Airway Simulation Evaluation Tutorial

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Airway Simulation Evaluation Tutorial

• Gordon Kokx
• Boise State University

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Purpose

• This project has been designed to evaluate the
  efficacy of using a web-based venue to assist
  paramedic instructors in their efforts to
  successfully teach students endotracheal
  intubation using high fidelity simulation.
• The project will serve as the first phase of a
  several phase venture that will eventually
  provide research data to determine the use of
  high fidelity simulation in achieving entry level
  paramedic competency in the skill of endotracheal
  intubation.

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Instructional Design Model

• Analysis need for airway training
• Design web-based simulation project
• Development for EMS faculty and students
• Implementation pilot test with subject matter
  expert feedback
• Evaluation post use surveys and skill
  evaluation instrument

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Objectives

• At the completion of this training tutorial, the
  participant will be able to
• Develop an awareness of the integration of
  simulation into teaching and evaluating
  endotracheal intubation
• Utilize the provided assessment instrument to
  evaluate student skill performance
• Provide feedback regarding the value of the
  training module
• Employ the web-based instructional model to
  conduct future airway training

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HIGH FIDELITY SIMUALTION ENDOTRACHEAL INTUBATION
EVALUATION REPORTING FORM

• 1. Recognizes indication for invasive airway
  management (oxygen saturation lt85, respiratory
  failure, or cardiac arrest)
• 2. Steps in the endotracheal intubation (ETI)
  attempt
• 3. Patient scenario variables
• 4 Basic
• ?Noise
• ?Darkness
• ?In-line C-spine immobilization
• ?CPR (chest compressions)
• 3 Advanced
• Pharyngeal edema
• Cervical neck fusion
• Pharyngeal edema and cervical neck fusion

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HIGH FIDELITY SIMUALTION ENDOTRACHEAL INTUBATION
EVALUATION REPORTING FORM

• 4. Patient subsets (Check if used)
• ECG monitor, Pulse-Oximetry, IV accesss
• C-spine immobilization, CPR (chest compressions)
• 5. Drugs used (if any) to facilitate intubation
• 6. Patient demographic information
• Why is intubation necessary? (including GCS)
• 7. Was attempt successful?
• 8. What was the final determination of the
  placement (location) of ET tube?
• 9. Vital signs after intubation attempt
• 10. If all intubation attempts FAILED, indicate
  suspected reasons for failed intubation

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HIGH FIDELITY SIMUALTION ENDOTRACHEAL INTUBATION
EVALUATION REPORTING FORM

• 11. Critical scenario chronology elements
• Time of decision to intubate
• Time of successful intubation
• Time intubation abandoned
• 12. Critical complications encountered during
  airway management
• Inability to recognize need for intubation
• Poor intubation technique
• Inability to manage scene
• Inability to direct other rescuers
• Lack of adequate preparation
• Failure to choose proper equipment
• 13. Glottic View (according to student)
• Full
• Partial
• None
• Laryngospasm

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Steps of the procedure

• The following are critical steps of the training
  procedure

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Look, Listen and Feel for Airway
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Don Body Substance Isolation
11
Perform Jaw Thrust
12
Place Oropharyngeal Airway
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Provide BVM with Room Air
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Provide BVM Ventilation with Supplemental 02
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Check Laryngoscope
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Check Pilot Balloon
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Perform Sellick Maneuver
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View Glottis and Cords
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Place Tube
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Remove Laryngoscope
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Remove Stylet
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Inflate Bulb Syringe
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Ventilate via tube within 20 seconds of last
ventilation
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Methods of tube confirmation

• Ventilation
• Auscultation
• Syringe
• Bulb Aspirator
• Colormetric End Tidal C02

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Ventilation Observe Chest Rise
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Auscultation
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Syringe
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Bulb Aspirator
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End-tidal C02 Detection
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Secure tube
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Scenario Variables

• Room noise
• Cervical Neck Fusion
• Trismus
• Tongue Edema
• Pharyngeal Swelling
• Laryngospasm

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Loud Television Noise
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In-line Cervical Stabilization
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Cervical Neck Fusion
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Trismus
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Tongue Edema
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Pharyngeal Swelling
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Laryngospasm
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Perform CPR
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Place Cardiac Monitor
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Measure Pulse Oximetry
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Common RSI Medications
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Auscultate Blood Pressure
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Rating Glottic Views

• None
• Partial
• Full

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No Glottic View
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Partial Glottic View
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Full Glottic View
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Summary of Objectives

• At the completion of this training tutorial, the
  participant will be able to
• Develop an awareness of the integration of
  simulation into teaching and evaluating
  endotracheal intubation
• Utilize the provided assessment instrument to
  evaluate student skill performance
• Provide feedback regarding the value of the
  training module
• Employ the web-based instructional model to
  conduct future airway training

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Questions

• gkokx_at_csi.edu