Remote Resus Room Planning

Kangaroo Island, SA@KangarooBeachTim Leeuwenburg

Remote ResusRoom Planning

Remote Resusfeng shui

the karmic resus

PATIENT

TEAM

ENVIRONS

SELF

rural resus clinician

mad bad dangerous to know

anything & everything

alphabet courses not adequate

critical illness does not respect geography

asynchronous & up-to-date

Rural Doctors Masterclass

quality care out there

prehospitalmed.com FOAM4GP.com

broomedocs.com ruraldoctors.net KIdocs.org

FOAM4GP.com

community

ACRRM just a minute instant tutorials

!

blogs & curated sites !

podcasts & vodcasts !

JAMIT just a minute instant tutorials

in resus noone can hear you scream

rural resus team

real team ?

limited personnel many hats ‘big sick’ infrequent

train hard fight easy

high repetition low fidelity

anywhere anytime anyone

guerilla sim

training

Ramping NODESAT RSI Kit Dump Preload bougie Post-RSI planning

find the bleed stop the bleed

C-ABC TXA & CAT

Perimortem C-section Always carry a scalpel

shared mental model for processes

training for stressful situations

metacognition & error theory

rural resus room

O2 / suction

monitoring

assistant

circuit

fluid warmer

ALL PLUMBING

KIT DUMPPROCEDURES / TRANSFER

360 degree access

rural difficult airway

equipment

RSI is like jumping off a cliff

!

!

Rich Levitan @airwaycam

53%

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

rural resus patient

standardised kit & protocols

avoid therapeutic vacuum

改善

aggregation of marginal gains

standardisation team training

right tools for the job

be the fence at top of the cliff not the ambulance at bottom

Wildlife Vehicle Collisions

trauma prevention

the future ?

OK Glass, lets RSI

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

quality care out there

come visit Kangaroo Island de-stress share knowledge

fin