Can’t Intubate Can’t Oxygenate (CICO)

Slides:

Advertisements

Similar presentations

ALERTALERT ! The Oxford ALERT Programme Siobhan Teasdale Clinical Educator AICU Outreach Team John Radcliffe Hospital September 2009.

Advertisements

Advanced Airway Management

ENDOTRACHEAL INTUBATION. NEONATAL FLOW ALGORITHM BIRTHBIRTH Term gestation? Amnlotic fluid clear? Breathing or crying? Good muscle tone?u Provide warmth.

Sydney Clinical Skills and Simulation Centre Management of the Critically Obstructed Airway Session 6: Managing Transition - 7 failure factors and strategies.

Managing the Artificial Airway RC 275 Tracheotomy/Tracheostomy When intubation can’t be done or the need for the airway is indefinitely long Traditional.

Difficult Airway Trolley (DAT) What does the ideal DAT look like? Top work surface and 4-5 drawers Mobile Robust Stocked in a logical sequence Clearly.

DAS Guidelines update April 2015

#8 Essential Emergency Airway Care- Surgical Airways 1 Andrew Brainard, MD, MPH, FACEM, FACEM

Basic Airway Management: Bag-Mask Ventilation Pat Melanson, MD.

TEMPLATE DESIGN © com Comparison Of Manikin models versus Live Sheep in Can’t Intubate Can’t Ventilate training A.P.M. Moran.

Sydney Clinical Skills and Simulation Centre Management of the Critically Obstructed Airway Session 2: Supraglottic Airway Rescue and Transition to Infraglottic.

Continuous Positive Airway Pressure in the Neonatal Intensive Care Level 1 Mark A. Willing, RRT-NPS.

Emergency Intubation An instructional program for Licensed Respiratory Practitioners at Kaleida Health.

Sydney Clinical Skills and Simulation Centre Management of the Critically Obstructed Airway Session 1: Why is CICO a problem?

Laryngectomy & Tracheostomy Emergency Management & Patient Perspective

BAG & MASK VENTILATION.

Sydney Clinical Skills and Simulation Centre Management of the Critically Obstructed Airway Session 8: Being prepared – A systems plan.

Paediatric Resuscitation Guidelines 2005

Respiratory Failure Sa’ad Lahri Registrar Dept Of Emergency Medicine UCT / University of Stellenbosch.

Difficult tracheal intubation

What equipment should be in your Difficult Airway Cart ?

Abdullah Alsakka E.M. Consultant. Questions For The Emergency Physician: 1. Can I predict the difficult airway? 2. How often can I expect to be faced.

Research In Airway Management Medic One Tuesday Series April 2009 Keir J. Warner, BS Paramedic Training.

First Aid Devangna Bhatia. Equipment: ABC’s: A: Airways B: Breathing C: Circulation.

Sydney Clinical Skills and Simulation Centre Management of the Critically Obstructed Airway Session 5: Infraglottic Airway Rescue Practical Session.

#8 Crash Cricothyrotomy Learning Objectives – Review Prep team/plan/room/equipment Discuss Difficult Airway Algorithm Describe a “Crash Airway” Declare:

Basic Emergent Airway Management. Station: Laryngeal Mask Ventilation—Rescue airway and Applied Guidelines practice -LMA Indications, contraindications,

Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Airway Management and Ventilation Team Work Chapter 6.

Basic Life Support (BLS) Advanced Life Support (ALS) Dr. Yasser Mostafa Prof. of Chest Diseases Ain Shams University.

Without reference, identify principles about volume/pressure and high frequency ventilators with at least 70 percent accuracy.

Maintaining Oxygenation Phase 2 Medical Students Respiratory System A. J. Shearer Consultant Anaesthetics & Intensive Care.

Oxygenation And Ventilation

Emergency in Dentistry: Part I B asic life support (BLS) - Sequence of BLS - Sequence of BLS - Equipment - Equipment - Techniques - Techniques.

