The Vortex Approach: Management of the Unanticipated Difficult Airway

The Vortex Approach: Management of the

Unanticipated Difficult Airway

By Nicholas Chrimes & Peter Fritz

Smashwords Edition

Copyright Nicholas Chrimes 2013.

Smashwords Edition License Notes

Although this is a free e-book, it remains the copyrighted property of the authors, and may not be reproduced, copied or distributed for commercial or non-commercial purposes. If you found this e-book interesting please encourage your friends to download their own free copy. Thank you for your support.

To view other resources relataing to the Vortex approach including a narrated presentation and videos of the Vortex being used in clinical practice, go to vortexapproach.com

Comments by Senior Critical Care Physicians on the Vortex Approach

I see the Vortex model as an advance on the current unidirectional algorithms advocated for difficult airway management – Dr Mark Adams: Director of Anaesthesia, Monash Medical Centre

The Vortex describes the way I already think about difficult airway management but articulates it in a way that can be easily communicated to others – Dr Craig Walker: Director of Intensive Care, Monash Medical Centre

The Vortex is a simple way to ensure that when bad things could happen in a critical situation, the operator is given permission to return to the last safest step, reassess and 'take their own pulse' – Professor George Braitberg: Professor of Emergency Medicine, Southern Clinical School, Monash University; Director of Emergency Medicine, Southern Health

The Vortex approach describes the difficult airway as we teach it - carefully forward with a planned escape route – Dr John Monagle: Director of Anaesthesia, Southern Health; (Acting) Medical Director Critical Care Program, Southern Health

Contents

Terminology

Introduction

Goals of Airway Management

The Unanticipated Difficult Airway

Overview of the Vortex Approach

Use of the Vortex

Features of the Vortex

Emergency Surgical Airway

Facilitating an Optimal Attempt to Achieve Airway Patency

Assessing Airway Patency

Airway Training Programs

Conclusion

Glossary

Acknowledgements

About the Authors

Other Publications by these Authors

Monash Simulation

Clinical Cred

References

Terminology

One of the challenges in discussing difficult airway management is that the precise meaning of even commonly used terms such as ‘apnoea’, ‘ventilation’, ‘oxygenation’, ‘surgical airway’ and even difficult airway itself, are subject to varying interpretation by different clinicians. The intended definitions of the key terms, as they are used in the following text, are listed in the glossary at the end of the text.

Introduction

In emergency situations, established clinical protocols are intended to help avoid fixation, facilitate teamwork and help ensure that time critical management options are not delayed or overlooked. Observations in both clinical & simulated settings, however, demonstrate that adherence to a guideline or protocol may be compromised in situations that are stressful and time pressured. This demonstrates the need for emergency guidelines to be as simple as possible so that they can be recalled and implemented effectively in a crisis situation. It is also crucial that knowledge of the appropriate protocol is shared by all members of the team, to enable them to anticipate treatment priorities or to prompt the group if the performance of an individual becomes compromised [1]. The Advanced Cardiac Life Support (ACLS) guidelines for management of cardiac arrest [2] are probably the best known example of this, and have adopted the principle of creating a simple standardised protocol, applicable to all cardiac arrest situations and teaching it universally to all staff expected to be involved in this aspect of patient care.

Developing emergency guidelines for difficult airway management presents some unique challenges. Unlike cardiac arrest,