Emergency Intubation An instructional program for Licensed Respiratory Practitioners at Kaleida Health.

Purpose Purpose: An essential function of Licensed Respiratory Practitioners is to ensure the adequate maintenance of airway patency and ventilation during emergency situations. The purpose of this presentation to is to offer information to facilitate emergency airway management.

Objectives Objectives of this tutorial are: to demonstrate the proper technique for emergency airway management, outline the Kaleida policy regarding emergency airway management, and outline the role of the Licensed Respiratory Practitioner in emergency airway management.

Kaleida Health Policy Policy statement: In the event that no member of the Department of Anesthesiology is available to provide for the establishment and maintenance of patient airways, a member of the Department of Respiratory Therapy shall provide such coverage.

Kaleida Health Policy Special circumstances will arise where the establishment of an airway falls outside the expertise of Respiratory Therapy (such as patients with surgical halos or collars, or other difficult airways.) In these instances, patient airway shall be maintained by mask by a Licensed Respiratory Practitioner if necessary, and the on-call staff MDA shall be notified immediately.

Kaleida Health Teaching Protocol Licensed Respiratory Practitioners must Be familiar with the guidelines for establishing and maintaining adequate patient airways. Have performed eight (8) successful intubations annually (2 each quarter) under the direct supervision of an MDA.

Certification of Competency Competency is certified by: A signed copy of Attachment 1(of policy) maintained in both the Department Respiratory Therapy, and updated annually. A Certificate of Award (see Attachment 2 of policy), signed by the Site Director of Respiratory Therapy, issued annually, and a copy maintained on all members of the Department of Respiratory Therapy.

Maintenance of Competency Proficiency is maintained by performing at least 2 successful supervised intubations each quarter (supervised by an MD member of the Department of Anesthesiology) for a total of 8 supervised intubations annually. Documentation of training is maintained in the Department of Respiratory Therapy

Key points prior to intubation: Call for help Wash hands Double identify patient Assemble equipment Select the appropriate size blade and endotracheal tube

INTUBATION PROCEDURE There are two sources for the intubation procedure: Intubation tutorial video that follows this presentation Mosby Nursing Skills (access from left navigation bar on Kaleida Campus page—search by clicking on I, then choose Endotracheal Intubation Advanced Practice)

Post intubation Key points Continue to oxygenate with manual resuscitation device until patient is placed on mechanical ventilation Ensure that post intubation x-ray is obtained for verification of ET tube placement Document procedure in the patient progress notes Notify the Licensed Independent Practitioner regarding any adverse effects or conditions

Continuing Competency Kaleida Health’s Department of Anesthesia will partner with Licensed Respiratory Practitioners for providing intubation opportunities Practice equipment is available in your individual department Please refer to policy

THANK YOU! Please proceed to the post-test. Your Manager and site Anesthesia Department are your partners in this important patient safety initiative. Thank you for your role in ensuring patient safety.

Please proceed to the Intubation Video that follows. Before watching this video please note: Kaleida Health recommends cuff inflation of 8-10cc of air Blade choice is individual; use must ensure airway landmark manipulation to optimize vocal cord visualization