AIME STOP IC BARS SAVED

Checklist Plus

AIME
Call a colleague/ Not recognizing Difficult Difficult BMV Difficult Rescue Cooperation At risk Not
recruit medic/ your limits Intubation (BOOTS+) Oxygenation Physiology anticipating
extra nursing (MMAP) SGA/Surgical difficulty
Ask for Help /
Assess patient
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A= 1st attempt B=Cant intubate/ C=Cant Not having &

Best Look Can Oxygenate intubate/Cant communicating
Oxygenate plan; Not having
Identify Plan ready access to
! ! ! equipment

Cycle BP: adjust Maintain Monitor CO2 Abandoning Not anticipating

induction agents Saturations: throughout Oxygenation to post intubation
& dose/prepare consider Facilitated take control of hypotension,
Monitor/ or start pressors Oxygenation (DSI) hypoxic patient adrenaline
Modify induced
unintentional
approach ! ! ! hyperventilation

Communicate Preoxygenate / Expect poor Use best look Dont fixate on Dont abandon Adjust Volume Manage Appreciate
plan with team/ HFNP; Care with View: maneuverers on intubation Oxygenation to induction bolus/Mix your own threatening
Assign roles assisted BMV Mental first attempt take control of to BP/age/ pressors & anxiety Biases
Avoiding rehearsal hypoxic patient condition start early
Errors

STOP
-1-2 rigid Remember to
suctions check for
on/checked occlusion
and within port
Suction blind grasp

Predicted size Check cuff/ Load/lube stylet Parker Flex-tip Hyperacute stylet
plus 1/2 size inflate straight to cuff: for indirect ETI curve preventing
smaller 30-40* for DL, +/- with Bougie advancement
60-70* for VL
Tubes

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Preoxygenate: Preoxygenate: Preoxygenate: Consider drug Leave HFNP on Reoxygenate: Asynchronous -Prematurely
HFNP BMV/PEEP CPAP/BiPAP facilitated during ETI for OPA & 2-hand/ BMV of abandoning
(10-15 lpm)+ valve oxygenation apneic oxygenation 2-person BMV breathing oxygenation of
Non- passive or (DSI) patient, hypoxic patient
rebreather assist plus - Forgetting
plus HFNP apneic
Oxygenation oxygenation

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Awake DL/VL/FIS Cooperative/ Rapid Pretreat: Induction: Paralytic: Rescue: -Not having
Intubation Facilitated difficult airway: Sequence - Volume: - Propofol - Rocuronium - Phenyephrine . pressors
Cooperation -Lido 5% Intubation 10-20 ml/kg .5-1.5 mg/kg 1-1.5 mg/kg 5-1 mcg/kg mixed &
Ketamine ointment - Pressor: - Etomidate - Succinyl- - Ephedrine available
-Lido 10% Norepinephrine .2-.3 mg/kg choline .1 mg/kg -Not
Pharmacology spray 2-4 mcg/min - Ketamine 1.5 mg/kg - Norepinephrine adjusting
-Lido 4% 1-1.5 mh/kg .5-1 mcg/kg/min induction
atomized - Ket:Prop - Atropine dose for BP/
1 mg/kg .02mg/kg age

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 IC BARS
2 large IVs IO access if 2 IV failures < IM behaviour control for IV -Volume bolus 10-20 ml/kg Haemorrhage control: -Persisting with IV/Central
2min access: Haldol, Olanzapine, -Blood products/Massive -Splint pelvis, long bone # access instead of early IO
Ketamine transfusion -TxA
IV/IO/IM !
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Qualitative CO2 Preferred Quantitative CO2 -Clinician adrenaline

induced hyperventilation
Capnography !
! -Not believing capnography
I saw it go in

-Position 3 ways/2 hands/1st Bougie on bed Consider Straight blade -Not ramping obese -Depending on bougie
Ear-sternum attempt -Gentle endpoint 30cm+/-5, paraglossal for tongue -Not removing ant collar clicks
-Ramp obese 1..Sniff+lift if no CI clicks management -Too deep with insertion/ -Removing DL after bougie
-Epiglotoscopy 2. .ELM -ETT hold up:1/4 turn L lift placed
Best Look DL -Valleculospy 3. 2-hand lift -Parker Flex tip -Not looking for
epiglottis 1st/then cords

