Remote Resus	

Room Planning
Kangaroo Island, SA
@KangarooBeach
Tim Leeuwenburg
Remote Resus
Room Planning
Remote Resus
feng shui
the karmic resus
PATIENT
TEAM
ENVIRONS
SELF
rural resus clinician
mad bad dangerous to know
anything & everything
alphabet courses	

not adequate
critical illness	

does not respect geography
asynchronous & up-to-date
Rural Doctors	

Masterclass
quality care out there
prehospitalmed.com
FOAM4GP.com
broomedocs.com ruraldoctors.net
KIdocs.org
FOAM4GP.com
community
ACRRM	

just a minute instant tutorials
!
blogs & curated sites	

!
podcasts & vodcasts	

!
JAMIT	

just a minute instant tutorials
in resus noone can hear you scream
rural resus team
real team ?
limited personnel	

many hats	

‘big sick’ infrequent
train hard	

fight easy
high repetition low fidelity
anywhere	

anytime	

anyone
guerilla	

sim	

training
Ramping NODESAT RSI Kit Dump	

Preload bougie Post-RSI planning
find the bleed	

stop the bleed
C-ABC	

TXA & CAT
Perimortem C-section	

Always carry a scalpel
shared mental model for processes	

training for stressful situations	

metacognition & error theory
rural resus room
O2 / suction
monitoring
assistant
circuit
fluid
warmer
ALL PLUMBING
KIT DUMPPROCEDURES / TRANSFER
360 degree access
rural	

difficult	

airway	

equipment
RSI is like	

jumping off a cliff	

!
!
Rich Levitan @airwaycam
53%
ELECTIVE INTUBATION max 4 attempts
RAPID SEQUENCE INTUBATION max 3 attempts
OPTIMISE POSITION
USE BOUGIE OR STYLET
ALTERNA...
rural resus patient
standardised kit & protocols
avoid therapeutic vacuum
改善
aggregation of	

marginal gains
standardisation	

team training	

right tools for the job
be the fence at top of the cliff	

not the ambulance at bottom
Wildlife Vehicle Collisions
trauma prevention
the future ?
OK Glass, lets RSI
RSI checklist
!
timer started - four minutes
pre-oxygenation
nasal cannulae for ApOx
position optimised
!
drugs drawn & do...
quality care out there
come visit Kangaroo Island	

de-stress share knowledge
fin
Remote Resus Room Planning by Leeuwenburg
Remote Resus Room Planning by Leeuwenburg
Remote Resus Room Planning by Leeuwenburg
Remote Resus Room Planning by Leeuwenburg
Remote Resus Room Planning by Leeuwenburg
Remote Resus Room Planning by Leeuwenburg
Remote Resus Room Planning by Leeuwenburg
Remote Resus Room Planning by Leeuwenburg
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Remote Resus Room Planning by Leeuwenburg

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Resus room Feng shui. Tim Leeuwenburg on 'training hard to fight easy'. Challenges and strategies for the remote emergency department.

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Remote Resus Room Planning by Leeuwenburg

