The Age Of Simulation is Here.
The Airway Lead Concept
The UK Airway lead concept is a useful one to begin to establish an orderly development of airway capability within an institution or group of hospitals. The Airway lead will be dedicated to recommending appropriate equipment , setting up an Airway Rotation for Anesthesiologists, establishing appropriate expectations for staff and residents, and establishing a reporting system that reflects good and bad outcomes within the realm.
The Airway Rotation
The UK Airway lead concept is a useful one to begin to establish an orderly development of airway capability within an institution or group of hospitals. The Airway lead will be dedicated to recommending appropriate equipment , setting up an Airway Rotation for Anesthesiologists, establishing appropriate expectations for staff and residents, and establishing a reporting system that reflects good and bad outcomes within the realm.
The Airway Rotation
Experience with DL, VL, FOB, SGA(at least 1 selected), Simulation plan, and decision support with ASA style Algorithm. Attachment with designated enthusiasts for airway excellence training would be appropriate. Success of the program must be measured by institutional performance measurement. ICU and ED also must be incorporated in this effort because in these areas much valuable airway work is necessary.
High Fidelity Simulators
Extending Airway competence training to sister departments is a duty of the Anesthesia home of airway excellence. This can be done by establishing ED and ICU members of the Airway teaching group. Funding must be part of the solution because cost effective equipment must be available for self teaching and backed up by useful online airway curriculum that could be made universally available in the Hospital group catchment area. The airway community can thus be enlarged
Simple Manikins
Specific Device Performance teaching
Teaching New airway managers the fundamentals of use of complex airway tools like FOB or Video Laryngoscopy is increasingly being done with simulators in a calm teaching lab. This allows the understanding of the tool and how it performs prior to the clinical phase which then integrates the tool with patient variability. The tools have their own personality and there is occasional use by those who rather rely on their own bravado and skill rather that taking the time to find instruction. The tool may then be used in an advanced DAW situation and provide suboptimal performance-the tool gets the blame.
Preconceived strategies
Teaching pre-conceived clinical drills can add quickly to airway skill.
a. Tomahawk Procedure
The intubation of patients in a sitting position facing the intubator is an advanced skill that may be useful in ICU , ED, or EMS. This skill relies on inversion of the screen to get left and right corrected so that the procedure can be carried out easily.
b.Endotracheal Tube exchanges
This is a common procedure carried out in ICU to replace a double lumen tube or adjust the ETT size. Training makes the task much safer using a tube exchange catheter and a video Laryngoscope to guide the procedure and avoid tube advancement problems.
This is a common procedure carried out in ICU to replace a double lumen tube or adjust the ETT size. Training makes the task much safer using a tube exchange catheter and a video Laryngoscope to guide the procedure and avoid tube advancement problems.
This common act using an endotracheal tube exchanger is usually done in high risk ICU patients. The skills are specific and include getting assistance prior to the event. Planning extubation is closely related in risk and uses similar skills.
c. Intubation during simulated ongoing CPR.
This skill greatly enhances airway management during external compression. It is possible to train intubators to do Video Glidescope intubation without stopping CPR. It is proven that stopping CPR is undesireable.
c. Intubation during simulated ongoing CPR.
This skill greatly enhances airway management during external compression. It is possible to train intubators to do Video Glidescope intubation without stopping CPR. It is proven that stopping CPR is undesireable.
Salad Simulators
The SALAD -Suction Assisted Laryngoscopic (video) Airway Decontamination - simulator is experiencing increasing popularity as a training aid to teach caregivers to handle massive airway contamination. This picture shows a trainee handling a massive airway contamination event . There are some interesting strategies emerging such as placement of the continuous suction device to the left side of the pharynx during attempts at intubation to suction out the cavity.
The SALAD -Suction Assisted Laryngoscopic (video) Airway Decontamination - simulator is experiencing increasing popularity as a training aid to teach caregivers to handle massive airway contamination. This picture shows a trainee handling a massive airway contamination event . There are some interesting strategies emerging such as placement of the continuous suction device to the left side of the pharynx during attempts at intubation to suction out the cavity.
High Fidelity Full body Computerized Manikins
These highly computerized devices are used in larger fixed asset simulation ORs where team resource management is taught to train crisis organization for ED and ICU teams . This kind of training has been perfected in the aviation industry where cockpit resource management refines team performance.
These highly computerized devices are used in larger fixed asset simulation ORs where team resource management is taught to train crisis organization for ED and ICU teams . This kind of training has been perfected in the aviation industry where cockpit resource management refines team performance.
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