Anesthesia — Foundation of Discipline

F4 Identifying patients presenting with an anticipated difficult airway and preparing for management options

- This EPA includes:
▪ Identifying patients with an anticipated difficult airway
▪ 4 categories of anticipated difficulties: bag mask ventilation,
intubation, supraglottic airway, front of neck access (FONA)
▪ Discussing risks with the patient and obtaining informed consent
▪ Planning management options; this must include plans for ventilation and
oxygenation, and anticipated plans for safe extubation and postoperative
management. It should also include having at least plan A and plan B. ▪ Preparation of the operating room and equipment
- This EPA may be observed in adults and children.
Relation with other EPAs: This EPA does not include managing the airway – this will be observed in Core EPA « managing patients presenting with an anticipated difficult airway» Some observations of the Core EPA on doing a difficult intubation might happen in Foundations.

Form

F1: Observation

Milestones

• ME 1.3. Apply knowledge of airway anatomy and physiology

• ME 1.3. Apply knowledge of the indications, contraindications, basic pharmacology and risks of sedation during airway management

• ME 1.4. Perform focused clinical assessments

• ME 2.2. Synthesize clinical data to identify patients with the potential for a
  difficult airway and/or bag mask ventilation

• ME 1.4. Recognize urgent problems that may need the involvement of more
  experienced colleagues and seek their assistance

• ME 1.3. Apply knowledge of the criteria for a safe extubation

• ME 1.3. Apply knowledge of difficult airway management algorithms and cognitive aids

• ME 1.3. Apply knowledge of the indications, contraindications, risks and alternatives for the different airway management tools

• ME 1.3. Apply knowledge of the differences between adult and pediatric difficult airway management

• ME 2.4. Develop an airway management plan, and alternatives, for patients with an anticipated difficult airway

• ME 3.2. Ensure that the patient and family are informed about the risks and benefits of each treatment option in the context of best evidence and guidelines

• ME 3.2. Obtain and properly document informed consent for commonly performed anesthesia procedures and therapies

• ME 3.4. Prepare equipment and supplies for airway management

• ME 3.3. Consider urgency, and potential for deterioration, in advocating for the
  timely execution of a procedure or therapy

• COM 1.2. Optimize the physical environment for patient comfort, privacy, engagement, and safety

• COM 5.1. Document information about the airway difficulty in a manner that enhances intra- and inter-professional care

• COL 1.1. Respect established rules of their team

• COL 2.1. Actively listen to and engage in interactions with collaborators

• L 2.2. Apply evidence and guidelines with respect to resource utilization in common clinical scenarios

• S 1.2. Identify, record, prioritize and answer learning needs that arise in daily work, scanning the literature or attending formal or informal education sessions

• P 2.2. Demonstrate a commitment to patient safety and quality improvement through adherence to institutional policies and procedures

Context Variables

• Age (free-text)
• Type of airway management technique planned (free-text)

Requirements

• Collect a minimum of 5 observations (minimum 5)