remote resus room planning by leeuwenburg
DESCRIPTION
Resus room Feng shui. Tim Leeuwenburg on 'training hard to fight easy'. Challenges and strategies for the remote emergency department.TRANSCRIPT
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Remote Resus Room Planning
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Kangaroo Island, SA@KangarooBeachTim Leeuwenburg
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Remote ResusRoom Planning
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Remote Resusfeng shui
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the karmic resus
PATIENT
TEAM
ENVIRONS
SELF
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rural resus clinician
mad bad dangerous to know
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anything & everything
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alphabet courses not adequate
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critical illness does not respect geography
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asynchronous & up-to-date
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Rural Doctors Masterclass
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quality care out there
prehospitalmed.com FOAM4GP.com
broomedocs.com ruraldoctors.net KIdocs.org
FOAM4GP.com
community
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ACRRM just a minute instant tutorials
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!
blogs & curated sites !
podcasts & vodcasts !
JAMIT just a minute instant tutorials
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in resus noone can hear you scream
rural resus team
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real team ?
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limited personnel many hats ‘big sick’ infrequent
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train hard fight easy
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high repetition low fidelity
anywhere anytime anyone
guerilla sim
training
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Ramping NODESAT RSI Kit Dump Preload bougie Post-RSI planning
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find the bleed stop the bleed
C-ABC TXA & CAT
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Perimortem C-section Always carry a scalpel
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shared mental model for processes
training for stressful situations
metacognition & error theory
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rural resus room
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O2 / suction
monitoring
assistant
circuit
fluid warmer
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ALL PLUMBING
KIT DUMPPROCEDURES / TRANSFER
360 degree access
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rural difficult airway
equipment
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RSI is like jumping off a cliff
!
!
Rich Levitan @airwaycam
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53%
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ELECTIVE INTUBATION max 4 attempts
RAPID SEQUENCE INTUBATION max 3 attempts
OPTIMISE POSITIONUSE BOUGIE OR STYLET
ALTERNATIVE BLADE / SCOPEALTERNATIVE OPERATOR
PLAN A - INITIAL INTUBATION STRATEGY
PLAN B - SECONDARY INTUBATION STRATEGY
RSICLASSIC LMA (cLMA)
INTUBATING LMA (iLMA)eg : Fast Trach or AirQ
FIBREOPTIC INTUBATION THROUGH iLMAMALLEABLE FIBREOPTIC STYLET (eg : Levitan)
FIBREOPTIC SCOPE (eg : Ambu Ascope 2)+
PLAN C - MAINTAIN OXYGENATION & VENTILATION
ATTEMPT TO WAKE PATIENT UP
CONSIDER SUGGAMADEX IF AVAILABLE
FACE MASKNASOPHARYNGEAL AIRWAY
GUEDEL AIRWAYCLASSIC LMA (cLMA)
INTUBATING LMA (iLMA) eg : Fast Trach or AirQ
PLAN D - RESCUE TECHNIQUES FOR ‘CAN’T INTUBATE, CAN’T VENTILATE’
Bag 1 a, b, c Paediatric or Easy Anatomy NEEDLE CRICOTHYROIDOTOMYBag 2 Adult or Easy Anatomy SCALPEL-BOUGIE-ETT (greater success in NAP4)Bag 3 Impossible Anatomy SCALPEL-FINGER-NEEDLE
MELKERKIT
QUICK TRACH OXYGENATIONDEVICE
SCALPELBOUGIE - ETT
Refer to CICV FLOWCHART andNURSING PROMPT CARDS overleaf
BOUGIE ALTERNATE BLADE
AIRTRAQ VIDEOLARYNGOSCOPE
cLMAiLMA
FIBREOPTIC STYLETOR FLEXIBLE FIBREOPTIC SCOPE
cLMA, iLMAMASK, NPO, GUEDEL
PLAN B not appropriatein elective RSI
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rural resus patient
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standardised kit & protocols
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avoid therapeutic vacuum
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改善
aggregation of marginal gains
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standardisation team training
right tools for the job
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be the fence at top of the cliff not the ambulance at bottom
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Wildlife Vehicle Collisions
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trauma prevention
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the future ?
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OK Glass, lets RSI
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RSI checklist !
timer started - four minutes pre-oxygenation nasal cannulae for ApOx position optimised !
drugs drawn & dose checked !
equipment for Plans A-B-C-D monitoring in place, IV patent !
roles assigned 30 second drills agreed
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quality care out there
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come visit Kangaroo Island de-stress share knowledge
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fin
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