Exam technique Flashcards
(19 cards)
What is stage 1 of crisis management framework
SAFETY
I would CONFIRM the reading
Send for HElp (may or may not do)
Whilst SCANNING the patient, surgical field, monitors and equipment
Alert SURGEONS and consider stopping surgery
4 stages of crisis management framework
STOP
TEMPORISTION
CAUSE (identify)
TREATMENT with crisis resource management
Cause and Management - HYPOTENSION
Cause and Management - HYPERTENSION
Cause and Management - HYPOXIA
Cause and Management - BRADYCARDIA
Cause and Management - HIGH VENTING PRESSURES
Cause and Management - DELAYED EMERGENCE
Cause and Management - TACHYCARDIA
Cause and Management - STRIDOR
Standard Anaesthetic Assessment
Patient has a significant cardiac/resp issue - what do you ask about
Symptoms
Severity
Stability
Cause (risk factors)
Complications
Management e.g. drugs
Patient has malignancy/tumour - what do you ask about
5MC
Mass effect e.g. compressing other organs (bowel obstruction
Metastases
Metabolic activity e.g. carcinoid/siadh
Medications and treatment - sx/rx/chemo
Mental state
Cause (+risk factors)
General approach in an emergency situation e.g. pt. peri-arrest in ED
This is an emergency
I would ask for senior assistance / call cardiac arrest
ABCDE approach
Treat problems as they are diagnosed
Take a focussed AMPLE history (allergies, meds, PMHx, last meal, events leading to presentation)
Assess with Hx/Exam/Ix after stabilised
More detail of mass effect e.g. upper airway mass
Positional symptoms
Rapidity of PROGRESSION
Effect on critical local structures
- Syncope, SOB, dysphagia, pain, neck congestion)
Organ function
- Cardiac and resp
Important CRM principles e.g. for MH mx
- Call for help - emergency buzzer
(in order to mobilise resources) - Mobilise key equipment such as MH box/anaphylaxis box/cognitive aids
- My immediate priorities are…
Acting as the team lead I would allocate staff to these tasks - Check task cards and consistent re-evaluation
- Ask for a second opinion to avoid fixation errors
- Think about disposition of patient when crisis over - e.g. ICU transfer, transfer inter-hospital
- Plan for future issues - e.g. tryptase, alert card, allergy status
MH CRM management priorities
- Cease trigger
- Ventilate with 100% FiO2 + high flows
- Cease volatile
- Replace soda lime
- Commence propofol - Dantrolene administration
- Dose, administrators , contraindications (relative but liver disease high risk hepatotoxicity) - Cooling
- Ice packs to groin/axilla/neck, reduce theatre temp, cooled fluids and irrigation - Management of complications
- Acidosis, hyperkalaemia, arrythmias - Lines and access
Anaphylaxis CRM management priorities
My immediate priorities are
- Ceasing the trigger
- Ensuring adequate oxygenation
- Volume status and hypotension
- Adrenaline
As team leader in this situation I would mobilise resources and allocate tasks whilst utilising cognitive aids to ensure nothing was missed
- Removing the trigger
- Stop abx, wash chlorhexidine, check latex - Oxygenation
- Hand ventilate with 100% , consider salbutamol if bronchospasm - Adrenaline
- 50-100mcg boluses IV or 0.5mls of 1:1000 adrenaline IM
- Infusion of 3mg in 50mls - Volume status
- Lie patient flat, 2L fluid crystalloid immediately
Access and monitoring - IV access, art line, finger on pulse
How will you anaesthetise this patient answer
Prep/position/location
- Adequate consent, WHO checklist
- Head up 30deg, positioned in theatre
Resus (Emergency drugs) drawn up
- State any special e.g. Atropine 20mcg/kg in kids
IV access secured +- additional widebore
Monitioing
- AAGBI
- +extras ?Art ?CVC ?NMmonitor ?BIS ?IDC
Airway + Assistant
- ETT 7.0 +- size
- Standard Mac 4 laryngoscope
- Difficult airway trolley available
Drugs
- Drugs for induction and case drawn up
Equipment
- E.g. Oxford help, fiberoptic
- Suction
I - Induction
- IV vs. Gas
- Drugs (state doses or state “give titrated boluses of X,Y maintaining a cardio stable induction)
M - Maintanence
- TIVA vs. Volatile
- ?Titrate to Dep Of Anaesthesia
- Fluids
- Analgesia
- Antiemetics
- Other drugs e.g. TXA, abx prophylaxis
E - Emergence
- Awake vs. Advanced extubation
- Ongoing analgesia ?blocks ?catheters
- Disposition - ICU/HDU/extended recovery/ward
