CCT in Anaesthetics - Core Level Training

Published: 14/08/2019

Airway management

Core airway knowledge and skills have also been included within the first six months “Basis of Anaesthetic Practice” section. Those competencies are repeated here in a standalone airway section, designed to reflect the fundamental importance of airway knowledge and skills to the novice Anaesthetist.

Core clinical learning outcomes

  • Able to predict difficulty with an airway at preoperative assessment and obtain appropriate help
  • Able to maintain an airway and provide definitive airway management as part of emergency resuscitation
  • Demonstrates the safe management of the can’t intubate can’t ventilate scenario
  • Maintains anaesthesia in a spontaneously breathing patient via a facemask for a short surgical procedure [less than 30 mins]

NB: All competencies annotated with the letter ‘E’ can be examined in any of the components of the Primary examination identified in the FRCA examination blueprint on page B-99 or in the Final examination identified in the Final FRCA blueprint on page C72 of Annex C.

Knowledge

Competence

Description

Assessment

Methods

GMP

AM_BK_01

Explains the methods commonly used for assessing the airway to predict difficulty with tracheal intubation

[Ref; OA_BK_05]

A,C,E

1,2

AM_BK_02

Describes the effect of pre-oxygenation and knows the correct technique for its use [Cross Ref;induction of GA]

A,C,D,E

1,2

AM_BK_03

Describes the principles of management of the airway including techniques to keep the airway open and the use of facemasks, oral and nasopharyngeal airways and laryngeal mask airways [Cross Ref; induction of GA]

A,C,D,E

1,2

AM_BK_04

Explains the technique of inhalational induction and describes the advantages and disadvantages of the technique. [Cross Ref; induction of GA]

A,C,D,E

1,2

AM_BK_05

Knows the factors influencing the choice between agents for inhalational induction of anaesthesia [Cross Ref; induction of

GA]

A,C,D,E

1,2

AM_BK_06

In respect of tracheal intubation:

  • Lists its indications 
  • Lists the available types of tracheal tube and identifies their applications
  • Explains how to choose the correct size and length of tracheal tube
  • Explains the advantages/disadvantages of different types the laryngoscopes and blades including, but not exclusively, the Macintosh and McCoy
  • Outlines how to confirm correct placement of a tracheal tube and knows how to identify the complications of intubation including endobronchial and oesophageal intubation
  • Discusses the methods available to manage difficult intubation and failed intubation
  • Explains how to identify patients who are at increased risk of regurgitation and pulmonary aspiration and knows the measures that minimise the risk
  • Understands the airway management in a patient with acute illness who is at risk of gastric reflux
  • Categorises the signs of pulmonary aspiration and the methods for its emergency management  [ Cross Ref;induction of GA; emergency surgery]

A,C,D,E

1,2

AM_BK_07

In respect of restoring spontaneous respiration and maintaining the airway at the end of surgery:

  • Explains how to remove the tracheal tube and describes the associated problems and complications
  • Recalls/describes how to manage laryngospasm at extubation
  • Recalls/lists the reasons why the patient may not breathe adequately at the end of surgery
  • Recalls/identifies how to distinguish between the possible causes of apnoea
  • Lists the possible causes of postoperative cyanosis
  • Understands how to evaluate neuro-muscular block with the nerve stimulator [Cross Ref; post-operative]
   
AM_BK_08

With respect to oxygen therapy:

  • Lists its indications 
  • Knows the techniques for oxygen therapy and the performance characteristics of available devices
  • Describes the correct prescribing of oxygen
  • Recalls/explains the causes and management of stridor [Cross Ref; post-operative]
   
AM_BK_09 Discusses the indications for RSI [Cross Ref; intra-operative]     
AM_BK_10 Describes the care of the airway in an unconscious patient in the recovery room, including safe positioning [Cross Ref; postoperative]    
AM_BK_11

Lists advantages and disadvantages of different techniques for airway management during resuscitation, including but not limited to:

  • Oro and nasopharyngeal airways
  • Laryngeal Mask type supraglottic airways including but not limited to: LMA, Proseal, LMA supreme, iGel
  • Tracheal intubation [Cross Ref; management of respiratory and cardiac arrest]
   
