Difficult airway trolley at Alfred Hospital
Hi folks, Dr Pierre Bradley , Consultant anaesthetist at the Alfred Hospital in Melbourne shared some details of the difficult airway trolley in their department. Thanks Pierre!
“Senior members of the Alfred Department of Anaesthesia and Perioperative Medicine, who have a specific interest in airway education and equipment, undertook the development of a difficult airway trolley based around ANZCA PS 56 document and CRM principles. They currently have a regular small group teaching session on infraglottic oxygenation for all members of staff and orientation to the DA Trolley.
Specifically the aim was simplify the process along CRM principles
Plan A Intubation
Plan B Supraglottic oxygenation
Plan C Wake up
Plan D Infraglottic oxygenation
The draws on trolley follow that plan
Draw 1: Topicalisation gear including Madgic atomiser , guedels, ovasappian, nasal airways ( ie awake /adjuncts)
Draw 2: Selection of laryngoscope and handles
Draw 3 & 4: Videolaryngoscopes
Draw 5& 6: Supraglottic devices
Draw 7: Infraglottic including needle cric pack, surgical and manujet
Sides: AEC, Frovas ( planning on aintree soon) and Algorithm
Top: Not shown – fibrescope lightsource
Dr Pierre Bradley
Chair of Airway Management Special Interest Group (ANZCA, ASA, NZSA)
Department of Anaesthesia and Perioperative Medicine
Adjunct Senior Lecturer – Monash University – Academic Board of Anaesthesia and Perioperative Medicine
Advanced Airway Management Refresher Course
iPAD / iPhone App
Topicalisation & Sedation for Awake Fibreoptic Intubation”
The emergency surgical airway kit shown here is now fairly standard across Australian anaesthesia departments based on the concept promoted by Dr Andy Heard from Perth with his 2009 paper
You see there are two distinct and labelled surgical airway kits in the bottom drawer in clear plastic bags, all prepared to deploy. There is the scalpel, bougie and ETT 6.0 kit. The bougie is a Cook Frova design with a ventilation channel and the Rapifit adapter to attach a BVM to the end of it if need be. The idea is that you can rapidly insert the bougie and oxygenate immediately before railroading the ETT into the trachea. This is the theory anyway.
Then there is the needle cric kit with 14G needle cannula , syringes and saline ampoules. The idea is that you use a saline filled syringe to help detect aspiration of air once you think you are in the trachea. You are supposed to do this twice: firstly on initial tracheal puncture, then again to reconfirm prior to delivering oxygen via the cannula. The oxygen delivery system is shown as O2 tubing with a Y connector to control flow and a Luer Lock connector at the delivery end to connect to the cannula. I see in the bottom drawer there is also a Melker cuffed cricothyrodotomy kit for Seldinger technique and a Manujet (manual jet ventilator)
Overall very nice airway trolley!