Anesthesia — Core of Discipline

C4 Managing patients presenting with a difficult airway, including developing plans for extubation

- This EPA builds on the skills of Foundations related to discussing the assessment and plans for anticipated difficult airway.
- At Core, the task focuses on preparation of full OR equipment and medication including at least 2 additional management options, consideration of potential side effects and complications, execution of the management plan and thorough documentation.
- This EPA requires medical expertise to manage the clinical situation as well as leadership skills to facilitate teamwork and crisis resource management
- The extubation plan must include anticipation of and management strategies to minimize risk of failure, and a postoperative disposition appropriate for the level of care required.
- The observation of this EPA should be documented with every encounter of a patient with an unanticipated difficult airway.

Form

F1: Observation

Milestones

• ME 1.4. ME 1.4 Perform an appropriate history and physical assessment to identify patients with the potential for a difficult airway

• ME 2.2. Synthesize patient information to identify a difficult airway, including identifying co-morbidities placing the patient at a higher risk of having a difficult airway, in a timely manner

• ME 2.2. Identify those patients and disease states which are at higher risk of a difficult airway

• ME 2.4. Formulate and implement management plans that consider all of the patient’s health problems and context, in a timely manner, in collaboration with patients and their families and, when appropriate, the interprofessional team

• ME 2.4. Integrate all sources of information to develop a clear and safe plan, including extubation and post-operative care

• ME 3.4. Competently and safely provide airway management in a timely manner

• ME 4.1. Establish plans for ongoing and postoperative care

• ME 5.2. Apply the principles of situational awareness to clinical practice

• ME 5.2. Adopt strategies that promote patient safety and address human and system factors

• COM 3.1. Convey information related to the patient’s status, care, and needs in a timely, honest, and transparent manner

• COM 3.2. Communicate the reasons for unanticipated clinical outcomes to patients and disclose patient safety incidents

• COM 5.1. Document clinical encounters to adequately convey clinical reasoning and the rationale for decisions

• COL 1.3. Communicate with the health care team using closed loop communication and clear language

• L 4.2. Assume a leadership role, and delegate tasks and responsibilities in an appropriate and respectful manner

• S 1.2. Keep a log of difficult airway cases and include techniques and airway adjuncts to guide future required learning experiences

• P 2.1. Demonstrate a commitment to maintaining and enhancing competence

• P 4.1. Demonstrate the ability to remain calm and professional in stressful situations

Context Variables

No context variables defined.

Requirements

• Direct observation by supervisor
• Form collects information on:
• Location: OR; ICU; ward; ER
• Age:
• Airway issue [select all that apply]: anticipated difficult BMV; unanticipated difficult BMV; anticipated difficult intubation; unanticipated difficult intubation; airway foreign body; other airway issue
• Type of airway management technique [select all that apply]: fiberoptic; direct laryngoscopy; video laryngoscopy; adjunct airway use; other management technique
• Extubation plans observed: yes; no
• Collect observations from a large breadth of both anticipated and unanticipated difficult airway with the expectations not all will be achieved, with a minimum of six (6) observations of achievement