  1. 1. Remote Resus Room Planning
  2. 2. Kangaroo Island, SA @KangarooBeach Tim Leeuwenburg
  3. 3. Remote Resus Room Planning
  4. 4. Remote Resus feng shui
  5. 5. the karmic resus PATIENT TEAM ENVIRONS SELF
  6. 6. rural resus clinician mad bad dangerous to know
  7. 7. anything & everything
  8. 8. alphabet courses not adequate
  9. 9. critical illness does not respect geography
  10. 10. asynchronous & up-to-date
  11. 11. Rural Doctors Masterclass
  12. 12. quality care out there prehospitalmed.com FOAM4GP.com broomedocs.com ruraldoctors.net KIdocs.org FOAM4GP.com community
  13. 13. ACRRM just a minute instant tutorials
  14. 14. ! blogs & curated sites ! podcasts & vodcasts ! JAMIT just a minute instant tutorials
  15. 15. in resus noone can hear you scream rural resus team
  16. 16. real team ?
  17. 17. limited personnel many hats ‘big sick’ infrequent
  18. 18. train hard fight easy
  19. 19. high repetition low fidelity anywhere anytime anyone guerilla sim training
  20. 20. Ramping NODESAT RSI Kit Dump Preload bougie Post-RSI planning
  21. 21. find the bleed stop the bleed C-ABC TXA & CAT
  22. 22. Perimortem C-section Always carry a scalpel
  23. 23. shared mental model for processes training for stressful situations metacognition & error theory
  24. 24. rural resus room
  25. 25. O2 / suction monitoring assistant circuit fluid warmer
  26. 26. ALL PLUMBING KIT DUMPPROCEDURES / TRANSFER 360 degree access
  27. 27. rural difficult airway equipment
  28. 28. RSI is like jumping off a cliff ! ! Rich Levitan @airwaycam
  29. 29. 53%
  30. 30. ELECTIVE INTUBATION max 4 attempts RAPID SEQUENCE INTUBATION max 3 attempts OPTIMISE POSITION USE BOUGIE OR STYLET ALTERNATIVE BLADE / SCOPE ALTERNATIVE OPERATOR PLAN A - INITIAL INTUBATION STRATEGY PLAN B - SECONDARY INTUBATION STRATEGY RSI CLASSIC LMA (cLMA) INTUBATING LMA (iLMA) eg : FastTrach or AirQ FIBREOPTIC INTUBATION THROUGH iLMA MALLEABLE FIBREOPTIC STYLET (eg : Levitan) FIBREOPTIC SCOPE (eg :Ambu Ascope 2)+ PLAN C - MAINTAIN OXYGENATION & VENTILATION ATTEMPT TO WAKE PATIENT UP CONSIDER SUGGAMADEX IF AVAILABLE FACE MASK NASOPHARYNGEAL AIRWAY GUEDEL AIRWAY CLASSIC LMA (cLMA) INTUBATING LMA (iLMA) eg : FastTrach or AirQ PLAN D - RESCUE TECHNIQUES FOR ‘CAN’T INTUBATE, CAN’T VENTILATE’ Bag 1 a, b, c Paediatric or Easy Anatomy NEEDLE CRICOTHYROIDOTOMY Bag 2 Adult or Easy Anatomy SCALPEL-BOUGIE-ETT (greater success in NAP4) Bag 3 Impossible Anatomy SCALPEL-FINGER-NEEDLE MELKER KIT QUICK TRACH OXYGENATION DEVICE SCALPEL BOUGIE - ETT Refer to CICV FLOWCHART and NURSING PROMPT CARDS overleaf BOUGIE ALTERNATE BLADE AIRTRAQ VIDEO LARYNGOSCOPE cLMA iLMA FIBREOPTIC STYLET OR FLEXIBLE FIBREOPTIC SCOPE cLMA, iLMAMASK, NPO, GUEDEL PLAN B not appropriate in elective RSI
  31. 31. rural resus patient
  32. 32. standardised kit & protocols
  33. 33. avoid therapeutic vacuum
  34. 34. 改善 aggregation of marginal gains
  35. 35. standardisation team training right tools for the job
  36. 36. be the fence at top of the cliff not the ambulance at bottom
  37. 37. Wildlife Vehicle Collisions
  38. 38. trauma prevention
  39. 39. the future ?
  40. 40. OK Glass, lets RSI
  41. 41. RSI checklist ! timer started - four minutes pre-oxygenation nasal cannulae for ApOx position optimised ! drugs drawn & dose checked ! equipment for Plans A-B-C-D monitoring in place, IV patent ! roles assigned 30 second drills agreed
  42. 42. quality care out there
  43. 43. come visit Kangaroo Island de-stress share knowledge
  44. 44. fin
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