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“Dirty Laundry” of Airway Management

“Dirty Laundry” of Airway Management. Ashley Grace Piper SRNA. Dec. 7, 1941. Airway ^. OBJECTIVE. Review the design and results of… ASA Closed Claims Project NAP4 Project. ASA Closed Claims Project: DESIGN.

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“Dirty Laundry” of Airway Management

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  1. “Dirty Laundry” of Airway Management Ashley Grace Piper SRNA

  2. Dec. 7, 1941 Airway ^

  3. OBJECTIVE Review the design and results of… • ASA Closed Claims Project • NAP4 Project

  4. ASA Closed Claims Project:DESIGN • Examined closed claim files from 35 US professional liability insurance companies • 5,480 claims entered in the database (1961-1999) • Reviewing process: • 1+ trained/practicing MDs periodically review/collect claim files on site at each insurance company • Standardized information collection forms completed • Reviewer assigns severity score • Data forms further reviewed by a Closed Claims Project committee

  5. ASA Closed Claims Project:RESULTS

  6. ASA Closed Claims Project:RESULTS

  7. NAP4: Design Phase two: identify all cases of major complications of airway management in the same population as in phase one. NUMERATOR Phase One: census of airway management techniques used in the UK National Health Service (309 hospitals) DENOMINATOR

  8. NAP4: Results What types of airway device are used during anesthesia and how often? 30% _____ 65% ___________ 5%

  9. NAP4: Results How often do major complications, leading to serious harm, occur in association with airway management in anesthesia, in the intensive care units and in the emergency departments of the UK? 15% 2008

  10. NAP4: Results What is the nature of these events and what can we learn from them, in order to reduce their frequency and consequences? 4% 4% 39% 16% 17%

  11. NAP4: Results What is the nature of these events and what can we learn from them, in order to reduce their frequency and consequences? # of EVENTS # of annual GAs EVENTS 133 46.3 1 __________________________ _______________________________ ______________________________ _______________________ GAs 2,872,600 1,000,000 21,598

  12. NAP4: Results What is the nature of these events and what can we learn from them, in order to reduce their frequency and consequences? 18% 41% 33% 8% 18% 25% 50% 7% !?!?!?! 15% 21% 53% 11%

  13. NAP4: Results What is the nature of these events and what can we learn from them, in order to reduce their frequency and consequences? Clinical Themes & Recommendations: • Anesthesia induction and maintenance • End of anesthesia and recovery • Airway devices • Management of the CVCI situation • Fiberoptic intubation • Obesity • Pediatrics • Obstetrics

  14. Anesthesia Induction and Maintenance

  15. End of Anesthesia & Recovery

  16. Airway Devices: SADs

  17. Airway Devices: Tracheal intubation

  18. Management of the CVCI situation

  19. Fiberoptic Intubation

  20. Obesity

  21. Pediatrics

  22. Obstetrics

  23. “There is one skill above all else that an anesthetist is expected to exhibit and that is to maintain the airway impeccably” M Rosen, IP Latto 1984

  24. In short…. Questions/Comments References available upon request

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