AM_BK_12

Compares the methods by which ventilation can be maintained in a patient suffering a respiratory or cardiac arrest, using:

  • Mouth to mask
  • Self-inflating bag
  • Anaesthetic breathing system
  • Mechanical ventilator [Cross Ref; management of respiratory and cardiac arrest]
   
AM_BK_13 Discusses the different types of laryngoscope blades available in routine practice and the indications for their use    
AM_BK_14 Outlines the advantages/disadvantages and reasons for development of new laryngoscopes [e.g. glidescope]    
AM_BK_15 Outlines the indications for fibre-optic intubation and how awake intubation may be achieved    
AM_BK_16 Describes the management of the ‘can’t intubate, can’t ventilate’ scenario    
AM_BK_17 Describes the principles of, and indications for, the use of needle crycothyrotomy and manual jet ventilation    
Skills

Competence

Description

Assessment

Methods

GMP

AM_BS_01

Demonstrates satisfactory proficiency in performing a relevant clinical examination and assessment of the airway and dentition [Cross Ref; intra-operative]

A,D,E

1

AM_BS_02

Identifies normal appearances and significant abnormalities in radiographs including:

  • Cervical spine, chest 
  • Head CT and MRI showing clear abnormalities relevant to the airway [Cross Ref; intra-operative]

A,C,E

1

AM_BS_03

Reliably predicts the level of supervision they will require [Cross Ref; intra-operative]

A, C,E

1

AM_BS_04

Demonstrates effective pre-oxygenation, including correct use of the mask, head position and clear explanation to the patient [Cross Ref; induction of GA]

A,D

1,2,3

AM_BS_05

In respect of airway management:

  • Demonstrates optimal patient position for airway management, including  head tilt, chin lift, jaw thrust
  • Manages airway with mask and oral/nasopharyngeal airways
  • Demonstrates hand ventilation with bag and mask [including self- inflating bag]
  • Able to insert and confirm placement of a Laryngeal Mask Airway
  • Demonstrates correct head positioning, direct laryngoscopy and successful nasal/oral intubation techniques and confirms correct tracheal tube placement
  • Demonstrates proper use of bougies 
  • Demonstrates correct securing and protection of LMAs/tracheal tubes during movement, positioning and transfer
  • Correctly conducts RSI sequence 
  • Correctly demonstrates the technique of cricoid pressure 

 [Cross Ref; management of respiratory and cardiac arrest; induction of GA]

A,D

1,2,3

AM_BS_06

Demonstrates correct use of advanced airway techniques including but not limited to Proseal, LMA supreme, iGel

[Cross Ref; management of respiratory and cardiac arrest]

D,S

1,2

AM_BS_07

In respect of inhalational induction of anaesthesia:

  • Satisfactorily communicates with the patient during induction
  • Satisfactorily conducts induction [Cross Ref; induction of GA]

A,D

1,2,3

AM_BS_08

Demonstrates the ability to maintain anaesthesia with a face mask in the spontaneously breathing patient

[Cross Ref; intra-operative]

A,D

1,2

AM_BS_09

Demonstrates failed intubation drill [Cross Ref; induction of GA]

D,S

1,2

AM_BS_10

Demonstrates management of ‘can’t intubate, can’t ventilate’ scenario [Cross Ref; critical incidents]

D,S

1,2

AM_BS_11

Demonstrates correct use of oropharyngeal, laryngeal and tracheal suctioning [Cross Ref; induction of GA]

A,D

1,2

AM_BS_12

Demonstrate appropriate management of tracheal extubation, including;

  • Assessment of return of protective reflexes
  • Assessment of adequacy of ventilation 
  • Safe practice in the presence of a potentially full stomach [Cross Ref; postoperative]

A,D

1

AM_BS_13

Demonstrates how to turn a patient into the recovery position [Cross Ref; postoperative]

A,D

1

AM_BS_14

Demonstrates small and large bore needle cricothyrotomy and manual jet ventilation 

D,S

1,2

AM_BS_15

Demonstrates surgical cricothyrotomy 

D,S

1,2