Pre-hospital Emergency Anaesthesia SOP

Question 1

Summarise the PHEA SOP

Answer 1

All clinical staff

Indications
Patient assessment
Role Allocation
Positioning and preparation
Optimisation and pre-O2
Pharmacology
Intubation
Failed intubation
Transport and maintenance
Paediatric anaesthesia

Question 2

What are the indications for PHEA?

Answer 2

Airway compromise
Ventilatory compromise
Unconsciousness
Severe unmanageable agitation
Humanitarian reasons
Anticipated clinical course

Question 3

What patient factors need to be considered when planning PHEA?

Answer 3

Difficult airway
Injuries and Pathophysiology
PMH

Question 4

Describe the particular elements of role allocation in relation to PHEA

Answer 4

• Two person LNAA team, doctor and para
• Most experienced in drug-assisted intubation
• Other clinician does the kit dump, preparing the drugs and managing scene
• Brief at the start of the shift
• Consider roles in the flash team

Question 5

Describe the positioning and preparation of a patient for PHEA

Answer 5

On the trolley +/- scoop
360 access
Balance patient condition and environment
Optimise eye to glottis, ear to sternal notch

Kit dump and monitor on the right
Remove collar and add MILS
Two IVA with fluids
AAGBI Monitoring consider A. line

Question 6

What interventions may be required for optimisation prior to PHEA?

Answer 6

• Decompression of PTXs
• Volume resus
• Haemorrhage control
• Use of vasopressors

Question 7

How can a patient requiring PHEA be preoxygenated?

Answer 7

Patent airway with BVM/NRB with 15L
Use apO2
May need sedation

Question 8

What drugs are used in PHEA? What modifications would you make to your PHEA drugs?

Answer 8

Fent 500mcg/10ml vials
Ket 200mg/20ml PFS
Roc 50mg/5ml vials

3:2:1/1:2:1

Omit Fent if profoundly hypovolaemic
Consider Midaz if cardiac (1-5mg)

Question 9

Describe the process of intubation during PHEA

Answer 9

Maximise FPS

1. Checklist (Immediate if required)
2. First attempt +/- circoid
3. If challenging or unsuccessful, go for 30 second drills
4. Confirm with colorimetric and waveform CO2 following by normal signs of placement
5. Note length and tie

Question 10

What are the 30 second drills during difficult PHEA?

Answer 10

• Remove cricoid
• BURP
• Change position
• Suction
• Insert blade to maximum then withdraw
• Change kit
• Change operator

Question 11

What are your considerations when packaging a patient post PHEA?

Answer 11

A and B: ventilator settings
C: Location of IVA, infusins
D: Monitor for awareness and maintain paralysis/anaesthesia
E: temperature monitoring and management