The key to safe and effective airway management is appropriate preparation.
I use the following format to remember the key aspects of preparation for intubation. This format works for any procedure from draining an abscess to putting a patient on ECMO.
- Self – protective equipment
- Staff – delegate roles
- Patient – consent, position etc
- Equipment – includes drugs
- Department – who will take care of other patients while you are doing procedure
- Prepare for failure – plans B & C
This mental checklist is useful to give me a broad overview of things I need to think about. However, there are so many small things that need to be remembered that I’m sure to forget something if I rely on my brain alone. More importantly, even if I have a photographic memory, I am not the one who will be doing most of the preparation. Other team members will be delegated to monitor the patient and get drugs or equipment.
There is an increasing body of literature demonstrating that checklists improve team performance in crisis situations. A recent randomized trial published in NEJM demonstrated a marked improvement in team performance when a checklist was used
N Engl J Med 2013; 368:1459-1460
Scott Weingart from EMCrit.org has made a nice podcast explaining his own intubation checklist.
A basic checklist without the Weingartisms comes from the guys at saferintubation.com
One of my favorite checklists comes from Dr Tim Leeuwenburg of KI-Docs.com. The great thing about this checklist is that it incorporates a visual “dump kit” which allows anyone to see exactly what equipment is needed and set it up.
Although these checklists have different formats the all have many things in common. They help us by reducing our cognitive load during a resuscitation thereby allowing us to focus on the key task of keeping the patient alive. The key is tailoring a checklist to the needs of your environment and using it for every intubation.
I’ll close this post with a video from the Sydney Helicopter Emergency Medical Service that manages to make something as boring as checklists look pretty cool!