ALFRED ICU INTUBATION CHECKLIST ASSESS q Is a

ALFRED ICU INTUBATION CHECKLIST ASSESS q Is a difficult airway predicted? EQUIPMENT q Is monitoring ready? q Pulse oximetry (Sp. O 2) q ETCO 2 q BP (cycle q 1 min if NIBP) q ECG q Is there risk of physiological compromise? q Cardiovascular instability q Hypoxaemia q Acidaemia q Increased ICP q Aspiration q Underlying disease q Allergies q Are the ICU consultant and ANUM aware? q Do anaesthetics or ENT need to be contacted? q Is equipment checked & ready? q BVM with O 2 flowing q Airway adjuncts q Supraglottic airway device q ETT x 2 (incl 1 size down) q Laryngoscopes x 2 (Direct/Video) q Bougie q CICO** rescue equipment q Suction q Stethoscope q Are drugs & lines ready? Anaesthetics CIC: x 44627 q IV checked & fluids on pumpset q Induction & paralytic drugs q Inopressors q Post-intubation sedation Modified from the RTIC Severn Checklist by the Alfred ICU Airway Team TEAM q Have team roles been assigned? q Team leader q 1 st intubator* q 2 nd intubator* q Airway assistant q CICO** rescuer q Drug administrator q Senior support nurse q +/- Cricoid Pressure q +/- Manual in-line stabilisation PLAN q Is the patient optimised? q Position q Oxygenation q Ventilation q Haemodynamics q NGT suctioned q What are the plans for anticipated physiological compromise? q What are Plans A, B, C & D if the airway is difficult? * Two airway competent doctors MUST attend **CICO = can’t intubate, can’t oxygenate – proceed to cricothyroidotomy q What drugs/doses are to be given? When and how? q Does anyone have questions or concerns? Version 15, 17 May 2017

Unanticipated Difficult Intubation Plan A Direct / Video laryngoscopy Successful intubation Failed optimal laryngoscopy (2 attempts) B Bag mask oxygenation Maintain oxygenation, seek definitive airway plan* *Can’t Intubate Can Oxygenate Seek additional expert airway assistance Consider: • Waking patient to spontaneously ventilate if safe to do so • Further intubation attempt with optimisation and most skilled operator • Intubation through supraglottic airway device • Fibreoptic intubation • Surgical airway Failed bag mask oxygenation C Supraglottic Airway Device Maintain oxygenation, seek definitive airway plan* Failed SAD oxygenation Declare “this is a can’t intubate, can’t oxygenate situation” D Cricothyroidotomy Scalpel bougie technique OR needle cricothyroidotomy Predictors of Difficult: Bag Mask Ventilation Bearded Obese No teeth Elderly Sleep apnoea/snoring Supraglottic Airway Insertion Restricted mouth opening Obstruction Distorted airway Stiff lungs or c-spine Always check previous airway history