Tag Archives: critical care

14th Annual Critical Care Symposium

Ventilation

6ml/kg, <30 cm H20, PEEP, SpO2 94-98%, recruit

 

Trials to review:

Recruitment, FEAT, FACTT, ACBIOS

 

Successful ward round

Patient, Doc, nurse, MDT

My name is (first name) to team, Dr xx to patient. call them by surname

Family present at WR. Adv: gain new info, open/honesty. Pre-claimer. Teach & treat.  Will translate.

White board next to each patient with important info, plan details.

Start at same time everyday – good for MDT

Daily plan understood by all, nurse/junior repeats back. To do list. Check

Interactive, educational, professional, fun

 

Crit care practitioner

service need, fill rota gaps. crit care practitioner podcast

robust ciricullum, education, cpd + appraisal pathway/training. Some can prescribe. know your limits. consistency, permanent

P. paradoxus – downwards swing in pleth/BIP in SV patient on inspiration

Digital Meeting

Positive reporting in Datix

Education – twitter journal clubs

‘Rapid weaver’ – Mac based website development

Safety events/handoever every 12 hours

[c.f. neonates WR – learning point of the 24 hours/week]

ipad/screen next to ABG with learning message

Use raspberry Pi

Check out portsmouth crit care

Unanticipated difficult intubation – DAS guidelines 2015

Updates & take-home messages:

  • Laryngoscopy -> SAD -> FM ventilation -> cricothyroidotomy
  • If poor view at laryngoscopy remove cricoid under direct vision + suction at hand
  • Use second generation SAD device
  • Removed cricoid for SAD insertion
  • Successful SAD = ‘stop and think’ moment
  • CICO -> paralyse, continue supraglottic O2 attempts -> front-of-neck
  • Laryngeal handshake
  • Front-of-neck = scalpel (No.10, broad blade), bougie, 6.0mm COETT

 

  • Limit the number of airway interventions
  • DO NOT REPEAT SAME TECHNIQUE
  • First attempt is the best. Make it so.
  • Use apnoeic oxygenation in high risk patients
  • Neuromuscular blockade (rocuronium)

https://www.das.uk.com/guidelines/das_intubation_guidelines