The Emergency Department Professor Jonathan Benger College of

The Emergency Department Professor Jonathan Benger College of Emergency Medicine 30/03/2011 1

What We Already Know • RSI occurs every 4 -5 days in an average ED • Emergency airway management outside the operating theatre is hard! - Higher complication rate - Difficult intubation 10 x more common - Surgical airway rate of 0. 3 to 0. 5% • Patient versus system factors • RSI in major trauma 30/03/2011 2

Spot The Difference. . . 30/03/2011 3

Emergency Department Numbers • • • 15/184 (8%) of events occurred in the ED 40% ASA grade 1 -2 67% male 80% aged < 60 years Half were classed as obese 7 cases in the day, 4 in the evening, 4 overnight 30/03/2011 4

Who Was In charge? Grade and specialty Number Consultant/AS in anaesthesia 7 ST 7 in anaesthesia 1 ST 6 in critical care (non-anaesthetist) 2 Sp. R in emergency medicine 1 ST 3 in anaesthesia 3 ACCS trainee in anaesthesia (month 5) 1 30/03/2011 5

Emergency Department Problems • Difficult or failed intubation in 14 cases - 1 aspiration • 12 involved tracheal intubation - 2 surgical airways for obstruction - 1 facemask anaesthesia for cardioversion • 10 surgical airways - 2 died, 2 permanent injury, 6 full recovery • 2 unrecognised oesophageal intubations 30/03/2011 6

Key Learning Points 30/03/2011 7

Right Person 30/03/2011 8

Right Place 30/03/2011 9

Right Equipment 30/03/2011 10

Right Preparation 30/03/2011 11

Recommendations • • Excellent communication between specialties Predict and plan for problems Timely availability of skilled staff and support Standardise and familiarise Capnography Joint training Checklist Audit 30/03/2011 12

Recommendations • Right person • Right place • Right equipment • Right preparation 30/03/2011 13

Questions 30/03/2011 14