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FONA Readiness



the readiness is all

Cultivating your Fearless FONA Minded requires spending some time thinking about the tactics used to achieve your objective. We show you how here.

“Strategy without tactics is the slowest route to victory. Tactics without strategy is the noise before defeat.” ― Sun Tzu, The Art of War


time + difficulty = readiness level

The first set of FONA tactics I ever saw was from @emcrit.CricCon presented a simple set of tactics that could be applied at the bedside. It was a game changer. Assessing the need for FONA and implementing a readiness status requires that you consider all the logistics (where is the kit, do you have a scalpel, did you palpate landmarks, who will perform FONA) and ensures that FONA is amplified and escalated appropriately.


The double set up

The next tactic is the double set-up: were time + really scary airway should equal maximal preparation.

The double set-up means that surgical airway equipment is open and at the bedside, the neck is prepped, and the anatomy is marked. If possible, designate someone to be ready with scalpel in hand at the side of the bed ready for the handoff if intubation fails. Here is this concept as originally presented by Reuben Strayer @EMUpdates.


impending hypoxia & low chance of intubation success?
Transition to Direct access early & bypass further intubation attempts

The last FONA tactic presented here is the final escalation. Some cases require direct access with few to no attempts at intubation. If that patient with stridor from an inhalation burn needs a definitive airway, it may be you only get one chance at an endotracheal tube. If you suspect you might fail, then be ready by deciding before any attempt at intubation that if you fail, no further attempts will be made that might further delay restoring oxygen to your patient.

Don’t wait until critical hypoxia occurs and you’re under the gun with time running out. Instead transition to the simpler and more direct option of the surgical airway in a calm and unhurried manner.


don’t just think you’re ready – be ready
a summary of four valuable fona tactics

Like the meaningless phrase “have a high index of suspicion” in medicine, Thinking you’re ready for FONA and being ready are two very different things. Doing these 4 things prior to EVERY intubation will get you one step closer to true FONA readiness.

the bottom line
Use these tactics to implement your FONA strategy.

  • Always assess the need for FONA with every intubation
  • Determine and discuss with your team a readiness status
  • In the highest alert status, the double setup is advisable
  • Act early before critical hypoxia occurs

For in person learners, locate any of the posters below within the installation to continue your training. Then snap the QR codes embedded within them to access the learning space. Look for the ✋emoji for integrated hands on training opportunities.

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