This training video was filmed on the high dependency unit at Ysbyty Gwynedd, Bangor, North Wales (Betsi Cadwaladr University Health Board) in May 2012. The staff were asked to intubate a patient with respiratory failure and sepsis secondary to pneumonia.
The team leader was asked to deliberately forget a few things in the first take (fluids, capnography, suction and failed intubation plan). In the second take, the emergency induction checklist was used.
The emergency induction checklist at Bangor has been adapted from the one recommended in the appendix of the 4th National audit project of the Royal College of Anaesthetists (NAP4).
The purpose of this training video is to illustrate how easily things can get missed when a team are under pressure to intervene with a sick patient. This happens frequently with no significant consequences, because it rarely matters when things go well. Every now and again, however, things will not go to plan and without proper preparation the consequences can be severe. The NAP4 project identified a disproportionate number of complications of airway management arise from intensive care patients. This is not surprising as they are often sicker patients, with multiple comorbidities, there is often less time for preparation and often the equipment is not as good as we are used to in the operating theatre. What is not known is how many patients suffer harm from transient hypotension and hypoxia as a result of poorly managed inductions.
The purpose of the checklist is to ensure that the team is well prepared for potential difficulties. It is not intended as a step by step guide to a rapid sequence intubation. That is what the staff are trained for. Neither is it a box ticking exercise. We do not keep a paper record of it. It is all about getting the team together and communicating in a structured, organised way, making sure that important equipment and drugs are available, and that the patient is as good as they can be before commencing.
The checklist is a cheap, simple solution. It is easy to follow and does not take up a significant amount of time. We have tested it in a short simple study and it has been shown to be effective in reducing errors in preparing for a rapid sequence induction. Our staff are now trained to use the checklist for all emergency RSI's in critical care and the Emergency department. Feedback from anaesthetists who have used the checklist has been overwhelmingly positive.
We hope that you find the video educational (and entertaining).
The simulator is a standard Laerdal SimMan. The video was filmed with a HD video camera and an iPhone 4. It was edited using iMovie.
Many thanks to Eirian, Ifan, Suzanne, Ami, Farbod, Einir, Adam, Phil.