COURSE OVERVIEW LEARNING OBJECTIVES Knowledge Knowledge Recall Knowledge Analysis Knowledge Synthesis Knowledge Application Skills Attitudes

Transcription

1 Rotation Director ( ) Rotation Name Marc Hassid Airway COURSE OVERVIEW Course Overview ( words describing the course) The airway rotation is a CA-1 rotation that provides residents with a rich exposure to the complexities of basic and advanced airway management. Residents will gain experience formulating strategies for intubation and extubation of the routine and difficult airway. Residents will gain experience applying a broad spectrum of airway management techniques. Residents will receive training in the technology and equipment associated with airway management. The rotation will conclude with an oral and written quiz. LEARNING OBJECTIVES Knowledge Knowledge Recall Airway Exam Identify signs of difficult airway Ventilation List maneuvers to improve mask ventilation Anatomy Identify anatomical structures encountered during intubation Esophageal intubation Name methods of determining endotracheal intubation Difficult airway Define difficult airway Mallampati classes Define the Mallampati classes Complications List potential complications of difficult airway management Assistance Name ways an assistant can help with airway management (BURP, etc) Knowledge Analysis Esophageal intubation Distinguish esophageal intubation from endotracheal intubation Awake vs. asleep Compare merits of awake versus asleep airway management Spontaneous ventilation Compare spontaneous versus controlled ventilation during airway management Airway preparation Compare various techniques for upper airway preparation for awake fiberoptic intubation Controversies Analyze controversies in airway management (cricoid pressure, ventilate before paralysis) Knowledge Synthesis Airway plan Formulate a plan for intubation and extubation of a routine and difficult airway Failed airway Propose secondary and tertiary plans to manage failed intubation attempts Knowledge Application Difficult airway Apply the ASA Difficult Airway Algorithm algorithm Retrograde intubation Illustrate setup and technique for retrograde intubation Cricothyroidotomy Illustrate setup and technique for emergency cricothyroidotomy Transtracheal jet vent Illustrate setup and technique for transtracheal jet ventilation Skills Perform asleep and awake flexible fiberoptic orotracheal and nasotracheal intubation Perform direct laryngoscopy with curved and straight laryngoscopes for orotracheal and nasotracheal intubation Perform endotracheal intubation through an LMA with and without fiberoptic guidance Perform rigid video laryngoscopy (Glidescope) Perform endotracheal intubation over tracheal tube guides Demonstrate methods for preparation of the airway for awake fiberoptic intubation Demonstrate setup of the flexible fiberoptic video tower Point out ways an assistant can help with airway management and provide clear, succinct instructions Perform one and two handed mask ventilation Attitudes Show consideration for patient comfort during airway discussions and awake airway management Show respect for surgical team members Pay attention to and address patient concerns Express point of view when discussing airway plans with the patient, attending anesthesiologist and surgeons Express satisfaction in successfully implementing difficult airway plan

2 Patient Care: Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. Objective 1. Formulate, prepare equipment for, communicate and implement an airway management plan for a patient with a difficult airway Objective 2. Prepare the upper airway for awake fiberoptic intubation Simulation Lab FOB Course Objective 3. Perform asleep fiberoptic intubation in a timely maner Simulation Lab FOB Course Explain airway management plan and risks to a patient with known difficult airway. Counsel a patient found to have an unanticipated difficult airway.

