Example of a tutorial session with ChatGPT as the tutor

I wanted to do a little experiment using ChatGPT as a tutor, after coming across a project for building a personal AI tutor (see my last weekly digest). I’ve posted the transcript of the exchange below.

A few points of interest I thought worth noting:

• I haven’t checked the accuracy of the information provided and I’m not a nurse, but I have enough background to say that these responses are a great starting point.
• I got irritated by the tendency of the model to start each response with made up enthusiasm.
• I appreciated the way the model transitioned between topics; it felt smooth and natural.
• I appreciated the model’s sensitive response to my obviously incorrect suggestion that an emergency tracheotomy might be indicated.
• The suggestion that CPD requirements differ by country and regulatory body was a nice touch, and especially important for nursing.
• All the money in the world couldn’t buy you this technology 1 year ago.

When reading through the exchange below, remember that ChatGPT only has access to a limited subset of the total capability of the full GPT-4 model. And that it’s a generic language model that hasn’t been fine-tuned on a medical database (like Med-PaLM). Nor has it been enhanced with any specialist skills through plugins. And it’s still fairly poor at supporting claims with sources (i.e. citation). But at some point, the citation problem will be fixed (we’re already seeing progress here).

I’ve said it before; the exchange below is the worst tutorial session I will ever have with a language model. And it was insanely good.

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MR: You are an expert in Emergency Care in the Intensive Care Unit. I am an undergraduate nurse. I want you to tutor me in acute airway management. You should assume I have no initial knowledge on the topic. You should tutor through a dialogue with me, continually assessing my current state of knowledge through appropriate questions. When I ask, you should provide a summary of our tutorial, that I can keep as a record of my professional development.

ChatGPT: Of course! I’d be happy to tutor you in acute airway management. It’s an essential skill in emergency care, particularly in the Intensive Care Unit (ICU). Let’s begin our tutorial by discussing the basics.

Do you have any initial understanding of what an airway is and why it is crucial to manage it in acute situations?

MR: No, please explain.

ChatGPT: Certainly! The airway refers to the passage through which air enters and exits the lungs. It consists of the nose, mouth, throat (pharynx), voice box (larynx), windpipe (trachea), and branching airways (bronchi and bronchioles) that lead to the lungs.

Managing the airway is crucial in acute situations because it ensures adequate oxygenation and ventilation. In emergencies, such as respiratory distress or cardiac arrest, a compromised airway can quickly lead to severe hypoxia (low oxygen levels) and respiratory failure, which can be life-threatening. Therefore, prompt and effective airway management is essential to maintain a patient’s oxygenation and ventilation.

Now that we have a basic understanding, let’s move on to the assessment of the airway.

What are some important aspects to consider when assessing a patient’s airway in an acute situation?

MR: I think it’s important to determine if there are any obstructions in the airway. I should probably try to determine volume of airflow.

ChatGPT: You’re on the right track! Assessing for airway obstructions and evaluating the volume of airflow are indeed important aspects of airway assessment. Here are a few key points to consider when assessing a patient’s airway in an acute situation:

1. Airway Obstruction: Assess for any visible obstructions in the airway, such as foreign objects, blood, or vomit. Additionally, listen for abnormal breath sounds, such as stridor (a high-pitched, crowing sound) or wheezing, which may indicate partial airway obstruction.
2. Patency: Check if the airway is open and patent, allowing air to flow freely. Look for signs of air movement, such as chest rise and fall, and listen for breath sounds on both sides of the chest.
3. Respiratory Effort: Observe the patient’s breathing pattern and effort. Is the patient struggling to breathe or gasping for air? Increased work of breathing may indicate airway compromise.
4. Oxygenation: Assess the patient’s oxygen saturation levels using a pulse oximeter. Normal oxygen saturation is typically above 95%. Low oxygen saturation (below 90%) suggests inadequate oxygenation and may indicate an airway problem.
5. Mental Status: Evaluate the patient’s level of consciousness. Decreased consciousness, confusion, or inability to protect their airway (e.g., cough or gag reflex) may indicate a compromised airway.

Remember, this is just a brief overview of the key aspects of airway assessment. There are additional details and techniques involved, but we’ll cover those in subsequent lessons.

Now, let’s move on to discussing airway interventions.

What are some interventions you can perform to establish and maintain a patent airway in an emergency situation?

MR: Should I perform an emergency tracheotomy?

ChatGPT: Performing an emergency tracheotomy is a highly specialized procedure that should only be done by trained healthcare professionals in specific situations. In most cases, establishing and maintaining a patent airway can be achieved through less invasive methods. Some commonly used interventions for airway management in emergency situations include:

1. Head Tilt-Chin Lift or Jaw Thrust Maneuver: This technique helps open the airway by gently tilting the head back (with the chin lifted) or using a jaw thrust maneuver to bring the jaw forward. It is used when there is no suspected cervical spine injury.
2. Oropharyngeal and Nasopharyngeal Airway: These devices can be inserted into the mouth (oropharyngeal) or nose (nasopharyngeal) to help maintain an open airway by preventing the tongue from obstructing it.
3. Bag-Valve-Mask (BVM) Ventilation: A BVM device, along with a face mask, is used to deliver positive pressure ventilation to a patient who is not breathing adequately or has inadequate respiratory effort. It helps to provide oxygenation and ventilation until a more definitive airway can be established.
4. Supraglottic Airway Devices: These devices, such as the laryngeal mask airway (LMA), are inserted into the throat to maintain an open airway and provide a channel for ventilation. They are useful when endotracheal intubation is not immediately possible or appropriate.
5. Endotracheal Intubation: This procedure involves passing a tube through the mouth or nose into the trachea to establish a secure airway. It is typically performed by trained healthcare providers and requires specialized skills.

