ruralresusroommx-pdf
ruralresusroommx-pdf
ruralresusroommx-pdf
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Tim Leeuwenburg<br />
@KangarooBeach<br />
Kangaroo Island, SA
Remote Resus<br />
Room Planning
Remote Resus<br />
feng shui
the karmic resus<br />
SELF<br />
TEAM<br />
PATIENT<br />
ENVIRONS
ural resus clinician<br />
mad bad dangerous to know
anything & everything
alphabet courses <br />
not adequate
critical illness <br />
does not respect geography
asynchronous & up-to-date
Rural Doctors <br />
Masterclass
community<br />
prehospitalmed.com<br />
broomedocs.com<br />
ruraldoctors.net<br />
NomadicGP<br />
FOAM4GP.com<br />
KIdocs.org<br />
quality care out there
ACRRM <br />
just a minute instant tutorials
logs & curated sites <br />
!<br />
podcasts & vodcasts <br />
!<br />
JAMIT <br />
just a minute instant tutorials <br />
!
ural resus team<br />
in resus noone can hear you scream
eal team ?
limited personnel <br />
many hats <br />
‘big sick’ infrequent
train hard <br />
fight easy
high repetition low fidelity<br />
guerilla <br />
sim <br />
training<br />
anywhere <br />
anytime <br />
anyone
Ramping NODESAT RSI Kit Dump <br />
Preload bougie Post-RSI planning
C-ABC <br />
TXA & CAT<br />
find the bleed <br />
stop the bleed
Perimortem C-section <br />
Always carry a scalpel
ural resus room
circuit<br />
O2 / suction<br />
monitoring<br />
fluid<br />
warmer<br />
assistant
360 degree access<br />
ALL PLUMBING<br />
PROCEDURES / TRANSFER<br />
KIT DUMP
ural <br />
difficult <br />
airway <br />
equipment
RSI is like <br />
jumping off a cliff <br />
Rich Levitan @airwaycam<br />
!
53%
PLAN A - INITIAL INTUBATION STRATEGY<br />
ELECTIVE INTUBATION<br />
RAPID SEQUENCE INTUBATION<br />
max 4 attempts<br />
max 3 attempts<br />
OPTIMISE POSITION<br />
USE BOUGIE OR STYLET<br />
ALTERNATIVE BLADE / SCOPE<br />
ALTERNATIVE OPERATOR<br />
BOUGIE<br />
ALTERNATE<br />
BLADE<br />
AIRTRAQ<br />
VIDEO<br />
LARYNGOSCOPE<br />
PLAN B - SECONDARY INTUBATION STRATEGY<br />
RSI<br />
CLASSIC LMA (cLMA)<br />
INTUBATING LMA (iLMA)<br />
eg : Fast Trach or AirQ<br />
+<br />
FIBREOPTIC INTUBATION THROUGH iLMA<br />
MALLEABLE FIBREOPTIC STYLET (eg : Levitan)<br />
FIBREOPTIC SCOPE (eg : Ambu Ascope 2)<br />
PLAN B not appropriate<br />
in elective RSI<br />
cLMA<br />
iLMA<br />
FIBREOPTIC STYLET<br />
OR FLEXIBLE FIBREOPTIC SCOPE<br />
PLAN C - MAINTAIN OXYGENATION & VENTILATION<br />
ATTEMPT TO WAKE PATIENT UP<br />
CONSIDER SUGGAMADEX IF AVAILABLE<br />
FACE MASK<br />
NASOPHARYNGEAL AIRWAY<br />
GUEDEL AIRWAY<br />
CLASSIC LMA (cLMA)<br />
INTUBATING LMA (iLMA) eg : Fast Trach or AirQ<br />
MASK, NPO, GUEDEL<br />
cLMA, iLMA<br />
PLAN D - RESCUE TECHNIQUES FOR ‘CAN’T INTUBATE, CAN’T VENTILATE’<br />
Bag 1 a, b, c Paediatric or Easy Anatomy NEEDLE CRICOTHYROIDOTOMY<br />
Bag 2 Adult or Easy Anatomy SCALPEL-BOUGIE-ETT (greater success in NAP4)<br />
Bag 3 Impossible Anatomy SCALPEL-FINGER-NEEDLE<br />
Refer to CICV FLOWCHART and<br />
NURSING PROMPT CARDS overleaf<br />
MELKER<br />
KIT<br />
QUICK TRACH<br />
OXYGENATION<br />
DEVICE<br />
SCALPEL<br />
BOUGIE - ETT
ural resus patient<br />
Prehospital tracheal intubation in severe facial trauma: <br />
a short window of opportunity <br />
Bredmose P P, Rock S, & Lockey D J <br />
Emerg Med J 2012;29:767e768
standardised kit & protocols
avoid therapeutic vacuum
standardisation <br />
team training <br />
right tools for the job
serious about trauma?
e the fence at top of the cliff <br />
not the ambulance at bottom
Wildlife Vehicle Collisions
trauma prevention
the future ?
OK Glass, lets RSI
RSI checklist<br />
!<br />
timer started - four minutes<br />
pre-oxygenation<br />
nasal cannulae for ApOx<br />
position optimised<br />
!<br />
drugs drawn & dose checked<br />
!<br />
equipment for Plans A-B-C-D<br />
monitoring in place, IV patent<br />
!<br />
roles assigned<br />
30 second drills agreed
quality care out there
de-stress share knowledge
KIDocs.org <br />
ruraldoctors.net<br />
@KangarooBeach
fin
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