DAS 2016 LogoANNUAL SCIENTIFIC MEETING

Workshop Programme – Wednesday 22 November

Workshop timetable:

09:15-09:45   Registration
09:45-10:30   First rotation
10:30-11:15   Second rotation
11:15-11:45   Tea and coffee
11:45-12:30   Third rotation
12:30-13:15   Fourth rotation
13:15-14:15    Lunch
14:15-15:00   Fifth rotation
15:00-15:45   Sixth rotation
15:45-16:15   Tea and coffee
16:15-17:00   Seventh rotation
17:00-17:45   Eighth rotation

Delegates will rotate around 8 stations throughout the day, the stations and their descriptions are below.

Workshop stations:

1.  Virtual Endoscopy
2.  Airway Ultrasound & SALAD
3.  Videolaryngoscopy
4.  Fibreoptic Intubation via SAD
5.  Paediatric Airway
6.  Fibreoptic skills / ORSIM
7.  Awake Fibreoptic Intubation ( AFOI )
8.  Scalpel cricothyroidotomy

Objectives & learning points for each station:

1. Virtual Endoscopy:

  • Tutorial by experts on how to make 3D reconstructions and virtualendoscopy videos from head and neck CT images.

2. Airway Ultrasound & SALAD:

  • Learn how to identify airway structures on live models, as demonstrated by expert faculty

3. Videolaryngoscopy:

  • Compare to Macintosh blade for direct laryngoscopy
  • Experience all the different classes of videolaryngoscopes available
  • Unique features and techniques for intubation demonstrated
    • Unchannelled:
      Glidescope
      C-Mac
      APA
      McGrath
    • Channelled
      Airtraq
      KingVision
      APA
    • Stylets:
      Bonfils
      Levitan

4. Fibreoptic Intubation via SAD:

(a) 2nd generation SADs: insertion techniques:

  • All the latest 2nd generation SADs appropriate for Plan B in DAS algorithm
  • Discuss their advantages and disadvantages

(b) Intubating through SAD:

  • Fibreoptic assisted Intubation via SGA, 1 stage technique
  • Fibreoptic assisted Intubation via SGA, 2 stage Aintree exchange cathetertechnique
  • Hands-on practice of intubating through various 2nd generation SGAs

5. Paediatric Airway:

  • Learn how to use equipment & techniques designed to manage thedifficult paediatric airway
  • Learn how to manage the difficult paediatric airway in a DGH setting
  • Demonstrated by experts in advanced paediatric airway management

6. Fibreoptic skills / ORSIM:

  • Develop hand eye co-ordination skills using the ORSIM bronchoscope simulator
  • Practice fibreoptic skills on airway mannequins

7. Awake Fibreoptic Intubation:

  • Importance of awake FOI
  • Sedation & topicalization techniques
  • Optimization of procedural oxygenation & position
  • Oral Vs nasal intubation
  • Railroading of ETT & overcoming impingement

8. Scalpel cricothyroidotomy:

  • Hands on training of Scalpel Bougie Tube technique on purpose built airway models
  • Discuss non-technical aspects of scalpel cricothyroidotomy

This will run as an all day course, registration at 09:00 and will run from 09:30 – 17:30

Workshops lead by Dr Andrew Baker (Torquay, UK) and Dr Kim Chishti (Plymouth, UK)

ORSIM

This workstation will allow delegates to develop their fibreoptic intubation skills. The ORSIM bronchoscopy simulator can simulate a huge variety of airway pathologies and delegates can challenge themselves to perform a fibreoptic intubation at their chosen level of difficulty. With a ratio of one ORSIM and faculty member to every two delegates it will be a very interactive session and it has been a firm favourite in the past.

Virtual Laryngoscopy

This workstation will introduce delegates to this cutting edge preassessment tool. The faculty will demonstrate how 2D CT scans can be transformed into a 3D virtual laryngoscopy and delegates will be shown how they can introduce this technique in their hospitals.

Paediatric Difficult Airway

This workstation will be run by faculty from the paediatric BEAST (Bristol Emergency Airway Simulation Training) course. It will aim to refresh the skills and knowledge required by the non-paediatric anaesthetist in managing children with a difficult airway. It will also offer the opportunity to discuss management of the emergency paediatric airway and allow delegates to familiarise themselves with current paediatric airway equipment.

