Implementation tool for airway Mx by @NicholasChrimes. Addresses human factors considerations to facilitate real time use by teams during a crisis.
Australia
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This video demonstrates how this might look in real-time during an airway crisis. The staff already know one another so names/roles aren't declared.
Note slightly different Vortex terminology in this era (optimal attempt = best effort, ESA status = Priming Status)
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When help arrives at an airway emergency the responsibility to communicate key information is shared by both the operator & arriving help - but the help may be better cognitively placed to ensure this occurs.
Actively seek the following info when attending an airway crisis.
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A 'best effort' at any upper airway lifeline (FM, SGA, TT) should incl an attempt with full NM blockade
Intubation wout NMB ⬆️ trauma & ⬇️ success
NMB ⬆️ success w FM & SGA
NMB also provides optimal conditions for neck rescue
vortexapproach.org/lifelines…
sciencedirect.com/science/ar…
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"Sniffing position" = BOTH base of neck flexion & AO extension (=> #Flextension per @doctimcook)
Torso elevation helps ⬆️ FRC, ease of PPV & may be necessary to achieve flextension if high BMI.
Ramping = flextension + torso elev
vortexapproach.org/lifelines…
sciencedirect.com/science/ar…
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A 'best effort' at facemask ventilation should always include a 2-handed attempt using "vice grip".
vortexapproach.org/lifelines…
sciencedirect.com/science/ar…
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'Priming' refers to escalations in readiness to perform neck rescue undertaken BEFORE a neck rescue emergency arises, to minimise delays to restoring O2 delivery.
Priming status tool provides a structured approach to this.
sciencedirect.com/science/ar…
VortexApproach.org/cico#cico…
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The Vortex airway rescue cart integrates presentation of equip w the Vortex so that it becomes an extension of the cognitive aid, prompting performance.
More info on HF based airway carts in @Anaes_Journal:
associationofanaesthetists-p…
Create your own free:
VortexApproach.org/airwaycar…
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Turning a plan into a strategy requires repeatedly asking "What is the plan if that plan fails?"
Each component plan in the strategy should address optimising lifelines, degree of priming for neck rescue & appropriate actions if the Green Zone is entered
vortexapproach.org/planning
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Inability to intubate is an inconvenience. Inability to ventilate is a crisis.
Repeated airway instrumentation can convert a "can ventilate" situ into a "can't ventilate" situ.
When ventilation is possible, use the opportunities of the Green Zone before reinstrumenting the aw.
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The key question that separates an airway 'plan' from an airway 'strategy':
"What is the plan if that plan fails?"
Keep asking yourself that question until the answer is "I would perform neck rescue".
Then you have a strategy.
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Also thanks to Phil Cohen & the GP Anaesthetists of the ‘Rural Anaesthesia Down Under Facebook Group’ for designing & providing the Vortex 3D model.
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An additional attempt may be allowed in rare circumstances where it introduces “gamechanger”optimisations, considered to have a profound impact on the likelihood of success at the relevant lifeline, that were unable to be introduced within the 3 attempt limit.
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The Vortex Airway Rescue Cart: 3 key features.
1. Dedicated airway rescue cart
2. Icons & layout integrated with Vortex cognitive tool
3. Visual cues for non-equipment interventions during airway rescue
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The ARA simulation unit (ARASIM) in Rosario, Argentina is training the city's anesthesiologists in human factors aspects of managing anaesthetic crises using the @VortexApproach, incl distributing Vortex airway trolleys to public hospitals in the region.
ararosario.com.ar
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Vortex Approach airway rescue carts & education being rolled out at 70 public hospitals as part of major airway safety initiative in Buenos Aires
Amazing program presented at #CLASA2019. Asociación de Anestesia Analgesia y Reanimación de Buenos Aires are funding @VortexApproach training & airway carts to 70 public hospitals. Rolled out to 11 hospitals so far. Collecting airway morbidity/mortality data pre/post intervention
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Places selling fast for the @VortexApproach workshop with @NicholasChrimes & @DrGivasHit at @WAMM_2019. Don’t miss out.