3 Medical Knowledge: Residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological and social-behavioral sciences, as well as the application of this knowledge to patient care. Objective 1. List signs of a difficult airway Written test Objective 2. List means to confirm endotracheal intubation Written test Objective 3. Identify airway anatomical structures Written test Simulation Lab FOB Course Discuss controversial issues in airway management such as cricoid pressure and the practice of demonstrating controlled ventilation before paralytics

4 Practice-based Learning and Improvement: Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life-long learning. Residents are expected to develop skills and habits to be able to meet the following goals: o identify strengths, deficiencies, and limits in one s knowledge and expertise; o set learning and improvement goals; o identify and perform appropriate learning activities; o systematically analyze practice using quality improvement methods, and implement changes with the goal of practice improvement; o incorporate formative evaluation feedback into daily practice; o locate, appraise, and assimilate evidence from scientific studies related to their patients health problems; o use information technology to optimize learning; and, o participate in the education of patients, families, students, residents and other health professionals. Objective 1. Identify areas for improvement in airway management Objective 2. Establish goals to address areas for improvement Objective 3. Incorporate formative evaluation feedback into daily practice Search literature for recent advances in airway management

5 Interpersonal and Communication Skills: Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and health professionals. Residents are expected to: o communicate effectively with patients, families, and the public, as appropriate, across a broad range of socioeconomic and cultural backgrounds; o communicate effectively with physicians, other health professionals, and health related agencies; o work effectively as a member or leader of a health care team or other professional group; o act in a consultative role to other physicians and health professionals; and, o maintain comprehensive, timely, and legible medical records, if applicable. Objective 1. Communicate effectively with patients, families, and the public, as appropriate, across a broad range of socioeconomic and cultural backgrounds. Objective 2. Objective 3. Communicate effectively with physicians, other health professionals with emphasis on airway issues. Work effectively as a member or leader of a health care team or other professional group Objective 5 Act in a consultative role to other physicians and health professionals with special attention to airway issues Maintain comprehensive, timely, and legible medical records with clear details of airway difficulty and management.

6 Professionalism Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. Residents are expected to demonstrate: o compassion, integrity, and respect for others; o responsiveness to patient needs that supersedes self-interest; o respect for patient privacy and autonomy; o accountability to patients, society and the profession; and, o sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation. Objective 1. Demonstrate responsiveness to patient needs that supersedes selfinterest. Specifically understand that experience with various airway techniques must not compromise patient care. Objective 2. Demonstrate compassion, integrity, and respect for others. Objective 3. Demonstrate respect for patient privacy and autonomy. Demonstrate sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation.

7 Systems-based Practice Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care. Residents are expected to: o work effectively in various health care delivery settings and systems relevant to their clinical specialty; o coordinate patient care within the health care system relevant to their clinical specialty; o incorporate considerations of cost awareness and risk-benefit analysis in patient and/or population-based care as appropriate; o advocate for quality patient care and optimal patient care systems; o work in interprofessional teams to enhance patient safety and improve patient care quality; and o participate in identifying system errors and implementing potential systems solutions. Objective 1. Work in interprofessional teams to enhance patient safety and improve patient care quality. Objective 2. Participate in identifying system errors and implementing potential systems solutions. Objective 3. Coordinate patient care within the health care system relevant to anesthesiology and airway management. Incorporate considerations of cost awareness and riskbenefit analysis in patient-based care.

8 TEACHING METHODOLOGIES Students on this rotation will be expected to learn and achieve the learning objectives through the following methodologies and activities: Lecture Airway Management by Dr. Clark Lab Simulation Center Fiberoptic Bronchoscopy Course Drs. Walton and Nelson Daily direct one-on-one teaching in the Operating Room with patient encounters Independent Study Course Material by Dr. Hassid Independent Study Morgan & Mikhail pp at end of rotation Self assessment and rotation evaluation at end of rotation PATIENT ENCOUNTERS Residents on this rotation will be expected to work up and/or manage the minimum number of patients/cases with the specified conditions as listed below: (e.g., 10 craniotomies, 20 vaginal deliveries with CLE, etc.) Number Patient Condition / Case 8 Fiberoptic intubation 4 Nasal intubation 4 Intubation through LMA 8 Rigid video laryngoscope guided intubation 8 Intubation over tracheal tube guides FEEDBACK Please identify when and how the student will receive feedback on his/her performance. Daily Written Final Written Verbal Verbal SUBMITTED BY Today s date