DAT What does the ideal DAT look like Top work surface and 45 drawers Mobile Robust Stocked in a logical sequence Clearly labelled Easily cleaned Attached documentation DASmodified local guidelines ID: 754393
Download Presentation The PPT/PDF document "Difficult Airway Trolley" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
Difficult Airway Trolley(DAT)What does the ideal DAT look like?Top work surface and 4-5 drawersMobileRobustStocked in a logical sequenceClearly labelledEasily cleanedAttached documentationDAS/modified local guidelinesChecklist for restockingLogbook for daily checkingReproducible Slide2
Top of trolleyFlexible intubating fibrescopeportable scope with battery light sourceportable stack system e.g. Storz Tele Packor single use fibrescope e.g. Ambu aScopeSide of trolleyBougies – adult and paediatricAintree Intubation CatheterAirway exchange catheterSlide3
Drawer 1 – Plan AOptimise head positionBougieAlternative laryngoscopeContentsBougie (ideally on side of trolley)Short handle laryngoscopeMcCoy blade and/or straight bladeVideolaryngoscopeSlide4
Drawer 2 – Plan BLMAFollowed by fibreoptic tracheal intubation through LMAContentsLMA #3,4,5 &/or 2nd generation device #3,4,5Intubating LMA (iLMA) #3,4,5Aintree Intubating Catheter (ideally on side of trolley)Fibreoptic adjuvants*Slide5
Drawer 2 – Plan BFibreoptic adjuvants*Berman/Ovassapien airwaysMucosal atomisation devicesFibrescope-compatible angle connectorNasal sponge 4% lignocaine10% lignocaineInstillagelCo-phenylcaine(*Alternatively these can be stored in a separatestorage box which accompanies the trolley)Slide6
Drawer 3 – Plan CBag mask ventilation +/- airway adjunctsSupraglottic airway deviceContentsFacemasks – various sizesOropharyngeal airways – various sizesNasopharyngeal airways – various sizesLMA/Proseal LMA - #3,4,5Slide7
Drawer 4 – Plan DSurgical cricothyroidotomyContentsLarge bore cannula device eg. Quicktrach I or II (VBM)Scalpel (No. 20 blade)Tracheal dilator or tracheal hookBougieCuffed tracheal tube #6 & 7Slide8
Drawer 5 – Plan DCannula cricothyroidotomyContentsKink-resistant jet ventilation cannula e.g. Ravussin (VBM)High &/or low pressure ventilation systeme.g. Manujet III (VBM) Ventrain (Ventinova) Slide9
MiscellaneousDAS intubation guidelines (laminated)Or locally agreed algorithmsEquipment checklist for re-stockingLogbook for daily checking proceduresMay also consider:Specific extubation aids/equipment eg. Staged Extubation Set (Cook Medical)Extubation guidelines (laminated)
Slide10
Plan vs StrategyAn airway plan suggests a single approach to management of the airway. An airway strategy is a co-ordinated, logical sequence of plans, which aim to achieve good gas exchange and prevention of aspiration. Anaesthetists should approach airway management with strategies rather than plans.Difficult Airway Management Strategy (DAMS)Generic strategy before each list/caseSpecific strategy before anticipated difficult airway casesReinforcesKnowledgePreparation
Teamwork
Slide11
Suggestions for drawer labelsPlan AInitial intubation strategyOptimise Bougie Alternative position laryngoscope
Remember
to
move on
if not making progress
Plan
C
Maintain oxygenation
Facemask
LMA device
+/- airway adjunct
Postpone surgery
Awaken patient
Plan
B
Secondary intubation strategy
LMA device
Fibreoptic
intubation
Remember
to
move
on
if not making
progress
Plan
D
Can’t intubate, can’t ventilate
Cannula
cricothyroidotomy
Remember
to
move
on
if not making
progress
Plan
D
Can’t intubate, can’t ventilate
Surgical
cricothyroidotomy
Remember
to
move
on
if not making
progressSlide12
Drawer LabelsThe drawer labels can be customised as required to illustrate the particular type of equipment present in the various drawers.The specific make and model of equipment should be agreed locally with regular, comprehensive and continued training provided for all relevant staff.The examples of equipment given in these guidelines serve only as a guide and should not be considered as absolute recommendations by DAS.
Slide13
RememberA clearly labelled trolley will also serve as a visual guide and prompt one to move along the strategy if not making progress.What is most important is providing: the right equipmentin the right amountin the right placeat the right time
Know what you
need - PLANKnow who you need - COMMUNICATE
Have what you need - PREPARE
Do what you
need -
TRAIN