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
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