Procedures. Chapter 15 page 448 Objectives Spell and define key terms State the purpose of endotracheal intubation and describe how to assist with this.

Sydney Clinical Skills and Simulation Centre Management of the Critically Obstructed Airway Introduction.

For staff with direct patient contact

CardioPulmonary Resuscitation (CPR) Matthew Giannetti Grades 9-12.

A Modular Approach to an Airway Management Curriculum Dr Andrew McKechnie, Dr Branavan Retnasingham, Dr Jay Dasan Kings College Hospital, London Background.

Q4.10 – October 2010Airway Management Essentials© Copyright 2010 American Safety and Health Institute Airway Management Essentials.

Normofrequent Intratracheal Jet Ventilation - Simple and Useful for Endolaryngeal and Airway Stenosis Surgery. J.Samarütel, M.Kull Dept of Anaesthesia.

TRACHEOSTOMY & CRICOTHYROIDOTOMY

Facilitated Intubation t Sedation (decrease LOC) –Versed (January 2002 with patch) concerns for hypotensive patients helps blunt sympathetic response amnesia.

Indicate on this diagram any sutures in place This patient has a New TRACHEOSTOMY UPPER AIRWAY ABNORMALITY: Yes / No Document laryngoscopy grade and notes.

DIFFICULT AIRWAY IN THE ICU Dr Anitha Shenoy Professor and Head of Anaesthesiology Kasturba Medical College, Manipal.

Emergency Airway Algorithm

Paramedic Ventilator Management

Emergency Cricothyrotomy: Comparing Four Methods Summary and Comment by Aaron E. Bair, MD, MSc, FAAEM, FACEP Published in Journal Watch Emergency Medicine.

Beyond the algorithm... John Moore Teaching the teachers Tracheostomy Safety Project 2011.

Airway Doctor Two minute training Airway Doctor Airway manoeuvres and adjuncts Nasal prongs 15L/min Bag Valve Mask (Ambu Bag) + 15L/min +/- ventilate 2-person.

Sydney Clinical Skills and Simulation Centre Management of the Critically Obstructed Airway Session 3: Supraglottic Airway Rescue Practical Session.

Obesity and Anaesthesia Dr Nick Woodall. Obesity – UK Prevalence 24.5% Information Centre for health and social care. The health survey for England -

Airway Year 4 tutorial A B C D E. Goals of airway management Relieve airway obstruction & so maintain ability to adequately ventilate Relieve airway obstruction.

CPR & AED Course: Supplemental Slides. IMPORTANT NOTICE An important objective of the Guidelines 2010 process was to emphasise the importance of high-quality.

Indicate on this diagram any sutures in place This patient has a New TRACHEOSTOMY UPPER AIRWAY ABNORMALITY: Yes / No Document laryngoscopy grade and notes.

CPR Course Emergency medicine department. OBJECTIVES At the end of this course participants should be able to demonstrate: –How to assess the collapsed.

Intensive Care NAP4 Major complications of airway management in the UK Royal College of Anaesthetists, 13 July 2011.

Airway Training WGH Simulation afternoon WGH 22/01/2016 Thomas Bloomfield ST4 Anaesthetics.

Airway. Learning Objectives At the end of this session you will be able to Describe the main aims of airway management in trauma Predict specific difficulties.

Pediatric Basic Life Support

Unit 3 Lesson 2 Airway Adjuncts & Oxygen Therapy

ALFRED ICU INTUBATION CHECKLIST

Difficult Airway.

Basic Life Support for an Infant

Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults† C. Frerk, V.S. Mitchell, A.F. McNarry, C. Mendonca,

Intro to First Aid and CPR

Indicate on this diagram any sutures in place

Airway management If you do not manage the patient’s airway – they will die Simple MANOEUVRES save lives © BASICS Education March 2019.

