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Can’t Intubate Can’t Oxygenate (CICO). Management of the Critically Obstructed Airway Session 2: Supraglottic Airway Rescue and Transition to Infraglottic Airway Rescue. (Acknowledgements: adapted from talks by Dr Jamie Beit , Toowoomba), Helen Zois (Sydney) and Adam Rehak (Sydney). - PowerPoint PPT Presentation
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Sydney Clinical Skillsand Simulation Centre
Can’t Intubate Can’t Oxygenate (CICO)
Management of the Critically Obstructed AirwaySession 2: Supraglottic Airway Rescue and Transition to Infraglottic Airway Rescue
(Acknowledgements: adapted from talks by Dr Jamie Beit, Toowoomba), Helen Zois (Sydney) and Adam Rehak (Sydney)
CICO Plan
Part 1Supraglottic Airway Rescue
Part 2Transition to CICO
Part 3Infraglottic Airway Rescue
DAS summary flowchart
Benumof JL, Dagg R, Benumof R (1997) Critical hemoglobin desaturation will occur before return to an unparalyzed state following 1 mg/kg intravenous succinylcholine. Anesthesiology 87: 979-82.
The Vortex model
Desaturation
With permission Chrimes N & Fritz P 2013
The Vortex model
The Vortex model
The Vortex model
The Vortex model
Surgical airway (Infraglottic rescue)
Supraglottic Rescue
The Vortex model
Video
Best attempt face-mask ventilation Optimal position (ear > sternum) Head tilt chin lift jaw thrust 2 handed BMV Second person ventilates High fresh gas flows (O2 flush) Oro/Nasopharyngeal airway Cricoid off
Best attempt endotracheal intubation
Best person in room Best position (tragus >sternum) Best blade (e.g., videolaryngoscope) External laryngeal Manipulation (ELM) Bougie or stylet (only1 blind attempt) Consider muscle relaxant (if experienced) Cricoid off
Best attempt LMA ventilation Different type (e.g. Proseal™) Different size Insert under direct vision) Insertion with jaw thrust Pull tongue forward Cricoid off Consider muscle relaxant (if experienced)
There is no ideal number of attempts for face mask ventilation, endotracheal intubation or LMA ventilation.
A best attempt: • may involve >1 attempt• is unlikely to be beneficial
with >3 attempts
How many attempts?
Best attempt at:• Face-mask ventilation?• LMA ventilation? • Endotracheal intubation? AND
Oxygen saturations falling or persistently low?
Is this a CICO situation?
INFRAGLOTTIC RESCUE
YES
Continue Supraglottic
rescue
Consider waking patient
Review again in 1 min
With permission A. Heard and Working group for the Rural Health Continuing Education (RHCE) (Stream 1) ‘Critically Obstructed Airway Workshop’. Contact [email protected]. 2013
SUPRA-GLOTTIC RESCUE
NO
TR
AN
SIT
ION
‘Transition’ protocol - CICO
MOBILISE RESOURCES
FOR CICO