ALFRED ICU INTUBATION CHECKLIST

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Presentation transcript:

ALFRED ICU INTUBATION CHECKLIST ASSESS EQUIPMENT TEAM PLAN Is a difficult airway predicted? Is there risk of physiological compromise? Cardiovascular instability Hypoxaemia Acidaemia Increased ICP Aspiration Underlying disease Allergies Are the ICU consultant and ANUM aware? Do anaesthetics or ENT need to be contacted? Anaesthetics CIC: x44627 Is monitoring ready? Pulse oximetry (SpO2) ETCO2 BP (cycle q1min if NIBP) ECG Is equipment checked & ready? BVM with O2 flowing Airway adjuncts Supraglottic airway device ETT x 2 (incl 1 size down) Laryngoscopes x 2 (Direct/Video) Bougie CICO** rescue equipment Suction Stethoscope Are drugs & lines ready? IV checked & fluids on pumpset Induction & paralytic drugs Inopressors Post-intubation sedation Have team roles been assigned? Team leader 1st intubator* 2nd intubator* Airway assistant CICO** rescuer Drug administrator Senior support nurse +/- Cricoid Pressure +/- Manual in-line stabilisation * Two airway competent doctors MUST attend **CICO = can’t intubate, can’t oxygenate – proceed to cricothyroidotomy Is the patient optimised? Position Oxygenation Ventilation Haemodynamics NGT suctioned What are the plans for anticipated physiological compromise? What are Plans A, B, C & D if the airway is difficult? What drugs/doses are to be given? When and how? Does anyone have questions or concerns? Modified from the RTIC Severn Checklist by the Alfred ICU Airway Team Version 15, 17 May 2017

Predictors of Difficult: Supraglottic Airway Insertion *Can’t Intubate Can Oxygenate Seek additional expert airway assistance Consider: Waking patient to spontaneously ventilate if safe to do so Further intubation attempt with optimisation and most skilled operator Intubation through supraglottic airway device Fibreoptic intubation Surgical airway Unanticipated Difficult Intubation Plan Direct / Video laryngoscopy Successful intubation A Failed optimal laryngoscopy (2 attempts) Bag mask oxygenation Maintain oxygenation, seek definitive airway plan* B Failed bag mask oxygenation Predictors of Difficult: Supraglottic Airway Device Maintain oxygenation, seek definitive airway plan* C Bag Mask Ventilation Bearded Obese No teeth Elderly Sleep apnoea/snoring Supraglottic Airway Insertion Restricted mouth opening Obstruction Distorted airway Stiff lungs or c-spine Failed SAD oxygenation Declare “this is a can’t intubate, can’t oxygenate situation” Cricothyroidotomy Scalpel bougie technique OR needle cricothyroidotomy D Always check previous airway history