Module one of the pre-hospital critical care curriculum focuses on advanced airway management. This module will run for three consecutive weeks and will cover a wide range of topics. Upon successful completion of this module participants will have mastered the material as outlined in the course objectives and have completed a total of three different simulation scenarios (although you may complete the same simulation more then once – your role will be different each time).

Below you will find links to the module objectives and to the pre-simulation podcast lectures. Module one is composed of three chapters. Each chapter will focus on specific material that will be reinforced with in-situ simulation.

Module # 1 – Objectives

Airway Module – Chapter 1 – SOPs:Difficult Airway:Surgical Airway

Airway Module – Chapter 2 – The Neuroprotective Intubation:Pediatric RSI

Airway Module – Chapter 3 – Video Laryngoscope – Working in Austere Environments

Reference material: Below you will find links to material referenced in the podcast lectures.

Observational study of the success rates of intubation and failed intubation airway rescue techniques in 7256 attempted intubations of trauma patients by pre-hospital physicians.
Lockey D1, Crewdson K2, Weaver A2, Davies G2.
Br J Anaesth. 2014 Aug;113(2):220-5. doi: 10.1093/bja/aeu227.

Prehospital anaesthesia performed by physician/critical care paramedic teams in a major trauma network in the UK: a 12 month review of practice.
McQueen C1, Crombie N, Hulme J, Cormack S, Hussain N, Ludwig F, Wheaton S.
Emerg Med J. 2013 Oct 16. doi: 10.1136/emermed-2013-202890. [Epub ahead of print]
http://www.ncbi.nlm.nih.gov/pubmed/24132327

Development of a standard operating procedure and checklist for rapid sequence induction in the critically ill.
Sherren P, Tricklebank S, Glover G.
Scand J Trauma Resusc Emerg Med. 2014 Sep 11;22(1):41.

Delayed Sequence Intubation: A Prospective Observational Study.
Weingart SD1, Trueger NS2, Wong N3, Scofi J4, Singh N5, Rudolph SS6.
Ann Emerg Med. 2014 Oct 23. pii: S0196-0644(14)01365-1.[Epub ahead of print]

http://lifeinthefastlane.com/ccc/pretreatment-drugs-for-rapid-sequence-intubation-rsi/

The ketamine effect on ICP in traumatic brain injury.
Zeiler FA1, Teitelbaum J, West M, Gillman LM.
Neurocrit Care. 2014 Aug;21(1):163-73.

Pediatric airway management.
Santillanes G1, Gausche-Hill M.
Emerg Med Clin North Am. 2008 Nov;26(4):961-75

Pediatric airway nightmares.
D’Agostino J.
Emerg Med Clin North Am. 2010 Feb;28(1):119-26.

Module #1 – Pre-hospital Airway Management Objectives

Clinical and Technical Skills.

Upon completion of module 1 – Airway Management – course participants should be able to complete the following:

1.0 Anatomy
1.1 Describe basic airway anatomy
1.2 Describe the differences between the pediatric and adult airway

2.0 Identify the need for definitive management including:
2.1 Anatomical obstruction.
2.2 Lack/loss of airway protection.
2.3 Projected clinical course necessitating definitive airway management prior to arrival at receiving hospital.

3.0 Perform an accurate airway assessment and develop a management plan including:
3.1 Identification of (potential) difficult BMV
3.2 Identification of (potential) difficult intubation
3.3 Identification of (potential) difficult supraglottic airway
3.4 Identification of (potential) difficult surgical airway
3.5 Describe algorithm for both difficult and failed airways.

4.0 Airway Management
4.1 Demonstrate use of Pre-RSI checklist
4.2 Clearly assign airway roles (ICP vs HEMS physician vs. Crewman)
4.3 Optimize pre-oxygenation (eg. Nasal trumpets/OPA/etc)
4.4 Optimize patient position
4.4.1 Helicopter vs. Ambulance vs. Roadside
4.4.2 Anatomical positioning
4.4.3 Scene management
4.5 Describe the pharmacology of the following RSI medications:
Induction Agent
4.5.1.1 Ketamine
4.5.1.2 Etomidate
4.5.1.3 Fentanyl
4.5.1.4 Midazolam
Neuromuscular Blocking Agent
4.5.2.1 Suxmethonium
4.5.2.2 Rocuronium
Pediatric specific medications
4.5.3.1 Atropine
Rescue Medications
4.5.4.1 Adreniline
4.5.4.2 Metarminol
4.6 Intubation
4.6.1 Use Cormack-Lehane grading system to describe view of glottic opening.
4.6.2 Demonstrate correct placement of ETT tube under direct vision.
4.6.3 Demonstrate effective use of bougie
4.6.4 Demonstrate a working knowledge of video-laryngoscopy
4.6.5 Demonstrate correct placement of supra-glottic airway device

4.7 Surgical airway
4.7.1 Demonstrate a working knowledge of appropriate surgical anatomy required to perform a needle/ open cricothyrotomy
4.7.2 Demonstrate appropriate surface land-marking required to perform needle/open cricothyrotomy.
4.7.3 List the equipment necessary to perform a needle/open cricothyrotomy.
4.7.3 Demonstrate a needle/ open cricothyrotomy.

4.8 Confirm correct placement of ETT
4.8.1 Understand use of ETCO2 for confirming placement of ETT
4.8.2 Describe alternative methods to confirm placement of ETT

4.9 Post –Intubation Care
4.9.1 Appropriate use of Post-RSI checklist
4.9.2 Demonstrate an appropriate technique to secure ETT for potential rough/turbulent transport.
4.9.3 Describe the pharmacology of the following post-intubation medication used to:
Sedated/ Analgesic for transportation:
4.9.3.1 Ketamine
4.9.3.2 Fentanyl/ Morphine
4.9.3.3 Midazolam
Neuromuscular Blockade for transport
4.9.3.1 Rocuronium

4.10 Transport
4.10.1 Formulate plan for potential complication related to/ during transport phase.