8.13
Preconfigured Pediatric Scenarios
Cannot Intubate, Cannot Ventilate
This scenario begins in the Baseline state, with the simulated patient ready for
induction of general anesthesia and tracheal intubation. After induction drugs are
administered, the instructor sequences to the second state, Completely Obstructed
Airway. This state change causes the simulator to activate the airway visualization
occluder and the laryngospasm actuator, creating a “cannot intubate, cannot ventilate”
crisis. Severe oxyhemoglobin desaturation develops, with the time of onset dependent
on the degree of denitrogenation that proceeds induction. The learner is encouraged
to practice different therapies suggested in the American Society of Anesthesiology
Practice Guidelines for Management of the Difficult Airway, including esophageal-
tracheal combitube and transtracheal jet ventilation (TTJV). If the learner uses TTJV,
the instructor selects the Release Lungs for TTJV state. When the learner begins
to insert the combitube into the airway, the instructor selects the Deactivate for
Device Insertion state so that the airway visualization occluder retracts. If the learner
subsequently withdraws the airway device, the instructor reactivates the airway
occluder by re-selecting the Completely Obstructed Airway state.
Cannot Intubate, Cannot Ventilate
States, Events and Transitions
State 1
Baseline
Events Oxygen consumption: 300.00 mL/min
Transitions None
State 2
Completely obstructed airway
Events Airway visualization occluder: ON
Laryngospasm: ON
Chest wall compliance factor: 0.10, Onset 0.25
Lung compliance factor (left): 0.10, Onset 0.25
Lung compliance factor (right): 0.10, Onset 0.25
Bronchial resistance (left): 1000.00 cmH2O/l/s@20 LPM
Bronchial resistance (right): 1000.00 cmH2O/l/s@20 LPM
Transitions None
State 3
Release lungs for TTJV
Events Chest wall compliance factor: 1.00, Onset 0.25
Lung compliance factor (left): 1.00, Onset 0.25
Lung compliance factor (right): 1.00, Onset 0.25
Bronchial resistance (left): 0.81 cmH2O/l/s@20 LPM
Bronchial resistance (right): 0.81 cmH2O/l/s@20 LPM
Transitions None
State 4
Deactivate for device insertion
Events Airway visualization occluder: OFF
Laryngospasm: OFF
Transitions IF (Time in state) > (5.00 seconds) GOTO (Baseline)
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