A IS FOR AIRWAY AIRWAY CHECKLIST Dr Cline

A IS FOR AIRWAY: AIRWAY CHECKLIST Dr. Céline Jacobs Emergency Medicine Coordinator Health Frontiers

1 Know what kills! 2 Make a plan! 3 Get the drugs right! THE STEPS TO A GOOD INTUBATION

1. KNOW WHAT KILLS

Credit: Dr. Chris Nickson

HYPOXIA Credit: Dr. Chris Nickson

ACIDOSIS Credit: Dr. Chris Nickson

2. MAKE A PLAN

3. GET THE DRUGS RIGHT

TO HELP YOU WE USE AN AIRWAY CHECKLIST

Credit: Dr. Chris Nickson

IN MOST PATIENTS YOU HAVE TIME TO RESUSCITATE.

RSI Rapid Sequence Intubation

RSI Rapid Sequence Intubation

RSI Resuscitation Sequence Intubation

PREPARATION q Assign team q Consider indications for intubation q Protect C-Spine as needed q Assess the airway (Mallampati Score, Deformity, Dentures) q Position the patient (jaw thrust, SNIFF, ear to sternal notch) q Resuscitate before you intubate (IV fluids, O 2, BP) q Monitor BP, HR, RR, continuous O 2 sat q IV access (min 18 G) x 2 q Pre-oxygenation q Review plan with team q Equipment checklist

PREPARATION q. Assign team q. Roles assigned beforehand q. Everyone should know their role

PREPARATIO N q. Consider indications for intubation

PREPARATION q. Protect C-Spine as needed

PREPARATION q. Assess the airway (Mallampati Score, Deformity, Dentures)

PREPARATI ON q. Position the patient (jaw thrust, SNIFF, ear to sternal notch)

PREPARATION q. Resuscitate before you intubate (IV fluids, O 2, BP) www. medcalc. com/ivrate. html

Credit: Dr. Chris Nickson

PREPARATI ON Monitor BP, HR, RR, continuous O 2 sat

PREPARAT ION q. IV access (min 18 G) x 2

PREPARATIO N q. Pre-oxygenation q. Apnoeic oxygenation

HYPOXIA Credit: Dr. Chris Nickson

PREPARAT ION q. Review plan with team q. Plan A, Plan B, Plan C, etc.

PREPARATION q. Equipment checklist

PREPARATION q Assign team q Consider indications for intubation q Protect C-Spine as needed q Assess the airway (Mallampati Score, Deformity, Dentures) q Position the patient (jaw thrust, SNIFF, ear to sternal notch) q Resuscitate before you intubate (IV fluids, O 2, BP) q Monitor BP, HR, RR, continuous O 2 sat q IV access (min 18 G) x 2 q Pre-oxygenation q Review plan with team q Equipment checklist

EQUIPMENT CHECKLIST q Check all equipment q Ventilator q Oxygen source x 2 -3 q Suction q Endotracheal tubes (6. 0 – 8. 0) q Laryngoscopes (Macintosh 3, 4) q Syringe 10 cc q Bag Valve Mask q Bougie q Nasal Cannula q Non-Rebreather q Oral and nasal airway q LMA (if available) q Stylet q Stethoscope q Gloves/Goggles/Mask q Securing method q Cricothyroidotomy kit q Protective face mask

EQUIPMENT CHECKLIST q. Check all equipment. q. Make sure you have everything. q. Make sure nothing is broken.

EQUIPMENT CHECKLIST q. Ventilator q. Oxygen source x 2 -3 q. Suction q. Endotracheal tubes (6. 0 – 8. 0) q. Laryngoscopes (Macintosh 3, 4) q. Syringe 10 cc q. Bag Valve Mask q. Bougie q. Nasal Cannula q. Non-Rebreather q. Oral and nasal airway q. LMA (if available) q. Stylet q. Stethoscope q. Gloves/Goggles/Mask q. Securing method q. Cricothyroidotomy kit q. Protective face mask

INTUBATION Once patient is resuscitated, stable, oxygenated, and you are prepared only then should you consider intubating.

PREPARE MEDICATIONS

Credit: Dr. Chris Nickson

INDUCTION

RSI INDUCTI ON

PARALYTIC Must NEVER be given without sufficient sedative medication! Hypotensive patients: Use the higher dose

SEDATION This should be prepared before you intubate and started immediately after intubation.

EACH PATIENT IS DIFFERENT Critical thinking is essential! This is a guideline and a memory tool to help you but you still need to think if each step is appropriate for your specific patient.

IN CONCLUSION:

Credit: Dr. Chris Nickson

HYPOXIA Credit: Dr. Chris Nickson

ACIDOSIS Credit: Dr. Chris Nickson

USE THE AIRWAY CHECKLIST TO PREPARE AND PREVENT THESE!

FOAMED RESOURCES

First EM Airway Series: https: //first 10 em. com/airway-optimizing-the-basics/ https: //first 10 em. com/airway-is-the-patient-ready/ https: //first 10 em. com/intubation/ https: //first 10 em. com/cricothyroidotomy/ https: //first 10 em. com/post-intubation/ Resuscitation Sequence Intubation: http: //rebelem. com/critical-care-updates-resuscitation-sequence-intubationhypotension-kills-part-1 -of-3/ http: //rebelem. com/critical-care-updates-resuscitation-sequence-intubationhypoxemia-kills-part-2 -of-3/ http: //rebelem. com/critical-care-updates-resuscitation-sequence-intubation-ph-killspart-3 -of-3/

lifeinthefastlane. com/own-the-airway/ lifeinthefastlane. com/shock-tube https: //www. slideshare. net/precordialthump/no-apologies-intubationof-the-shocked-patient http: //rebelem. com/bougie-use-in-emergency-airway-managementbeam/