ED / ICU Emergency RSI Intubation Team Brief

ED / ICU Emergency RSI Intubation Team Brief

Prepare Equipment

Prepare Team

Prepare Patient

Prepare for Difficulty

Monitoring: (attached and working)

? Capnography ? ECG ? SpO2 probe ? Blood pressure

(if non invasive increase freq cycling during intubation)

Equipment: (checked and available)

? Difficult airway trolley

? Self inflating bag

? Two laryngoscopes

? Endotracheal tube x2

(

(=9.0, =8.0 + smaller size ready)

? Supraglottic airway (LMA)

? Bougie

? Working suction

? Tipping trolley

? Rescue technique equipment

-Quicktrac cricothyroidotomy

kit

-Ravussin needle and Manujet

-Scalpel and size 6 ETT

Drugs: (drawn up, labelled, checked)

? Induction agent ? Suxamethonium

(unless C.I ie MH, neuromuscular disease)

? Resuscitation drugs ? Maintenance sedation infusion ? Non depolarizing muscle

relaxant (Roc/Atrac)

Allocate roles:

? Team leader ? First and second intubator

(first = max 2 attempts)

? Cricoid pressure ? Drugs administrator

(ensure asepsis) ? Manual In line stabilization? ? Rescue airway (surgical)

CALL for HELP

1.Expecting difficulty: -help onsite and available

2. Expect no difficulty: - ensure communication and awareness of help

Physiology Optimal?

? Can physiology be improved?

Position optimal?

Trauma ? C+T spine precautions ? Manual in line stabilization ? Normally ? Pillow ? Neck flexed, head extended ? 30-40? head up tilt

Preoxygenation

? 3 minutes 100% O2 ? Consider CPAP ? Consider BMV during RSI

ASSESS airway Difficult: Ensure help present

No difficulty: Ensure help available ? Can we wake the patient up?

Is the patient a known difficult airway? ? If so find the plan if there is one

? consider awake trache/fibreoptic

Intubation Plan... READ ALOUD

Plan A RSI & Primary intubation

Plan B = BVM ventilation &airways May need two hands

Plan C = LMA &airway adjuncts (may need BVM vent again)

CALLING FOR HELP

ICU Registrar BLEEP 1987 Consultant ext 5752

Anaesthetist BLEEP 1622

Consultant (0800-1700) SPR (1700-0800)

ENT

-1700-0800; 2222 switchboard and ask for on call ENT Dr -In hours SEE OVER

Plan D = Rescue airway technique

FAILED INTUBATION

Call for help

Unanticipated difficult tracheal intubation algorithm on reverse

-Oxygenate; 100% O2 BVM

-FOLLOW Management of unanticipated difficult tracheal intubation algorithm on REVERSE

-Commence post intubation care. -Ensure ETCO2 monitoring at all times

Attempt Endotracheal Intubation

NO Confirming tracheal intubation: -ETCO2 x6 traces -Bilateral air entry in axillae

YES -Chest x-ray -Consider fibrescope

Modified from NAP 4 by Dr Patrick Tapley, Dr Matthew Williams, and Dr Peter McQuillan,ICU, QA Portsmouth, February 2013.

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