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-Know your device +/-60* stylet curve -Best view not best
-Midline insertion -hold up: delivery bigger on screen
-Look for epiglottis -1/4 turn R isnt better!
-Dont get too close -Pull back blade -Excessive stylet curve
Best Look VL - Blade tip in vallecula
-Parker ETT
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Channeled: Mac VL: Hyperacute blades Optical stylet with DL Device confusion: These are: you have time
-KVVL -CMAC -Glidescope -Levitan FPS -reaching for devices
Alternative -Airtraq -McGrath Mac -CMAC D blade Flexible Intubating Scope alternatives in failed Cant intubate/Can
(FIS) oxygenation oxygenate
intubation devices -not being able to
! ! ! ! problem solve chosen
device
-LMA ETT channel/resue Not sizing device/ These are: you have NO Not anticipating rapid
-LMA Supreme -ILMA having cuff inflation syringe time devices need to move on to
Rescue -I-Gel -AuraGain ready Cant intubate/Cant surgical airway
-King LTS -AirQ oxygenate
Oxygenation
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-Landmark 4 finger Bougie assisted: -Decision too late
from sternal notch, #10 blade/5.0-,6.0 adult -Not landmarking in
-Vertical landmark 1. landmark vertical preparation stage
incision incision
Emergency 2. horizontal CTM stab -Inadequate dilatation
3. dilate with blade or
Surgical Airway finger -Trigger: Falling sats with
4. Bougie then ETT ineffective BVM
SGD while ESA in progress
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SAVED
-Secure ETT with twill/ Sedation: -Avoid tape to secure ET-
commercial device - Propofol 15-25 mcg/kgmin -Inadequate sedation in
Suction/NG - Midazolam .02 mg/kg/hr paralyzed patient.
-X-ray - Ketamine .5-1 mg/kg/hr -Omitting analgesia.
Secure tube/ Analgesia: -Hypotension
- Fenatnyl 1mcg/kg/hr
Sedate Paralysis:
Rocuronium 0.6 mg/kg

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- Hypoxia Not anticipating/managing

- Hypotension preventable adverse events
- Hypocapnea
- Unrecognized esophogeal
intubation
- Aspiration
Adverse events - Oral/airway trauma
- Pneumothorax
- Cardiac arrest
- Death
- Other:

Assist Control/Volume Mode -Keep Plateau pressures (Pplat) Obstructive disease:: AC-Volume -Lack of knowledge/problem
TV 6-8 ml/kg (IBW) <30 cm H20 TV: 6-8ml/gkg solving skill
RR 10-12 -Consider incremental FiO2/ RR 6-10 -Alarm ignorance
IFR 60-80 l/min PEEP IFR 80-100l l/min -Relying on PIP, not Pplat
PEEP 0-5 PEEP 0 -underuse/overuse PEEP
Ventilation I:E 1:2 I:E 1:4/5 -inadequate sedation
FiO2 !00% FiO2: 100%

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-Clinical improvement -Low PSV (6-8 cm H20) if in doubt leave it in -Decision based on resources
-LOC (GCS 11-12T) -Normal RR -Not a difficult airway not patient condition
-muscle strength: cough, head -Adequate TV -Hemodynamically stable -Decision made without
Extubation lift 5s -PEEP<5 -No active ischemia knowledge of intubation
-minimal secretions -Fi02 <50% -Not combative difficulty
-PCO2<50 mm Hg -Lack of communication in
handover
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-Communicate directly to -Your patient until leave ED -Assuming your done once
consulting and managing -No extubation order unless intubated
services youre consulted -Accepting extubation plan
-Document airway -Travel to CT/floor with airway based on bed availability
Documentation/ assessment, difficulty, & go kit -
Disposition management details in
procedure note

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