Book now at confpartners.eventsair.com/w…
Register for conference at wamm2019.com
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The updated completely text-free version of the @VortexApproach presented by @NicholasChrimes at #ACGlasgow19
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Vortex Tool now available in Chinese (with thanks to Kenjo Ho).
This and other non-English Vortex resources available at:
🌐 vortexapproach.org/downloads
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#VortexPics
The @ANZCA team w the #3Dprinted @VortexApproach model.
@lowebrad @notjustairway @hypoxicchicken @NicholasChrimes
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Have you been photographed w the #3Dprinted @VortexApproach model yet? The @dasairway crew have.
@dr_imranahmad @ProfEllenO @AndyHiggsGAA
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Vortex & CICO Status Tools now available in Japanese (with thanks to Takesi Naito).
This and many other foreign language versions available at vortexapproach.org/downloads
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Cognitive Aids
Interactive Training Program
Training App
3D printable CICO rescue trainer
Videos
Instructions & Lables for Airway Cart
...& a multitude of other resources.
🌐 All available free at VortexApproach.org
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Updated #GreenZone Tool features simplified opportunities when the Green Zone is entered:
1. Optimise
2. Strategise
3. Mobilise
🌐 vortexapproach.org/greenzone
(with thanks to @DrGivasHit & Dr Oliver Hambidge)
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To get hands-on experience of the impact of these features of the @VortexApproach on team dynamics during airway management, register for the Vortex Workshop at @ANZCA #ASM19KL.
Registration now open at asm.anzca.edu.au/
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For anyone wanting to highlight the location of particular airway devices, additional icons for direct laryngoscope, videolaryngoscope and endoscope - as well as one to locate the airway cart itself - are now available for free download at VortexApproach.org/downloads…
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Once you've set up your Vortex Emergency Airway Cart use this signage to make sure staff can locate it easily. Download with a variety of text captions or text free at vortexapproach.org/downloads…
More info on the cart at vortexapproach.org/airwaycar…
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#CICOstatus creates a team based approach to #priming by linking defined escalations in readiness for #CICOrescue to specific events in the management of the upper airway & using #CriticalLanguage to communicate these clearly & efficiently.
vortexapproach.org/cico/#cic…
#EA18
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The opportunities of the #GreenZone:
Oxygenate
Assemble Resources
Develop a Strategy
vortexapproach.org/greenzone…
#EA18
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For more information on the @VortexApproach including concepts of #Priming, #GreenZone, #BestEffort & #CriticalLanguage visit VortexApproach.org
Free graphics, videos, education program & more.
#EA18
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Vortex Emergency Airway Cart
Concept & Contents
VortexApproach.org/AirwayCar…
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New @dasairway @FICMNews @ICS_updates @RCoANews National Guidelines for management of tracheal intubation in critically ill adults - incorporating the @VortexApproach!
bjanaesthesia.org/article/S0…
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Taking the #CICOstatus to ‘SET’ allows #CICOrescue to be initiated with #ZeroLatency if it is required.
VortexApproach.org/cicostatu…
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Vortex Training App - Updated with V2 terminology/graphics. Now available for iPhone. Download free from the app store to train your team.
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It's time to #Inspire your airway team.
Free online training program for the @VortexApproach now available at VortexApproach.org
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How well do you understand the 'Best Effort' concept? Take the quiz & find out.
Part of the #Inspire program.
vortexapproach.typeform.com/…
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#SAM2017 @NicholasChrimes: Vortex #CICOrescue trainer has neck & larynx components - realistic anatomy incl chin. Total printing cost ~$25
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#SAM2017 @NicholasChrimes: Shoutout to @ketaminh @TessaRDavis & @pzfritz for help in developing the #VortexApp - new iPhone version out soon
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#SAM2017 @NicholasChrimes: Inspire program includes 3D printable #CICOrescue trainer thanks to @edexam.
Download at thingiverse.com/thing:253047…
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#SAM2017 @NicholasChrimes launches Inspire Training Program for @VortexApproach.