Human factors can't intubate can't oxygenate (CICO) bundle is more important than needle versus scalpel debate A.W.G. Booth, K Vidhani British Journal.

Presentation transcript:

Can’t Intubate Can’t Oxygenate (CICO) Management of the Critically Obstructed Airway Session 4: Infraglottic Airway Rescue

CICO Plan Part 1 Supraglottic Airway Rescue Part 2 Transition to CICO Infraglottic Airway Rescue

Session aims CICO infraglottic rescue: Algorithm (A Heard) Techniques Kit Team-based algorithm

Acknowledgements References Dr Andy Heard - Original content Expert Working Group, RHCE Critically Obstructed Airway Course References Heard, R. J. Green and P. Eakins. The Formulation and Introduction of a ‘Can’t Intubate, Can’t Ventilate’ Algorithm into Clinical Practice. Anaesthesia, 2009, 64, pages 601–608. Dr A.M.B Heard. The Wet Lab-Emergency Airway Management Techniques for the ‘Can’t Intubate, Can’t Oxygenate’ Scenario. March, 2011.

CICO algorithm (Heard) Cannula Cricothyroidotomy or Cannula Tracheotomy Palpable Neck Airway Anatomy? Scalpel Finger Cannula Scalpel Bougie Melker 5.0 Cuffed Seldinger Technique Railroad size 6.0 ET Tube Melker 5.0 Cuffed Seldinger Technique Consider: Awaken/Other upper airway techniques FAILURE Oxygenate and stabilise SUCCESS NO YES CICO A. M. B. Heard, R. J. Green and P. Eakins. The Formulation and Introduction of a ‘Can’t Intubate, Can’t Ventilate’ Algorithm into Clinical Practice. Anaesthesia, 2009, 64, pg. 601–608.

CICO techniques Cannula Cricothyroidotomy Jet oxygenation Scalpel-bougie Scalpel-finger-cannula Melker size 5 cuffed Seldinger conversion to a definitive airway

Video – Cannula Cricothyroidotomy http://www.vimeopro.com/johnmackenzie/cant-intubate-cant-oxygenate/page/1

Cannula cricothyroidotomy Equipment

Jet oxygenation You are trying to achieve 2 things with jet oxygenation in the CICO scenario: Provide oxygen Prevent/improve airway and alveolar collapse

Jet oxygenation Providing oxygen The ManujetTM Set at 1.0 bar (i.e., Infant setting, in the Yellow Zone) delivers inspiratory flow of approx 250 mls/second Rapid - O2 oxygen cricothyroidotomy insufflation device (nee Leroy) Connected to piped O2 at 15L/min, delivers inspiratory flow of approx 250 mls/second

Jet oxygenation in a 70kg male Prevent/improve airway and alveolar collapse Initial breath 4 seconds duration=approx 1000mL If there is no response or improvement in SpO2 after 30 seconds, a second jet of 2.0 seconds should be administered. Whilst applying the first jet, signs of flow must be sought by checking the chest for movement, and listening for flow.

Jet oxygenation in a 70kg male Prevent/improve airway and alveolar collapse Subsequent breaths Do not jet again until the SpO2 have dropped by 5% from the maximum achieved with the initial jet. Subsequent jets should be of 2 seconds duration (Approx 500 mls)

Jet oxygenation IF jetting with the manujet, and there are no signs of expiratory flow THEN disconnect the manujet to allow some expiration through the cannula (taking care to not inadvertently remove the cannula). This is to ensure hyperinflation causing reduced venous return does not occur. The Leroy and ENK allow expiration through the cannula and do not require disconnection.

Jet oxygenation IF there is no saturation reading for whatever reason THEN it is safe to insufflate 500 mls every 30 seconds if using a 14g cannnula and Rapid - O2 (Leroy) / ENK (Or disconnected Manujet) even in complete upper airway obstruction.

