page and is an invaluable resource. Goes into a little more detail than we will on Tuesday, but the rest we will be covering on another airway session.
– UK Site, based on the outcomes from the NAP4 study. Good, one page RSI checklist developed by anaesthetic regs in the UK and a nice presentation of the rationale behind safer intubation using a pre-intubation checklist.
http://clubmona.org/2013/04/05/using-the-paediatric-rsi-checklist/
– By Cliff Reid (of the resus.me blog). This is an awesome video demonstrating a concise run-through an RSI checklist. Useful for a brush-up on paeds RSI.
http://prehospitalmed.com/2013/01/22/how-to-do-rsi-on-side-of-a-cliff-watch-and-learn-by-gsa-hems/
– Just for a bit of fun! If NSW HEMS can do it safely on the side of a cliff it can be done safely anywhere!
From Dr Fen Moy – drug information sheets. This will be covered in a second session later in the run
Click HERE for the file
If only patients came with labels…
If you have your Auckland Trainee Airway and Procedural Skills logbook – please bring it along with you on the day! Cheers – Alana
AED has a Glidescope video laryngoscope available in the resus area.
This is a step-by-step training video for using the Glidescope.
The technique of use is different from the Macintosh blade. The video link goes through the basic steps.
4 steps to remember –
1) Look at the mouth (to insert the blade in the MIDLINE)
2) Look at the screen (to get the laryngeal view)
3) Look at the mouth (to pass the ETT into the back of the mouth)
4) Look at the screen (to pass the ETT through the cords)
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From Scott Weingart at emcrit.org, this is a (somewhat irreverent!) debate on whether video laryngoscopy should be used for ALL emergency intubations:
In an important quality initiative for AED, Dr Fen Moy (ED Specialist) has recently launched an airway registry to gather data on endotracheal intubation in the emergency department. The results will be used to improve clinical care and training:
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The Adult Emergency Department Airway Register
Reason for Establishing an Airway Register:
Currently AED does not have any records of the number of intubations done in the department. Nor is there any information about the indications, which staff are performing the intubations, difficulties encountered, and complications occurring.
Emergency Medicine Australasia published a prospective observational study of the airway register used in Royal North Shore Hospital in Sydney. It was the first descriptive study of intubations in an Australasian ED. It highlighted the lack of information of intubations done in Australasian EDs. There has been more information from North America with the establishment of an online National Emergency Airway Registry since 1996 (however it only has 25 participating hospitals).
Benefits of an Airway Register:
1. The register will provide objective data for AED & DCCM regarding numbers of intubations done in AED.
2. Collected information which can lead to quality improvement for AED and other departments. Specifically: frequency of complications; experience & success rates of intubators; need for rescue devices; need for Airway Emergency Team call-outs.
3. This can then be used for further education & training of staff.
Expectations:
It would be expected that the intubator will be responsible for filling out the form, particularly the sections highlighted #. The forms are on the side of each Resus bay’s write-up platform, and the completed forms can be placed in the adjacent plastic sleeve.
The team leaders – please remind the intubator to fill in the form.
Feedback:
Results of the register will be analysed and fedback to AED during Clinical Governance sessions, as well as to the Department of Anaesthesia and the DCCM. We are using this registry within AED currently, but may look at joining the Australasian Registry at some stage in the future for wider collaboration.
Dr Fen Moy
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Current version of AED airway registry (click to enlarge):
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Minh Le Cong from Prehospitalmed.com recently interviewed Dr Toby Fogg, the author of the airway registry study referenced above, and released it as an audio podcast. The podcast, which contains discussion around the the results of the study plus airway registries in general, RSI checklists, airway skills maintenance, video laryngoscopy, and criciod pressure is here. Minh Le Cong’s podcast page, with references, is here.
A recent concept that has been widely discussed on FOAM sites, as well as at the SMACC conference, is The Vortex (pdf)
The Vortex is a simple cognitive aid that can be used in the setting of an unanticipated difficult airway. Conceived by Nicholas Chrimes (Melbourne anaesthetist) and Peter Fritz (Melbourne emergency physician), it aims to simply concepts, move away from complex algorithims, and be applicable in multiple settings.
Key to the concept is that the key goal in an unexpected difficult airway situation is alveolar oxygen delivery. Techniques to deliver oxygen (LMA, ETT, face mask) are regarded as equivalent, as any of these, if successful, will move a desaturating patient out of the Vortex into the ‘green zone’ where oxygenation is adequate for a ‘time out’ and alternative planning to occur. At the centre of the vortex is a surgical airway.
Resources regarding The Vortex:
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Improving care in ED 