Once a month, the structured reviews of all of our intubation attempts are presented at a Clinical Governance Day. Common themes and specific finer points are brought forward in an effort to improve our performance as a group. Below are some of the take home points from our last Airway Registry (23/03/16).
- It is essential to verify the function of your peripheral access just before induction, particularly if the patient has been moved. A minimum of two points of reliable access is ideal.
- If a patient has a lot of subcutaneous tissue, consider using an ultrasound guided peripheral line or cutting down to an IO site.
- Know the location of:
- Backup laryngoscope handles in case of bulb/battery failure: Dropdown Airway (DEA) Kit, pediatric airway kit in the Red Primary Pack (short handle)
- PEEP valves – In the adult side of the intubation kit and on the BVM itself in the Red Primary Pack, in the Medumat bag, and small black pouch of the Green Interhospital Pack
- In outdoor bright light conditions, improve your view of the vocal cords by optimizing your position and shading the sun.
- Position yourself so the sun is to your back and not directly in your face
- You can shade yourself and the patient in a variety of ways (use your imagination and the creativity of your team)
- Strategically positioned vehicle
- A pop up tent or awning – check with Fire or Police Rescue
- Inside a nearby shed or building (still with 360 degree access) or under a (gum) tree
- Blanket, sheet, or space blanket held up or draped over you and the patient (consider how this affects your team communication, bougie/tube passing, etc.)
- Remember it will take time for your eyes to adjust to the relative darkness; at a minimum, be in your shade at the time of pushing induction medications, if not before.
- As usual, when documenting your airway attempt, include as much detail as possible: positioning, timings, adjuncts, pre-oxygenation, shading, changes in between attempts, and specifics about anything out of the ordinary.
A big thanks to Dr. Clare Hayes-Bradley for diligently synthesizing and presenting the Airway Registry every month.