Jet oxygenation After connecting the cannula to the jet oxygenation device, never let go of the cannula. Only jet oxygenate whilst watching the chest rise and fall The rate-limiting step for the frequency of safe jet oxygenation is the patency of the expiratory pathway.

CICO algorithm (Heard) Cannula Cricothyroidotomy or Cannula Tracheotomy Palpable Neck Airway Anatomy? Scalpel Finger Cannula Scalpel Bougie Melker 5.0 Cuffed Seldinger Technique Railroad size 6.0 ET Tube Melker 5.0 Cuffed Seldinger Technique Consider: Awaken/Other upper airway techniques FAILURE Oxygenate and stabilise SUCCESS NO YES CICO A. M. B. Heard, R. J. Green and P. Eakins. The Formulation and Introduction of a ‘Can’t Intubate, Can’t Ventilate’ Algorithm into Clinical Practice. Anaesthesia, 2009, 64, pg. 601–608.

Video - Scalpel-Bougie http://www.youtube.com/watch?v=TveIsbjmakU&feature=channel&list=UL http://www.youtube.com/watch?v=J1pUJYOWfog&feature=channel&list=UL

Scalpel-Bougie Equipment

CICO algorithm (Heard) Cannula Cricothyroidotomy or Cannula Tracheotomy Palpable Neck Airway Anatomy? Scalpel Finger Cannula Scalpel Bougie Melker 5.0 Cuffed Seldinger Technique Railroad size 6.0 ET Tube Melker 5.0 Cuffed Seldinger Technique Consider: Awaken/Other upper airway techniques FAILURE Oxygenate and stabilise SUCCESS NO YES CICO A. M. B. Heard, R. J. Green and P. Eakins. The Formulation and Introduction of a ‘Can’t Intubate, Can’t Ventilate’ Algorithm into Clinical Practice. Anaesthesia, 2009, 64, pg. 601–608.

Video – Scalpel Finger Cannula http://www.youtube.com/watch?v=waGiiEyzqX8&feature=channel&list=UL

MelkerTM conversion Equipment

CICO infraglottic rescue Key points for success CICO is recognised CICO is declared A plan is activated Equipment is immediately available People know their roles

‘Transition’ protocol - CICO SUPRA-GLOTTIC RESCUE Continue Supraglottic rescue Consider waking patient Review again in 1 min TRANSITION Is this a CICO situation? NO Best attempt at: Face-mask ventilation? LMA ventilation? Endotracheal intubation? AND Oxygen saturations falling or persistently low? YES MOBILISE RESOURCES FOR CICO INFRAGLOTTIC RESCUE With permission A. Heard and Working group for the Rural Health Continuing Education (RHCE) (Stream 1) ‘Critically Obstructed Airway Workshop’. Contact smsc@nsccahs.health.nsw.gov.au. 2013

CAN’T INTUBATE & CAN’T OXYGENATE (CICO) EMERGENCY PROTOCOL SUPRAGLOTTIC RESCUE – MOBILISE RESOURCES FOR CICO Is this a CICO situation? Best attempt at supraglottic rescue? Oxygen saturations persistently low? Face mask ventilation LMA ventilation Endotracheal intubation Continue supraglottic rescue Consider waking patient Review again in 1 min NO Mobilise resources for CICO YES DECLARE CICO INFRAGLOTTIC RESCUE Algorithm ALGORITHM Resources 1. Cannula-cricothyroidotomy kit Jet oxygenation tubing Melker™ kit Self-inflating bag 2. Scalpel – bougie kit 3. Scalpel – finger – cannula kit 4. Arrest trolley Team roles Teamleader Proceduralist – infraglottic rescue Proceduralist – supraglotic rescue Assistant – supraglotic rescue Assistant – infraglottic rescue Assistant – equipment set up Scribe With permission A. Heard and Working group for the Rural Health Continuing Education (RHCE) (Stream 1) ‘Critically Obstructed Airway Workshop’. Contact: smsc@nsccahs.health.nsw.gov.au. 2013 .