We think you have liked this presentation. If you wish to download it, please recommend it to your friends in any social system. Share buttons are a little bit lower. Thank you!
Presentation is loading. Please wait.
Published byRonald Little
Modified about 1 year ago
TEMPLATE DESIGN © com Comparison Of Manikin models versus Live Sheep in Can’t Intubate Can’t Ventilate training A.P.M. Moran 1, J. Dinsmore 2, D.A. Lacquiere 3, A.M.B. Heard 2. Departments of Anaesthesia: 1. Guys and St Thomas Hospital 2. Royal Perth Hospital, Australia 3. Taunton and Somerset NHS foundation Trust Background Discussion Further Information From our results a live sheep model appears to be a better training tool than a manikin model for all forms of cricothyroidotomy training. This is because there is greater similarity to human anatomy and the use of a live sheep model produces a more realistic scenario. There is not only time pressure and a sense of personal responsibility (as the sheep becomes hypoxic), but also movement of skin over the cricothyroid membrane, blood and vomitus. Of interest the cricothyroid membrane was more easily identifiable in the manikin. This highlights a possible flaw in manikin training that the landmarks are too easily found. Can’t intubate can’t ventilate (CICV) situations are rare but are associated with high rates of morbidity and mortality. At Royal Perth Hospital a structured training program is in place to ensure all anaesthetic staff are prepared to deal with the CICV scenario 1. On a weekly basis participants undergo training that takes the form of ‘dry lab’ manikin based teaching followed by a ‘wet lab’ session during which participants undertake CICV rescue techniques on anaesthetised sheep. Attendees at the training who have subsequently faced CICV scenarios have stated that in retrospect the ‘wet lab’ session was significantly more realistic than the manikin based session. We therefore conducted a prospective survey to compare the perceived realism of the live sheep model to that of the manikin. Method Both animal and human ethics approval were obtained. Participants performed cannula cricothyroidotomy, Melker airway insertion and the “scalpel bougie” technique on a manikin (Portex TOT100 Tracheostomy trainer and case) and then on live anaesthetised sheep. They were then asked to assess the realism of landmark recognition, the skin, and the overall realism of each procedure using a visual analogue scale (VAS) of Finally participants were asked to state their overall preference for performing each procedure on either the sheep or the manikin. As the VAS scores were not normally distributed, the results were analysed using the Wilcoxon paired-rank test. Insertion of Melker Airway technique Cannula Cricothyrodotomy technique Stabilise airway with non-dominant hand. Insert the tip of the needle through the skin advancing whilst aspirating. The end point of successful cannulation is the aspiration of air into the syringe. Secure the trochar with dominant hand, whilst the cannula is advanced over the needle into the airway. Perform a check aspiration. Following confirmation of position, attach the cannula to a jet ventilation source and begin ventilation. Videos of each technique can be found at: AMBHeardAirway Insert wire through the cannula. Withdraw the cannula over the wire. Insert scalpel blade making a stab incision along the wire. Ensure that the dilator is completely and fully seated inside the airway and that your grip prevents the dilator from moving backwards as the device is advanced. Advance combined unit in a caudal direction. Remove introducer and wire as one, inflate cuff and ventilate If desaturation occurs prior to successful Melker insertion the cannula can be carefully passed back over the wire and jet ventilation restarted Results 29 participants were included in this study The median Visual Analogue Score (VAS) for landmark recognition was significantly higher in the manikin than the sheep (median 9.5 (interquartile range ) vs 8 ( ), p=0.0009). The median VAS for skin realism was significantly higher in the sheep compared to the manikin (8.2 ( ) vs 5 ( ), p<0.0001). The VAS for realism of each procedure (cannula cricothyroidotomy, Melker insertion and scalpel bougie) was found to be significantly higher in the sheep compared to the manikin (9 (8- 9.5) vs 5.2 (4-6.5), 8.9 (8-9.3) vs 5.6 ( ), 9 (8-9.4) vs 5.3 (2.8-6) all p values <0.0001). All participants stated a preference for learning each procedure on the live sheep model compared to a manikin. Reference 1. Heard AMB, Green RJ, Eakins P. The formulation and introduction of a ‘can’t intubate, can’t ventilate’ algorithm into clinical practice. Anaesthesia 2009; 64: 601–608 Scalpel bougie technique Identify cricothyroid membrane and stabilise with non-dominant hand (ND). Make horizontal stab incision through cricothyroid membrane. Rotate blade through 90 so that the blade points caudally. Pull scalpel towards you, maintain the perpendicular alignment – this produces a triangular hole. ND hand now stabilises the scalpel. With the bougie pointing away and parallel to the floor, insert tip into trachea using the blade as a guide. Rotate and align bougie to allow insertion along the line of the trachea. Remove blade and insert feeling for tracheal rings and/or “hold up”. Re-oxygenate via bougie with jet ventilator. Railroad lubricated 6.0 ETT Scalpel bougie technique contd.
Emergency Cricothyrotomy Protocol Needle Cricothyrotomy: 7. Attach a 14 gauge over-the-needle catheter to a 10 cc syringe filled with saline. Carefully.
DAS Guidelines update April 2015 In this presentation are 3 draft algorithms and highlights of things that are new or considered particularly important.
Cricothyrotomy Indications and Use for the NH Paramedic New Hampshire Division of Fire Standards & Training and Emergency Medical Services.
Sydney Clinical Skills and Simulation Centre Management of the Critically Obstructed Airway Session 4: Infraglottic Airway Rescue.
Seldinger Cricothyrotomy 2002 ACP Recert. Agenda MORNING ROTATION 08:45Emergency Advanced Airway 09:1512 Lead Acquisition 09:45Pediatric Review 10:30Break.
