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Scalpel + Finger + Cannula

EMERGENCY PROTOCOL CAN’T INTUBATE & CAN’T OXYGENATE (CICO). Railroad 6.0 cuffed ETT. Scalpel + Finger + Cannula. Scalpel + Bougie (frova). Seldinger technique: Melker 5.0 cuffed ETT. FAIL. Consider waking patient. Assistant 1. Assistant 2. open BAG 2 set up

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Scalpel + Finger + Cannula

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  1. EMERGENCY PROTOCOL CAN’T INTUBATE & CAN’T OXYGENATE (CICO) Railroad 6.0 cuffed ETT Scalpel + Finger + Cannula Scalpel + Bougie (frova) Seldinger technique: Melker 5.0 cuffed ETT FAIL Consider waking patient Assistant 1 Assistant 2 open BAG 2 set up scalpel-bougie kit open BAG 3 set up scalpel-finger kit get difficult airway trolley open BAG 1a set up cannula-cric kit get arrest trolley set up self-inflating bag open BAG 1c set up melker kit open BAG 1b set up oxygenation tubing IS THIS IS A CICO SITUATION? >3 attempts at intubation? AND Failed to oxygenate with supraglottic devices e.g., LMA? AND Oxygen saturations persistently low? REVIEW again in 1 min NO YES CALL FOR HELP Airway Experienced Doctors/Assistants: Anaesthetist/ ENT/ ICU/ ED/ Anaesthetic nurse ALLOCATE ROLES SUPPORT ROLES AIRWAY TEAM DOCTOR PERFORM CANNULA CRICOTHYROIDOTOMY/TRACHEOTOMY remember: pillow out, extend neck, stabilise trachea FAIL SUCCESS Is the neck anatomy palpable? no yes OXYGENATE & stabilise Use self-inflating bag OXYGENATE & stabilise Use jet insufflation kit – insufflate for 4s then wait till max sats drops 5% then insufflate for 2s OXYGENATE & stabilise Use jet insufflation kit – insufflate for 4s then wait till max sats drops 5% then insufflate for 2s FAIL With permission A.Heard and Working group for the Rural Health Continuing Education (RHCE) (Stream 1) “Critically Obstructed Airway Workshop”. Contact smsc@nsccahs.health.nsw.gov.au. 2012

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