das difficult intubation guidelines overview: western
TRANSCRIPT
Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults. C. Frerk, V. S. Mitchell, A. F. McNarry, C. Mendonca, R. Bhagrath, A. Patel, E. P. O’Sullivan, N. M. Woodall and I. Ahmad, Difficult Airway Society. intubation guidelines working group. British Journal of Anaesthesia, 115 (6): 827–848 (2015) doi:10.1093/bja/aev371
DAS DIFFICULT INTUBATION GUIDELINES OVERVIEW: Western General Hospital
Plan
B:
Mai
ntai
ning
oxy
gena
tion:
SA
D in
serti
on
STO
P AN
D TH
INK
Opt
ions
(con
side
r ris
ks a
nd b
enefi
ts):
1. W
ake
the
patie
nt u
p2.
Intu
bate
trac
hea
via
the
SAD
3. P
roce
ed w
ithou
t int
ubat
ing
the
trach
ea4.
Tra
cheo
stom
y or
cric
othy
roid
otom
y
Succ
eed
Supr
aglo
ttic
Airw
ay
Devi
ce
Plan
C:
Face
mas
k ve
ntila
tion
Wak
e th
e pa
tient
up
Succ
eed
Fina
l atte
mpt
at f
ace
mas
k ve
ntila
tion
Plan
D:
Emer
genc
y fro
nt o
f nec
k ac
cess
Cric
othy
roid
otom
y
Plan
A:
Face
mas
k ve
ntila
tion
and
trach
eal i
ntub
atio
nTr
ache
al in
tuba
tion
Succ
eed
Lary
ngos
copy
Faile
d in
tuba
tion
Faile
d SA
D ve
ntila
tion
CICO
This
flow
char
t for
ms
part
of th
e D
AS G
uide
lines
for u
nant
icip
ated
diffi
cult
intu
batio
n in
adu
lts 2
015
and
shou
ld b
e us
ed in
con
junc
tion
with
the
text
.
DAS
Diffi
cult
intu
batio
n gu
idel
ines
– o
verv
iew
2015
Com
mun
icat
e th
e na
ture
of t
he e
mer
genc
y to
the
team
, cal
l for
sen
ior h
elp,
del
egat
e ta
sks
1
Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults. C. Frerk, V. S. Mitchell, A. F. McNarry, C. Mendonca, R. Bhagrath, A. Patel, E. P. O’Sullivan, N. M. Woodall and I. Ahmad, Difficult Airway Society. intubation guidelines working group. British Journal of Anaesthesia, 115 (6): 827–848 (2015) doi:10.1093/bja/aev371
UNANTICIPATED DIFFICULT INTUBATION (DAS): Western General Hospital
Com
mun
icat
e th
e na
ture
of t
he e
mer
genc
y to
the
team
, cal
l for
sen
ior h
elp,
del
egat
e ta
sks
Man
agem
ent o
f una
ntic
ipat
ed d
ifficu
lt tr
ache
al in
tuba
tion
in a
dults
Suc
ceed
Suc
ceed
Suc
ceed
Dec
lare
faile
d in
tuba
tion
Dec
lare
faile
d S
AD
ven
tilat
ion
Dec
lare
CIC
O
Dec
lare
CIC
O
Opt
imis
e he
ad a
nd n
eck
posi
tion
Pre
oxyg
enat
eA
dequ
ate
neur
omus
cula
r blo
ckad
eD
irect
/ Vi
deo
Lary
ngos
copy
(max
imum
3+1
atte
mpt
s)E
xter
nal l
aryn
geal
man
ipul
atio
nB
ougi
eR
emov
e cr
icoi
d pr
essu
reM
aint
ain
oxyg
enat
ion
and
anae
sthe
sia
Plan
A: F
acem
ask
vent
ilatio
n an
d tra
chea
l int
ubat
ion
2nd
gene
ratio
n de
vice
reco
mm
ende
dC
hang
e de
vice
or s
ize
(max
imum
3 a
ttem
pts)
Oxy
gena
te a
nd v
entil
ate
Plan
B: M
aint
aini
ng o
xyge
natio
n: S
AD
inse
rtion
If fa
cem
ask
vent
ilatio
n im
poss
ible
, par
alys
eFi
nal a
ttem
pt a
t fac
emas
k ve
ntila
tion
Use
2 p
erso
n te
chni
que
and
adju
ncts
Plan
C: F
acem
ask
vent
ilatio
n
Sca
lpel
cric
othy
roid
otom
y
Plan
D: E
mer
genc
y fro
nt o
f nec
k ac
cess
Con
firm
trac
heal
intu
batio
n w
ith c
apno
grap
hy
If in
diffi
culty
c
all f
or h
elp
Wak
e th
e pa
tient
up
Post
-ope
rativ
e ca
re a
nd fo
llow
up
• Fo
rmul
ate
imm
edia
te a
irway
man
agem
ent p
lan
• M
onito
r for
com
plic
atio
ns•
Com
plet
e ai
rway
ale
rt fo
rm•
Exp
lain
to th
e pa
tient
in p
erso
n an
d in
writ
ing
• S
end
writ
ten
repo
rt to
GP
and
loca
l dat
abas
e
STO
P A
ND
TH
INK
Opt
ions
(con
side
r ris
ks a
nd b
enefi
ts):
1. W
ake
the
patie
nt u
p2.
Intu
bate
trac
hea
via
the
SA
D3.
Pro
ceed
with
out i
ntub
atin
g th
e tra
chea
4. T
rach
eost
omy
or c
ricot
hyro
idot
omy
This
flow
char
t for
ms
part
of th
e D
AS
Gui
delin
es fo
r una
ntic
ipat
ed d
ifficu
lt in
tuba
tion
in a
dults
201
5 an
d sh
ould
be
used
in c
onju
nctio
n w
ith th
e te
xt.
2015
Com
mun
icat
e th
e na
ture
of t
he e
mer
genc
y to
the
team
, cal
l for
sen
ior h
elp,
del
egat
e ta
sks
2
Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults. C. Frerk, V. S. Mitchell, A. F. McNarry, C. Mendonca, R. Bhagrath, A. Patel, E. P. O’Sullivan, N. M. Woodall and I. Ahmad, Difficult Airway Society. intubation guidelines working group. British Journal of Anaesthesia, 115 (6): 827–848 (2015) doi:10.1093/bja/aev371
UNANTICIPATED DIFFICULT INTUBATION (DAS): Western General Hospital
DAS Airway Management Guidelines 2015
3. Cricothyrotomy
1. Use pillow to re-position head
2. Identify the cricothyroid membrane with the laryngeal handshake:-
Stab TubeBougieTwist
Medical Photography Service, NHS Lothian - MD - 11.04.2016
Communicate the nature of the emergency to the team, call for senior help, delegate tasks
3
FAILED INTUBATION, FAILED OXYGENATION (DAS): Western General Hospital
Communicate the nature of the emergency to the team, call for senior help, delegate tasks
Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults. C. Frerk, V. S. Mitchell, A. F. McNarry, C. Mendonca, R. Bhagrath, A. Patel, E. P. O’Sullivan, N. M. Woodall and I. Ahmad, Difficult Airway Society. intubation guidelines working group. British Journal of Anaesthesia, 115 (6): 827–848 (2015) doi:10.1093/bja/aev371
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