Access via training link at
VortexApproach.org
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A "Best Effort" at any lifeline may involve up to 3 attempts
+1 extra in the unusual situation of a "Gamechanger"
vortexapproach.org/lifelines…
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Updated CICO Status tool visually reinforces link between descent into Vortex & priming for #CICOrescue.
vortexapproach.org/cico/#cic…
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Is your BVM delivering an FiO2 of only 30%?
vimeo.com/177780434
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Vortex in Polish courtesy Mateusz Zawadka & Pawel Andruszkiewicz
CICO Status in French by @JCOzenne
Thank you!
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How does the Vortex Approach differ from other airway management resources?
VortexApproach.org
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What is it about the Vortex that compels people to build one?
That’s the power of conceptual imprinting.
vortexapproach.org
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Labels & @VortexApproach cognitive aid available for free download at vortexapproach.org/downloads…
#RCoAWinter
@NicholasChrimes
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Clinical Integration: use Vortex iconography to label equipment in the clinical environment.
#RCoAWinter
@NicholasChrimes
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Less than 2 weeks to #RoCAWinter Symposium.
Controversies in preoperative practice - incl @NicholasChrimes presenting the @VortexApproach
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Make use of opportunities in the Green Zone:
1. Reoxygenate
2. Assemble resources
3. Develop a strategy.
vortexapproach.org/greenzone…
.
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The Vortex being presented by @NicholasChrimes at #RCoAWinter Symposium London Nov 24-25th
rcoa.ac.uk/education-and-eve…
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Whatever your preferred term for #CICORescue, make sure your team can find equip by labelling it w universal icon
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Universal airway tool:
Context independent
Specialty independent
Language independent
vortexapproach.org/downloads…
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Free full text of @VortexApproach article in @BJAJournals
bja.oxfordjournals.org/conte…
@NicholasChrimes
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Vortex, CICO Status & Green Zone Tool - now all available en Español.
VortexApproach.org/downloads
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German version of @VortexApproach implementation tool thanks to @jgollw
vortexapproach.org/downloads…
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The Oxygenation Continuum: relationship bw @VortexApproach & techs to incr safe apnoea time
vortexapproach.org/safeapnoe…
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#Vortexify your clinical environment
Download tools, labels & icons from VortexApproach.org
#VortexReloaded
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.@NicholasChrimes: clinicians relate to the #Vortex bc it articulates the way many already think.
#CSC2015 @pzfritz
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"You got to know when to hold 'em
Know when to fold 'em
Know when to walk away
And know when to run"
@_KennyRogers
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Vortex Training App is available for free download at:
appsto.re/us/dmlB6.i
iOS only
iPad only
@jcsteynberg
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Whereas algorithms are advance instructions of "what to do", Vortex is a real time check of "have you done?"
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Love it, hate it or never heard of it - be there 14:00, Room A4 when @NicholasChrimes brings the Vortex to #ESABerlin
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Train your clinical team using the #VortexApproach Training App. Free in the App Store
appsto.re/us/dmlB6.i
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If you love airways, iPads, education & the Vortex, this will make your day...
appsto.re/us/dmlB6.i
#VortexApp
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Download the #VortexApp for iPad & train your team to Mx airways using the #VortexApproach
appsto.re/us/dmlB6.i
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#VortexApp is now available in the App Store worldwide - but is only for iPad. appsto.re/us/dmlB6.i
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Train your team to use the #VortexApproach. #VortexApp available now free in the App Store.
appsto.re/us/dmlB6.i
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#VortexApproach overview by @NicholasChrimes & Mac 3 vs 4 challenge w @ketaminh - from #smaccGOLD airway workshop
youtu.be/oWnHw1O_bjE
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3 strikes, you're out! ESA Status to GO. Declare CICO, perform emergency surgical airway.
#VortexApproach #VortexApp
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2 Strikes on the #VortexApproach - ESA Status to SET
#VortexApp
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Use #VortexApp for iPad to train your team to use the #VortexApproach. Free soon in the App Store
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