This resource was part of AHRQ's Public Health Emergency Preparedness program, which was discontinued on June 30, 2011, in a realignment of Federal efforts. They tie in quite nicely with NAP4 recommendations and are an example of what we should all be doing in our own places of work… Coming up with agreed upon checklists and action plans for critical procedures, that are suited to the environment they will be used in. Finally a€” before I forget a€” if you doubt the power of checklists, read Atul Gawande’s great little book, The Checklist Manifesto.
Firstly, no one cares if there is no air in your patient’s stomach if they are dead from hypoxia!
RSI is a concept, first described in its common current iteration in the seventies by Stept and Safar. Here is a a more comprehensive idiot proof check list that ensures nothing is missed and serves as comprehensive documentation of who was called when, who arrived when, which drugs were given when etc. I have been running an airway registry in the ED at The Royal North Shore Hospital in Sydney for the last 2 years. I presented the first 18 months of data at the ASM in Sydney last year and I must admit, they showed room for improvement!.

I am happy for people to download the file and use it as is, or with appropriate modifications.
Furthermore I would love to hear from anyone keen to undertake an Airway Registry in their own ED -- a Pdf of the data collection form we use is also on the website.
As the authors of the NAP4 study conclude, it is essential we all audit our practice of this potentially high risk procedure.
George’s checklist and action plan emphasize the need for communication, the need for multiple plans and the need to recognise and prepare for failure (defined both clinically and in time). Key areas of interest include: the ED-ICU interface, toxicology, simulation and the free open-access meducation (FOAM) revolution. As one of the New York ambulance companies, battling traffic forces ambulette service members have to often take drastic measures to keep patients healthy during their trip. Our Team, headed by Mike Cadogan & Chris Nickson, consists (mostly) of emergency physicians and intensivists based in Australia and New Zealand. He says that these documents are stuck on top of his department’s difficult airway trolleys as an A3 poster.

It is also useful to use positive pressure for maintain apneic oxygenation after drug administration.
An open appendicectomy was the traditional technique that has been improved in select cases with laparascopic technique. Finally, all this equipment, including the checklist and action plan, is put to use in team-based simulation scenarios so that it becomes second nature for everyone. It is useful in select cases when classic RSI( whatever that is currently), may present extraordinary danger to your hypoxic patient.
Applying cricoid, waiting till you run into trouble, then releasing it increases your chances of a failed intubation and then having to use bag ventilation between attempts massively increasingly aspiration risk.
We were taught that if we all performed RSI the same way , then we would all have the same success.

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Rubric: Emergency Preparedness Survival


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