The Pre-brief
Airway management is arguably one of the most exciting aspects of emergency and critical care education. It’s exciting for the learner because they are FINALLY INTUBATING!!!!!! It’s exciting for educators, too, but more in the way that riding a roller coaster in the dark is exciting – I CAN’T SEE ANYTHING AND I REALLY HOPE NO ONE DIES!!!! Below, I’m sharing a method I’ve used to teach emergency airway management which has significantly decreased both learner and teacher anxiety levels during the transition to real-life intubations.
As with most procedures, preparation is key to success in emergent airway management. As I mentioned in this post, practice in a simulation center should typically be the first step in teaching learners how to intubate, as they can begin to establish motor memory for the basics of using a blade and passing an endotracheal tube. However, it can be a big leap for learners to go from intubating a manikin head in the sim center to doing it in the hospital.
I recommend offering learners the opportunity to practice intubation in situ, that is, in the area of the hospital where they will actually be intubating patients. This is the learner’s opportunity to intubate a manikin with the ambient noise, lighting, etc that they will experience in reality, but more importantly, it allows them to learn how to prepare and set up for the intubation in a more realistic setting. Hopefully, your sim center allows you to take intubation task managers (the intubating heads) to the clinical setting, but if not, now’s a great time to request funding from your program for this valuable educational session! Having access to your own airway manikin gives you the flexibility to practice intubation at any time in the setting of your choice.
I can’t overstate the importance of having the learner find and turn on suction, attach an end-tidal CO2 monitor, locate and assemble the BVM, and so on. Remember that even things that seem intuitive to you as an expert will likely be new information to your learner – ask them to find the airway supplies, show you how to plug in the video laryngoscope, and tell you how they would obtain RSI medications in your practice setting. This will also give the learner a more in-depth understanding of exactly which tools, adjuncts, and support staff are available during an emergent intubation. Merging the procedural skill of intubating with environmental awareness and preparation skills will increase the confidence of your learner, and the success of real-life intubations.
Additionally, learners benefit the most from these sessions if you have the ability (essentially the educators and time) to offer the sessions one-on-one rather than in a group of learners with one teacher. learners are much more comfortable making mistakes and asking a “dumb question” when they aren’t worried about their peers watching them. This also allows you to personalize the session to your learner. Are they already comfortable with direct laryngoscopy because they had a previous life as an EMT? Great, move right on to video laryngoscopy! Working one-on-one, or at least in very small groups, really allows learners to direct their own education in these sessions.
The Debrief
Consider adding one-on-one in situ airway management sessions to your teaching arsenal to improve the effectiveness of your education, increase the confidence and success of your learners, and decrease your educator excitement level during their first real-life intubation!
