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).

1. 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.
2. 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
3. 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.)
       

       https://twitter.com/SydneyHEMS/status/562441294631280641

   • 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.
4. 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.