Critical Care Medicine — Core of Discipline

C4 Performing Procedures: Airway management

Key features:
- This EPA focuses on determining which procedures are necessary and appropriate to the patient’s condition, and performing the following procedures required for the care of complex or unstable patients, including bag-mask ventilation (BMV) with oropharyngeal airway (OPA); bronchoscopy (excluding fibreoptic intubation);
intubation in simple/stable and complex/unstable settings; cricothyroidotomy.
- This EPA may be observed in clinical or simulation settings.

Assessment Plan:
Direct observation by staff physician, or TTP resident
Use Form 2. Form collects information on:
- Procedure (select all that apply): OPA; BVM; intubation; bronchoscopy; cricothyrotomy
- Complex/unstable scenario: yes; no
- Setting: clinical; simulation
Collect 11 observations of achievement
- At least 1 BVM with OPA insertion in a clinical setting
- At least 3 complex/unstable intubations in a clinical setting
- At least 1 non-complex/stable intubation in a clinical setting
- At least 4 bronchoscopies in a clinical setting
- At least 1 cricothyroidotomy (simulation acceptable)
- At least 3 different staff physician observers

Form

F2: Procedure

Milestones

• ME 3.1. Preprocedure plan: Gather/assess required information to reach diagnosis and determine correct procedure required

• ME 3.4. Case preparation: Patient correctly prepared and positioned, understands approach and required instruments, prepared to deal with probable complications

• ME 1.3. Knowledge of specific procedural steps: Understands steps of procedure, potential risks, and means to avoid/overcome them

• ME 3.4. Technical performance: Efficiently performs steps, avoiding pitfalls and respecting soft tissues

• ME 3.4. Visuospatial skills: 3D spatial orientation and able to position instruments/hardware where intended

• ME 3.4. Efficiency and flow: Obvious planned course of procedure with economy of movement and flow

• ME 3.4. Postprocedure plan: Appropriate complete post procedure plan

• COL 1.3. Professional and effective communication/utilization of staff

Context Variables

• Procedure (select all that apply) (multiple-choice)
  • BVM
  • OPA
  • intubation
  • bronchoscopy
  • cricothyrotomy
• Complex/unstable scenario (single-choice)
  • No
  • Yes
• Setting (single-choice)
  • Clinical
  • Simulation

Requirements

• Collect 11 observations of achievement (minimum 11)
• At least 1 BVM with OPA insertion in a clinical setting (minimum 1)
  • Only counts when Procedure (select all that apply) is BVM
  • Only counts when Procedure (select all that apply) is OPA
  • Only counts when Setting is Clinical
• At least 3 complex/unstable intubations in a clinical setting (minimum 3)
  • Only counts when Procedure (select all that apply) is intubation
  • Only counts when Complex/unstable scenario is Yes
  • Only counts when Setting is Clinical
• At least 1 non-complex/stable intubation in a clinical setting (minimum 1)
  • Only counts when Procedure (select all that apply) is intubation
  • Only counts when Complex/unstable scenario is No
  • Only counts when Setting is Clinical
• At least 4 bronchoscopies in a clinical setting (minimum 4)
  • Only counts when Procedure (select all that apply) is bronchoscopy
  • Only counts when Setting is Clinical
• At least 1 cricothyroidotomy (simulation acceptable) (minimum 1)
  • Only counts when Procedure (select all that apply) is cricothyrotomy
• At least 3 different staff physician observers (minimum 3)
  • Only counts when Assessor kind is Faculty
  • Counted once per distinct Assessor