Harbor:Airway management team

Airway Consult (ED to Anesthesia)

• After evaluation of an airway in the ED, you may feel the airway is best handled by anesthesia or taken to the OR (angioedema, epiglottitis, know stenosis, mass, previously documented difficult airway, etc)
  • Call the anesthesiologist running the board (x65942) and request an airway consult (please do not use the words "airway backup")
    • Call the trauma surgeon (x66882) if you feel they need to be taken to the OR emergently and/or potentially need a surgical airway
  • The anesthesiologist will come to the ED to evaluate the airway and discuss a care plan with the ED attending
    • If the patient is stable, you can request the ED resident participates in the intubation attempt, but once you have relinquished management of the airway, it is up to the anesthesiology attending how to optimally manage the airway.

What Does the Airway Management Team Respond To

The airway management team is responsible FOR THE AIRWAY ONLY and will respond to:

1. All Airway Management Team Pages
2. All Code Blues (If already intubated - please check tube placement)
3. Code Whites: anesthesia responds to all Code Whites (Pediatrics may reach out to anesthesia directly as well); if someone accidentally calls for the airway management team on a day the ED is on, we will respond but hand off to the anesthesia team when they arrive.

Airway Coverage Times

ED - Sunday 7 AM to Wednesday 7 PM

• Anesthesia - Wednesday 7 PM to Sunday 7 AM
• Whoever has the pager around time of handoff will respond

Who Responds

• • Purple Attending, Purple Senior (PGY 3/4) (if available), and ED Pharmacist (if available).
  • The Purple Attending may ask the Green Attending or the Peds Attending for assistance at the Purple Attending's discretion.
  • The Purple Attending may take another senior resident (PGY 3/4) if the Purple Senior is not available.

Pager Handoff

• • Pick Up: Purple Senior gets from OR front desk at 6:50 AM on Sunday.
  • Drop Off: Purple Senior to OR front desk at 6:50 PM on Wednesday.
  • The pager cases for anesthesia (extra - not tied to phones) are in the purple doctor's box clipped to the boxes for the McGrath blades.
  • If pager is broken, need to go to Basement Pager office in arm B251, opens at 715a

Equipment

• • The airway management team bags - purple doc box in the drawers under the pager. There are two bags.
  • BVM/PPE/MAPS - plastic bags to the right of the drawers. There are two bags.
  • Please replace the ED airway tray with one from the crash cart on the floor where it was used
  • Missing or low on equipment such as McGrath blades or batteries - inform the overall charge nurse (more in nursing office)
  • PURPLE SENIOR - use the laminated checklist to stock AT EACH SHIFT CHANGE on on-call days
  • Locks let you know which compartments to check
  • ED pharmacists help with meds BUT SENIORS should double check.
  • TURN OFF McGRATH AFTER USE!
  • Can use new “GlideScope Go” with a MAC 3 & 4 blade, but bring it back. (It’s not part of bag).

Keys

• • The Purple Attending, Green Attending, Purple Senior, Green Senior and ED Pharmacist have keys to the drawers.

Medications

• Each bag in top compartment:
  • Rocuronium
  • Succinylcholine
  • Etomidate
• Pharmacy will check each day.
• Residents are also responsible for checking the medications and logging this in the log kept in the drawer for pharmacy.
• Replacement of Meds
  • Return the box to the pharmacist with a patient sticker for new box
  • If no pharmacist take used box with a patient sticker to the trauma nurse for new box

Restock and Bag Check

• • Whoever uses the bag is responsible for restocking it.
  • The bags will be checked by the Purple Senior as part of the 5S process.
  • Zip tie after restocking.
  • If zip tie is in place, no need to open

Documentation

• When you return to the ED:

1. Search for patient using magnifying glass in top right corner of Firstnet
2. Click “Ad-Hoc” button at top and complete “ED Procedures” form as usual (This will give you procedure log credit)
3. Start a new note
4. Right-click field at the top that says “Type:”
5. Choose “Document Type List” --> “Personal”
6. Choose “Rapid Response/Code Blue Records”
7. If you have not added this Document Type to your personal list, choose “Complete” to see entire list
8. Use the “.edairwayteam” autotext to add the template

See Also

• Harbor:Main