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Beyond the algorithm. John Moore Teaching the teachers Tracheostomy Safety Project 2011. When the expert arrives. There will be one of 3 situations First responder has resolved the situation Supportive intervention only Stable patient oxygenating by face or stoma

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beyond the algorithm

Beyond the algorithm...

John Moore

Teaching the teachers

Tracheostomy Safety Project

2011

when the expert arrives
When the expert arrives...
  • There will be one of 3 situations
  • First responder has resolved the situation

Supportive intervention only

  • Stable patient oxygenating by face or stoma

May need sedation or anaesthetic to facilitate re-intubation or re-fashioning of stoma

Non-emergency situation

  • A loss of airway crisis......
failed definitive airway management
Failed definitive airway management
  • Get further help as appropriate
  • Continue to attempt to oxygenate/ventilate via stoma and upper airway/Face mask/LMA
  • Advanced upper airway management with FOB. LMA, Aintree, Advanced laryngoscopes
  • FOB into stoma without Aintree maybe more flexible
  • Cricothyroidotomy
  • New percutaneous or surgical tracheostomy
slide8

Continue to attempt to

oxygenate/ventilate

via stoma and upper airway

Face mask

LMA

Further help

ICU

Anaesthetists

ENT/Max-fax

Arrest team

slide9

Continue to attempt to

oxygenate/ventilate

via stoma and upper airway

Face mask

LMA

Further help

ICU

Anaesthetists

ENT/Max-fax

Arrest team

slide11

Post-op major max-fax 2 days

On HDU, coughing+

Increasing oxygen requirements

CO2 shows reduced trace...

45 mins later

Patient becoming very agitated

SaO2 89% on CPAP

slide12

Team arrive

Patient now SaO2 80%

Still breathing but awful respiratory pattern

Patient critically hypoxia

Airway likely difficult

Management please

slide13

Algorithm

  • The right team
  • Equipment
  • When to give drugs and which ones
  • Alternative airway
slide14

Recovering swine flu patient ICU

Percutaneous tracheostomy

4 days ago

Weaning well since

Now very tachypnoeic

slide15

No problem..........

use the algorithm

Patient quickly deteriorates and arrests!

You take trach out but can’t ventilate through

airway or stoma

slide16

Could it be something else..

You bronchoscope......

Options...