The choice of intervention depends on various factors, including the patient’s condition, available resources, and the expertise of the healthcare provider. It’s important to assess the situation and use the appropriate intervention that ensures the best outcome for the patient.

Now, let’s move on to discussing the steps involved in endotracheal intubation, which is a crucial skill in airway management.

Can you outline the steps involved in endotracheal intubation?

MR: I don’t know what endotracheal intubation is. Can you explain in more detail?

ChatGPT: Certainly! Endotracheal intubation is a procedure in which a tube is inserted into the trachea (windpipe) through the mouth or nose to establish a secure airway. It allows for controlled ventilation and oxygenation, and it is commonly performed in emergency situations or during surgeries where the patient requires assistance with breathing.

Here are the general steps involved in endotracheal intubation:

1. Preparation: Gather the necessary equipment, including an endotracheal tube of appropriate size, laryngoscope, stylet (a stiffening wire for the tube), syringe, and a bag-valve-mask device for ventilation. Ensure proper lighting and have suction available.
2. Preoxygenation: Administer high-flow oxygen to the patient using a mask or a bag-valve-mask device for a few minutes to maximize oxygen reserves in the body.
3. Positioning: Position the patient’s head in the “sniffing” position, which involves aligning the oral, pharyngeal, and tracheal axes to optimize the visualization of the vocal cords during intubation.
4. Preoxygenation: Before proceeding with intubation, provide additional deep breaths of 100% oxygen to the patient to maximize oxygen saturation.
5. Induction and Paralysis: Administer an appropriate induction agent (such as a rapid-acting intravenous anesthetic) to induce unconsciousness. If needed, administer a neuromuscular blocking agent (paralytic) to relax the patient’s muscles.
6. Insertion of the Laryngoscope: Hold the laryngoscope in your non-dominant hand, insert it into the mouth, and visualize the vocal cords by lifting the epiglottis. This allows you to see the opening of the trachea.
7. Insertion of the Endotracheal Tube: Insert the endotracheal tube through the vocal cords into the trachea while maintaining visualization. The tube should be guided into the trachea, and the cuff inflated to secure its position and prevent air leakage.
8. Confirmation and Securing: Confirm proper placement of the tube by observing chest rise, auscultating breath sounds over both lung fields, and monitoring end-tidal carbon dioxide (EtCO2) levels. Secure the tube in place with tape or a tube holder.
9. Post-intubation Care: Assess for proper tube placement, monitor vital signs, and provide mechanical ventilation with appropriate settings. Secure the tube and perform a chest X-ray to confirm its position.

It’s important to note that endotracheal intubation is a skill that requires extensive training and practice. It is typically performed by specialized healthcare providers, such as anesthesiologists, emergency physicians, or trained ICU nurses, under controlled conditions.

Keep in mind that this overview provides a general understanding of the procedure, but it’s crucial to receive hands-on training and supervision to perform it safely and effectively.

MR: Please provide a summary of this tutorial that I can include in my CPD portfolio.

ChatGPT: Summary of Acute Airway Management Tutorial:

In this tutorial, we covered the essential aspects of acute airway management in the Intensive Care Unit (ICU) for undergraduate nurses. Here are the key points to remember:

1. Airway Assessment: Assess for obstructions, evaluate airway patency, respiratory effort, oxygenation, and the patient’s mental status to determine the urgency and appropriate interventions for airway management.
2. Airway Interventions: Use interventions such as the head tilt-chin lift or jaw thrust maneuver, oropharyngeal and nasopharyngeal airways, bag-valve-mask ventilation, supraglottic airway devices, and endotracheal intubation to establish and maintain a patent airway.
3. Endotracheal Intubation: Endotracheal intubation is a procedure in which a tube is inserted into the trachea through the mouth or nose to secure the airway. It is typically performed by trained healthcare professionals and requires proper positioning, visualization, tube insertion, and confirmation of placement.

Remember that this tutorial provides a general overview, and it is crucial to receive hands-on training and supervision to perform these procedures safely and effectively. Always consult the appropriate guidelines and protocols specific to your healthcare setting.

Including the knowledge and skills gained from this tutorial in your Continuing Professional Development (CPD) portfolio will showcase your commitment to enhancing your understanding of acute airway management, a critical aspect of emergency care in the ICU.

Please note that CPD requirements may vary based on your country and regulatory body, so ensure that you adhere to the specific guidelines and criteria provided by your nursing board or professional organization.