Airway Training WGH
Simulation afternoon WGH
22/01/2016
Thomas Bloomfield ST4 Anaesthetics
Reasons for session
• Majority of ICU junior medical staff without
formal airway training (ITU rotation from
other specialties and ACCS)
• Anxiety of these staff about how to handle
airway emergencies particularly overnight
• Opportunity to involve ICU nursing staff and
ANP’s in airway simulation
Aims of session
• Familiarise staff with equipment that may be
needed in an airway emergency
• Familiarity with NHS Lothian Airway Trolley
• Allow airway trained staff to practice with
emergency equipment: Cricothyroidotomy
equipment and airway exchange catheter
Aims of session
• Scenarios aimed at basic airway management
manoeuvres
• What nursing staff and junior staff might be
able to do in the absence of senior/expert
help
• Familiarity with emergency tracheostomy
management
How Session ran
• 4 practical stations:
– Crocothyroidotomy
– Use of AmbuScope and airway exchange catheter
– Tracheostomy management
– Lothian Airway trolley
How Session ran
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2 Simulation Scenarios
Management of displaced ETT in ITU patients
Use of airway manoeuvres
Use of simple airway adjuncts
Measures to maintain oxygenation until help
arrives
Equipment utilised
Cricothryoidotomy station:
• Melker Cricothyroidotomy kit
• Seldinger and surgical technique
demonstrated
• Larynx model with prosthetic skin coverage
• Several Cricothyroidotomy kits avaialable to
use
Equipment utilised
Airway exchange catheter:
• Ambu disposable scope
• I-Gel LMA
• Intubation model
• Aintree airway exchange catheter
Equipment Utilised
Tracheostomy safety training:
• “Trache Tracy” model
• NHS Lothian tracheostomy bedsigns
• Algorithm for management of tracheostomy
emergencies
• Different types of tracheostomy tubes and
attachments
Equipment utilised
Simulation Scenario 1
• ITU patient GCS 3. Intubated and ventilated
with sedation running.
• ETT accidentally displaced during routine turn
• Medical/nursing staff asked to attend
Simulation Scenario 1
• Invasive devices record indicating ETT site at
lips
• Capnography disappeared on monitoring
• SpO2 beginning to fall
Scenario 1
Learning points of scenario:
• Identify displaced ETT
• Call for help. Help is delayed.
• Apply high flow oxygen.
• Airway trolley into room and use of airway trolley
contents in an emergency.
• Simple airway manoeuvres; BMV, Gudel insertion.
• Sats begin to improve when LMA inserted.
• Allows temporary ventilation until patient can be reintubated
Simulation Scenario 2
• ITU patient being treated for pneumonia
• Breathing spontaneously with minimal
support
• Pulls out own ETT
• Medical/nursing staff called to assess
• Sats begin to fall
Simulation Scenario 2
Learning points for scenario:
• Apply high flow oxygen
• Call for help
• Airway trolley into room
• Simple airway manoeuvres
• Sats improve
• Maintain oxygenation with face mask until
help arrives
Simulation Equipment
• Low fidelity mannequin
• Mannequin could be ventilated and allows
airway insertion
• Monitoring provided using I-Pad and app
• Demonstration of Sats, Capnography,, ECG and
arterial line trace
• Simple airway adjuncts, Gudel, NP, LMA
Simulation Equipment
• Low fidelity mannequin and basic equipment.
• Purpose of scenarios to increase confidence of
staff with equipment available in an
emergency and temporising measures which
can be performed by nursing and junior
medical staff.
How did the session go?
• Attendees divided into groups and rotated
around stations
• Generally well received with good feedback
• Nursing staff in particular responded very
positively to opportunity to be involved in
simulation scenarios
• More experienced staff found opportunity to
use front of neck access and ILMA/scope
useful
What could have gone better
• First time session was run
• Initially large (20) audience. Probably too
many people.
• Difficult to give everyone chance to have role
in simulation scenarios.
• Fewer attendees later in afternoon; allowed
opportunity for more hands on experience
Plans for future
• Plan to run the session every 6 months to be
timed after changeover of junior doctors.
• More structured session: Attendees allocated
to timeslot in attempt to maintain small group
size.
• Focus on giving every attendee opportunity to
be involved in scenarios.
Plans for future
• Try to incorporate 2 new scenarios:
– Tracheostomy Emergency in real time
– Front of neck access in real time: access
equipment from trolley and insert on a model
• Allow session to be tailored at wide audience:
nursing staff, ANP’s, junior anaesthetists
Summary
• Simulation session utilising fairly low fidelity
equipment which was well received and
generated enthusiasm for future simulation
teaching.
• Multi-disciplinary attendance was good.
• Plan to improve confidence of junior medical
staff and nursing staff in dealing with airway6
emergencies.