Intubation Essentials with Dr. Alyssa Stoner and Dr. Gina Patel, Part 1 Preparation and Checklists
Jul 1, 2021
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Dr. Alyssa Stoner and Dr. Gina Patel discuss intubation essentials, emphasizing preparation and checklists. They cover equipment, sizing tubes based on age, positioning for success, and mnemonic SOAP ME for easy recall. The podcast delves into the importance of proper oxygen delivery, suction devices, and reviewing past airway info. The guests stress the significance of utilizing checklists to reduce adverse effects and ensure a smooth intubation process.
Progress from equipment selection for early learners to room management for advanced learners in intubation training
Deep dives
Preparing for Intubation: The SOAPME Checklist
When preparing for intubation, it's important to consider the SOAPME mnemonic. This checklist includes S for suction setup and multiple suctions if needed, O for oxygen setup with a working bag and appropriate mask size, A for assessing the age, weight, and airway equipment needed for the patient, P for personnel including respiratory therapists and nurses, and E for medication and monitoring equipment. It's crucial to have backup equipment available and to check all equipment functionality, such as inflating and deflating the cuffs. The checklist also emphasizes the importance of positioning the patient correctly based on their age and weight, as well as anticipating potential difficult airways and involving anesthesia or ENT if necessary. Monitoring the patient's vital signs during the procedure is essential, and keeping the checklist in mind helps ensure that nothing is missed.
Cognitive Load and Learning Strategies in Airway Preparation
The cognitive load of airway preparation varies depending on the level of experience. For early learners, focusing on the selection of blade and ET tube size, as well as familiarizing themselves with the equipment, can be overwhelming. However, with practice, providers gain confidence and can estimate the necessary equipment sizes based on the patient's age and weight. As learners become more experienced, they shift their focus to developing strategies for managing the room and preventing adverse events. Understanding the importance of personnel roles, patient positioning, and recognizing potential difficult airways are among the priorities for more advanced learners.
The Benefits of Using Checklists in Intubation
Using checklists in intubation procedures has been shown to reduce the frequency of adverse events. The checklist should encompass the necessary plan for intubation, the equipment required, such as blades, endotracheal tubes, and suction, the personnel involved, including their roles and experience levels, the medications and monitoring equipment needed, and the patient-specific considerations, such as positioning, IV access, and nasal gastric decompression. Developing institutional checklists or utilizing existing ones promotes consistency and reduces the risk of missing important steps. Even in high-stress scenarios, like crash intubations, following a checklist can help maintain focus, minimize mistakes, and increase the chances of success.
Dr. Alyssa Stoner is an Assistant Professor of Pediatrics, University of Missouri-Kansas City School of Medicine and practicing pediatric intensivist at Children's Mercy Kansas City. Dr. Gina Patel is a fellow in pediatric critical care at Children's Mercy Kansas City.
Objectives
The participant will be able to compile a complete list of equipment necessary to perform a pediatric intubation, with acknowledgment of mnemonic.
The participant will be able to determine the appropriate size and depth of insertion of endotracheal tube based on patient’s age utilizing a common estimation formulas.
The participant will be able to describe the appropriate patient set up; including positioning for a successful intubation.
When a checklist is elusive a simple mnemonic can be helpful to recall the necessary equipment:
Mnemonic: SOAP ME
Suction Device: Ensure suction is turned on and at appropriate level
Yaunker or large bore suction tube 14 French
Consider second suction set up especially if concerned about pulmonary hemorrhage or pulmonary edema
Oxygen Delivery system: ensure oxygen sources is connected and functioning appropriately
Nasal Cannula vs. High Flow/ Non-Rebreather
Consider non-Invasive if poor oxygenation
Consider need for apneic oxygenation depending on clinical situation
Self-inflating anesthesia bag with appropriately sized mask
Airway Equipment:
Direct Laryngoscope: Blade type and size considerations
Video Laryngoscope: CMAC or Glidescope dependent upon access and comfort
Endotracheal tube: Correct size + size down
Back up airway IE: Laryngeal Mask Airway (LMA)
Patient Position: Most of procedural success is based upon the appropriate patient positioning
Medication plan: specific to patient and clinical scenario, there are many combinations that can be utilized and some for specific scenarios.
Equipment: ensure all monitors placed appropriately (BP cuff and pulse ox on separate extremities)
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Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.comfor detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.
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