Fibreoptic intubation

This station will focus on oral and nasal manikin fibreoptic intubation: Handling of the scope, awake and asleep techniques will be shown and practised discussing techniques that maximise the chances of a successful intubation. Additional discussion around sedation regimes, topical anaesthesia, manoeuvres to improve fibreoscopy and other practical tips will be delivered.

Plan A station

This station focuses on how to optimise the initial intubation attempt. Specific attention will be paid to positioning the patient using the Oxford pillow, apnoeic oxygenation techniques (THRIVE/Optiflow or “NoDesat”) and videolaryngoscopes. Delegates will get to try a broad range of videolaryngoscopes and there will be opportunity to discuss the relative merits of each device and to gain handy tips to increase success in the clinical situation.

Plan D station

This station will concentrate on the management of the CICO (“can’t intubate, can’t oxygenate”) situation: How to make the transition from supraglottic to front of neck access to the airway and how to perform the scalpel techniques outlined in the 2015 DAS guidelines. The difference in technique depending on whether airway anatomy is palpable or impalpable will be explained and delegates will then rehearse the techniques on CricTrainers.

Nasendoscopy

Nasendoscopy has an expanding role as an airway assessment tool in both the emergency and elective situation. An experienced faculty will demonstrate the technique using live models then delegates will get the opportunity to practice their skills on manikin heads.

Ultrasound in Airway Management

Delegates will have the opportunity to develop their ultrasound skills on live models under the supervision of an expert faculty. Delegates will be taught how to identify airway structures, identify normal lung movement, and assess gastric contents.

This will run as an all day course.  Registration 09:00 and will run from 09:30 – 17:30.

CICO, Royal Perth Hospital Approach workshop  – lead by Dr Richard Hughes (Torquay, UK)

The 2015 DAS guidelines have drawn attention to the need for practical training for all anaesthetists in techniques for front of neck access. In clinical practice, “can’t intubate, can’t oxygenate” scenarios are rare events, but as an anaesthetist you are expected to have the skills and ability to manage them. This course provides an opportunity to practice the motor skills and learn about the practical problems inherent in surgical airway techniques, including safe jet ventilation. The workshop will be taught with a high ratio of 1:4 with expert faculty who regularly teach on wet lab airway courses.

The DAS Torquay 2016 half day interactive CICO airway workshop will cover the following:

1) Background talk by Dr Andrew Heard:

  1. Evolution of a CICO scenario,
  2. Supraglottic attempts at oxygenation,
  3. Transition to front of neck access
  4. Human factors in CICO situations
  5. Discussion of the 2015 DAS algorithm
  6. Pros and cons of narrow and wide bore cannulae
  7. Scalpel techniques
  8. Safe jet oxygenation strategy

2) Small group practical session to cover various front of neck procedures on cricotrainers:

  1. Narrow bore needle cricothyroidotomy
  2. Safe jet oxygenation strategy
  3. Conversion of cannula to a Melker tracheostomy using a guide wire
  4. Scalpel – bougie – tube

3) Small groups will then have an opportunity to put together the procedures practiced earlier on sheep respiratory tract specimens.

Tracheostomy safety course – lead by Dr Ben Ivory (Torquay, UK)

Displaced tracheostomy was identified by the NAP4 as the greatest cause of morbidity and mortality from airway problems in the ITU. This half day course (designed in collaboration with the CICO course) builds on the work the National Tracheostomy Safety Project using a combination of seminars and hands on sessions. It aims to provide both medical and AHP staff with the knowledge, skills and confidence to deal with the common and potentially serious problems affecting patients with tracheostomies.

The course will include:

  1. An overview of the various surgical techniques for tracheostomy and their implications for ongoing care
  2. An overview of the development and use of the NTSP algorithms
  3. Simulated scenarios addressing the practicalities of tracheostomy management
  4. Trouble shooting tips around the day-to-day management of patients with tracheostomies from experienced ITU consultants and allied health professionals

We are lucky to have a truly multi-disciplinary faculty, including Dr Brendan McGrath from the National Tracheostomy Safety Project, Mr Simon Hickey (consultant ENT surgeon) along with consultants from anaesthesia and ICU and senior members of ICU nursing and physiotherapy staff.