Simulation Scenarios Flashcards
Laryngospasm
Check circuit
Declare airway emergency
- likely laryngo spasm
Emergency buzzer
Pressure
Propofol 50-100ml
Paralysis - sux 100mg or roc 50mg
Intra op cardiac arrest
Check monitoring
Check CO
Declare cardiac arrest
Start CPR - take over Crash trolley Pads - rhythm check ASAP Airway - feel on bag then vent H&T
Declare rhythm
Rhythm check
Shockable
Palpate central pulse
1st rhythm check shows
VT/VF
Handover defibrillation Charging cont CPR Remove O2 Stop CPR Clear, shocking, shocked Back on the chest
Time 2 minutes please
Drugs after 3rd shock
- 1mg adrenaline, 300mg amiodarone
Rhythm check
Non shockable
Palpate a central pulse
1st rhythm check shows
Asystole/ PEA
Back on chest
Time 2 mins please
1mg adrenaline and flush
ROSC
ABCDE
BOXES
Bloods, lines, art Obs X-ray ECG Somewhere safe Family
Hs
Hypoxia
Hypotension
Hyperkalaemia - other metabolic
Hypothermia
Tx
Tension
Thrombus
Toxin - drug chart, allergies
Tamponade - echo
CICO
A: ETT Cricoid, BURP Runner - help, cMAC Position, cMac, blade Declare - can’t intubate - help Gentle ventilation
B: SGA (oxygenation)
IGel 4, size, LMA
declare failed supraglottic device
C: BVM 2 hand guedel, NP, APL Paralyse - sux/roc Ambu Bag Declare CICO
D: front of neck
10blade, bougie, ETT size 6
CI can oxygenate
Place of safety
Options Wake patient up Intubate via SAD Proceed without intubation Tracheostomy
RSI
Checklist
Suction Personel; names, help Equipment ETCO2 Drugs Bed; position, tilt O2; etO2>90 Monitor Brief: ABCD
Aspiration
Declare airway emergency
- patient aspirating
Head down Suction Paralyse, sux/roc Intubate Ventilate Art line/bronch/ITU
LA toxicity
Declare anaesthetic emergency
- likely LA toxicity
- help, buzzer
Stop LA 100% O2 Tx seizure - Loraz 4mg/ propofol Tx Brady/tachyarrhythmia Tx intralipid - 1.5ml/kg bolus and 15ml/kg/hr infusion
Cricothyroidotomy
Stand patient Left Laryngeal handshake Identify landmark Stabilise 10blade and twist inferior Switch hands Bougie ~10cm ETT size 6 Inflate, ventilate
Massive haemorrhage
Declare massive haemorrhage
Buzzer, 2222, hand s
Definitive Tx?
2x wide bore cannula IV fluids Shock pack, level 1 infuser Cell salvage TXA 1g Calcium chloride 10ml Bloods/ Rotem Reverse hypothermia, acidosis, coagulopathy
Blood goals in major haemorrhage and Tx Hb INR Fibrinogen Plt iCa K
Hb >70 INR <1.5 Tx FFP Fibrinogen >1.5 Tx cryoprecipitate (2pools) Plt >75 iCa >1 (10ml CaCl) K<5.5 (insulin dex)
Malignant hyperthermia
Declare likely MH Stop all triggers Help New breathing system 100% O2, hyperventilate TIVA Stop surgery ASAP Non depol NM blocker
Tx dantrolene: 2.5mg/kg
Monitor K, arrhythmia, acidosis, myoglobinaemia, coagulopathy
Unstable arrhythmia
Declare emergency
Help
Shock+- sedation
Syncope
Ischaemia
Heart failure
Tx
Synchronised DC shock x3
Amiodarone 300mg repeat
Stable narrow complex tachy
Regular
- modified valsalva
- adenosine 6,12,12
Irregular
- metoprolol upto 5mg
- digoxin
- amiodarone ?flecainide
Symptomatic bradycardia Tx
Atropine 500mcg Get pacing ready Sedation D/W cardiology Reg - transvenous pacing
Tracheostomy issue
Assess: waters circuit, capnography
Breathing? CO?
Declare emergency, help
High flow O2 x2 Remove inner tube Suction Deflate cuff Remove tracheostomy BVM either tracheostomy or mouth Intubate trache or orally
Anaphylaxis
Declare emergency, help ABCDE Adrenaline 0.5mg IM 1:1000 IV fluids ?ETT Hydrocortisone 200mcg Piriton 10mg IV Bloods mast cell tryptase
Sepsis
ABCDE
Take 3: lactate, cultures, U/O
Give 3: O2, fluids, Abx
No response
?needs vasopressors
D/W ITU
Coughed out tube
Check circuit
Feel bag
Declare airway emergency
Help, buzzer
?Deepen, paralyse Look position (laryngoscope) ?Reposition Take it out BVM, vortex
Safe place; options
Wake up, ETT, iGel
Handover patient
Age Operation, position HPC BG Allergies, Medications Reflux, Fasted Airway assessment Cannula Drugs Issues so far?
