This 50-minute workshop with pre-learning material will address the commonest problems leading to Can’t Intubate, Can’t Oxygenate (CICO) situations. The principles of the workshop are broadly based around the Vortex Approach, however, the Difficult Airway Society (DAS) guidelines and American Society of Anesthesiologists (ASA) airway management guidelines may also be considered as more detailed explanations of technical options during airway emergencies.
The intended audience of the workshop is a broad range of critical care clinicians. Ideally most, if not all, will have undertaken basic training in airway techniques and a structured program of experience. However, many might not have the opportunity to use airway management techniques on a regular basis. This workshop is primarily to outline a method of optimisation of key techniques to prevent CICO, but will discuss tricks, tips and some ‘green zone techniques’ that allow progression to an advanced plan after oxygenation has been achieved.
Four stations are planned within the workshop, each taking 10-12 minutes. Consequently the number of learning outcomes for each station are limited to two or three.
- Describe the three methods of supraglottic oxygenation and how they can be used sequentially in airway emergencies.
- Recall the main modes of optimisation techniques for each method
- Practice basic airway skills (Bag Valve Mask ventilation, Supraglottic Airway insertion and Endotracheal intubation) in preparation for the workshop
Bag Valve mask session
- Demonstrate ideal head position, insertion of adjuncts, Different hand grips, the role of suction and muscle relaxants in bag-valve mask ventilation.
- Discuss the difference between primary (low pressure) leaks due to poor mask seal and secondary (high pressure) leaks due to poor airway patency
- Show how the differences in anatomy between adults and children affects mask application to optimise airway patency
Supraglottic Airway insertion
- Demonstrate advanced SGA insertion techniques using fingers, laryngoscopes and bougies
- Discuss the advantages of second generation SGAs in airway emergencies
- Perform SGA insertion techniques on a child airway model
- Demonstrate the use of standard geometry and hyperangulated videolaryngoscopy blades
- Discuss the three phases of intubation (View, Delivery and Passage of the tube) and how to overcome difficulties
Green Zone techniques
- Discuss when green zone techniques are appropriate to consider
- Demonstrate methods of intubation when a supraglottic airway is already in situ using an Aintree catheter and fibreoptic scope.
Vortex Approach Primer
BVM optimisation (Jim)
Video on bougie technique of placement
Video on use of laryngoscope for placement
Brief Summary of some "Best Practices" Laryngoscopy-
Introduction to Larynx, Pharynx and Airway Anatomy
The Equipment Basics
- Airtraq https://youtu.be/RfjqJVyAjik
- Ambu aScope https://vimeo.com/123098295
- C MAC https://youtu.be/FVIDP_3kYbc
- C MAC + D blade https://vimeo.com/83351498
- C MAC Pocket Monitor https://youtu.be/_novUYR9yHU
- Fibreoptic Intubation by Levitan at SMACCGold https://youtu.be/gOYDlc2Jq8E
- King Vision https://youtu.be/Djy10C4uLA8
- McGrath https://youtu.be/Z6cO_O2pvg4
- McGrath X Blade https://youtu.be/fszreF5XTok
- King Vision https://youtu.be/6OH8ob_7aa4
- Awake oral intubation using King Vision https://youtu.be/KNzcoN00anE
- The importance of maintaining skills in DL https://youtu.be/3IjduRuwnEM
- Poor technique - Too deep and poor orientation with airtraq https://vimeo.com/45953993
- Anterior larynx with airtraq https://vimeo.com/45951744
- C MAC Video laryngoscope https://youtu.be/Yggmb8yE90Y
- Airtraq http://www.airtraq.com/
- Ambu http://www.ambu.com/corp/products/anaesthesia/product/aview-prod17194.aspx
- McGrath http://www.medtronic.com/covidien/products/intubation/mcgrath-mac-enhanced-direct-laryngoscope
- King Vision http://www.kingsystems.com/medical-devices-supplies-products/airway-management/video-laryngoscopes/
- Storz https://www.karlstorz.com/am/en/anesthesiology-and-emergency-medicine.htm
The video laryngoscope story
- The inventor of the video laryngoscope https://youtu.be/kiAuR0tRva4