Resus room Feng shui. Tim Leeuwenburg on 'training hard to fight easy'. Challenges and strategies for the remote emergency department.

1. Remote Resus
Room Planning

2. Kangaroo Island, SA
@KangarooBeach
Tim Leeuwenburg

3. Remote Resus
Room Planning

4. Remote Resus
feng shui

5. the karmic resus
PATIENT
TEAM
ENVIRONS
SELF

6. rural resus clinician
mad bad dangerous to know

7. anything & everything

8. alphabet courses
not adequate

9. critical illness
does not respect geography

10. asynchronous & up-to-date

11. Rural Doctors
Masterclass

12. quality care out there
prehospitalmed.com
FOAM4GP.com
broomedocs.com ruraldoctors.net
KIdocs.org
FOAM4GP.com
community

13. ACRRM
just a minute instant tutorials

14. !
blogs & curated sites
!
podcasts & vodcasts
!
JAMIT
just a minute instant tutorials

15. in resus noone can hear you scream
rural resus team

16. real team ?

17. limited personnel
many hats
‘big sick’ infrequent

18. train hard
fight easy

19. high repetition low fidelity
anywhere
anytime
anyone
guerilla
sim
training

20. Ramping NODESAT RSI Kit Dump
Preload bougie Post-RSI planning

21. find the bleed
stop the bleed
C-ABC
TXA & CAT

22. Perimortem C-section
Always carry a scalpel

23. shared mental model for processes
training for stressful situations
metacognition & error theory

24. rural resus room

25. O2 / suction
monitoring
assistant
circuit
fluid
warmer

26. ALL PLUMBING
KIT DUMPPROCEDURES / TRANSFER
360 degree access

30. rural
difficult
airway
equipment

31. RSI is like
jumping off a cliff
!
!
Rich Levitan @airwaycam

33. 53%

35. ELECTIVE INTUBATION max 4 attempts
RAPID SEQUENCE INTUBATION max 3 attempts
OPTIMISE POSITION
USE BOUGIE OR STYLET
ALTERNATIVE BLADE / SCOPE
ALTERNATIVE OPERATOR
PLAN A - INITIAL INTUBATION STRATEGY
PLAN B - SECONDARY INTUBATION STRATEGY
RSI
CLASSIC LMA (cLMA)
INTUBATING LMA (iLMA)
eg : FastTrach or AirQ
FIBREOPTIC INTUBATION THROUGH iLMA
MALLEABLE FIBREOPTIC STYLET (eg : Levitan)
FIBREOPTIC SCOPE (eg :Ambu Ascope 2)+
PLAN C - MAINTAIN OXYGENATION & VENTILATION
ATTEMPT TO WAKE PATIENT UP
CONSIDER SUGGAMADEX IF AVAILABLE
FACE MASK
NASOPHARYNGEAL AIRWAY
GUEDEL AIRWAY
CLASSIC LMA (cLMA)
INTUBATING LMA (iLMA) eg : FastTrach or AirQ
PLAN D - RESCUE TECHNIQUES FOR ‘CAN’T INTUBATE, CAN’T VENTILATE’
Bag 1 a, b, c Paediatric or Easy Anatomy NEEDLE CRICOTHYROIDOTOMY
Bag 2 Adult or Easy Anatomy SCALPEL-BOUGIE-ETT (greater success in NAP4)
Bag 3 Impossible Anatomy SCALPEL-FINGER-NEEDLE
MELKER
KIT
QUICK TRACH OXYGENATION
DEVICE
SCALPEL
BOUGIE - ETT
Refer to CICV FLOWCHART and
NURSING PROMPT CARDS overleaf
BOUGIE ALTERNATE
BLADE
AIRTRAQ VIDEO
LARYNGOSCOPE
cLMA
iLMA
FIBREOPTIC STYLET
OR FLEXIBLE FIBREOPTIC SCOPE
cLMA, iLMAMASK, NPO, GUEDEL
PLAN B not appropriate
in elective RSI

36. rural resus patient

38. standardised kit & protocols

39. avoid therapeutic vacuum

40. 改善
aggregation of
marginal gains

41. standardisation
team training
right tools for the job

42. be the fence at top of the cliff
not the ambulance at bottom

44. Wildlife Vehicle Collisions

45. trauma prevention

46. the future ?

47. OK Glass, lets RSI

48. RSI checklist
!
timer started - four minutes
pre-oxygenation
nasal cannulae for ApOx
position optimised
!
drugs drawn & dose checked
!
equipment for Plans A-B-C-D
monitoring in place, IV patent
!
roles assigned
30 second drills agreed

49. quality care out there

50. come visit Kangaroo Island
de-stress share knowledge

51. fin