Surgical and Nonsurgical Cricothyrotomy DR AQEELA BANO EMS 352.
Bougie ET introducer. Clinical Indications: Patients meet clinical indications for oral intubation Initial intubation attempt(s) unsuccessful Predicted.
Basic Emergent Airway Management. Station: Laryngeal Mask Ventilation—Rescue airway and Applied Guidelines practice -LMA Indications, contraindications,
GSACEP core man LECTURE series: Airway management Lauren Oliveira, DO LT, MC, USN Updated: 01MAR2013.
Emergency Airways Modification of Transtracheal Jet Ventilation and Retrograde Intubation Techniques BME 272 Senior Design Group 20 Project Undertaken.
A Modular Approach to an Airway Management Curriculum Dr Andrew McKechnie, Dr Branavan Retnasingham, Dr Jay Dasan Kings College Hospital, London Background.
Facilitated Intubation t Sedation (decrease LOC) –Versed (January 2002 with patch) concerns for hypotensive patients helps blunt sympathetic response amnesia.
Airway Training WGH Simulation afternoon WGH 22/01/2016 Thomas Bloomfield ST4 Anaesthetics.
Difficult Airway Trolley (DAT) What does the ideal DAT look like? Top work surface and 4-5 drawers Mobile Robust Stocked in a logical sequence Clearly.
What equipment should be in your Difficult Airway Cart ? Margaret Healy CNM 2 Anaesthesia University College Hospital Galway.
CHEST TUBE INSERTION Dr. Gwen Hollaar. Chest Cavity Punctured lung from rib fracture or penetrating injury to chest causes air &/or blood in space between.
CAP Module 5 - Combitubes (GHEMS/DG_April2015) CAP – Module 5 COMBITUBES.
St Mary’s Hospital ENT Department Founded by Joseph Toynbee in 1851 Airway and Tracheostomy Dave Pothier MRCS DOHNS ENT SHO.
39: Advanced Airway Management Identify and describe the airway anatomy in the infant, child, and the adult Explain the pathophysiology of.
Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Airway Management and Ventilation Team Work Chapter 6.
Administration of Vaccine via Intramuscular Route Hand hygiene is the first step in medication administration is hand hygiene. Use either an alcohol-based.
Airway Management GMVEMSC Education Committee. Objectives Review proper airway management Review assessment Review adjuncts and proper use.
Indicate on this diagram any sutures in place This patient has a New TRACHEOSTOMY UPPER AIRWAY ABNORMALITY: Yes / No Document laryngoscopy grade and notes.
MAGNETIC AND ARTICULATING (MNA) BOUGIE ASSISTED BREATHING TUBE PLACEMENT DURING INTUBATION Dalhousie University Senior Design Project Group #7 GROUP MEMBERS:
Non-Visual Intubation Techniques Orlando Hung Departments of Anesthesia, Surgery and Pharmacology, Dalhousie University Halifax, Nova Scotia.
Introduction Many types of supraglottic airway device have been used as a conduit for tracheal intubation. The technique may be useful in difficult airway.
Optional, AEMT. Course Objectives Describe Sellick’s maneuver and the use of cricoid pressure during intubation. Describe the necessary equipment needed.
Sydney Clinical Skills and Simulation Centre Management of the Critically Obstructed Airway Session 5: Infraglottic Airway Rescue Practical Session.
Seldinger Cricothyrotomy Review 2005 ACP Recert (Enhansed)
Difficult Airway Management 2009 Adrian Sieberhagen.
Failed Intubation in Children Dr Philip Ragg Royal Children’s Hospital Melbourne.
By: Parrish T. Eilers, MD LSU Emergency Medicine.
Implanted Ports: Procedure for Access and Care. Objective The learner will be able to: 1.Demonstrate proper care of an implanted port.
#8 Essential Emergency Airway Care- Surgical Airways 1 Andrew Brainard, MD, MPH, FACEM, FACEM
CENTRAL LINE PLACEMENT By Clare Di Bona November 2015.
Laparoscopic Placement of the BardPort Intraperitoneal Catheter and Reservoir Dr. Arlan F. Fuller, Jr. Gillette Center for Women's Oncology Massachusetts.
TRACHEOSTOMY CARE Joanna Sidey Paediatric Respiratory Nurse.
Airway management and ventilation. Airway management and ventilation Patients requiring resuscitation often have an obstructed airway, usually secondary.
Insert Program or Hospital Logo Introduction ► Due to changes in delivery room practices, improvement in clinical care, and limitations on the time spent.
TRACHEOSTOMY DR. A. NAVEED FRCS (Ed) ENT Department Tawam Hospital Al-Ain, Abu Dhabi U.A.E.
Preoperative Assessment and Resuscitation Dr Mark Lambert Consultant Anaesthetist Royal National Throat, Nose and Ear Hospital Airway.
Epidural anaesthesia is a central neuraxial block technique with many applications. The epidural space was first described by Corning in 1901, and Fidel.
Airway Mary Osinga Ontario Air Ambulance Sir Sandford Fleming College.
Maryland ExpressCare_20091 King LTS-D Airway Self-learning Module Practical Review.
Combitube In-service Joe Lewis, M.D.,FACEP Schofield Barracks Ambulance Service.
TRACHEOSTOMY CARE AND EMERGENCIES. Indications for tracheostomy Airway Severe Facial Trauma, Head and neck cancers / tumours Acute Angioedema.
A Comparison of AuraOnce TM and LMA-Unique TM as an Intubation Conduit in Patients Undergoing Elective Surgery C. Hagberg, N. Lam, M. Chan, D. Iannucci,
Unknowns How many children anaesthetised in UK Where: DGH, teaching hospital By who? How? Frequency of problems?
© 2017 SlidePlayer.com Inc. All rights reserved.