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19 Cards in this Set
- Front
- Back
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Cardiac arrest |
(ALS guidelines)
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Major haemorrhage |
Inform surgeon Verify BP Treat severe hypotension with vasopressor Restore volume Increase FiO2 Call for help Increase IV access Notify blood bank/massive transfusion |
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Difficult airway |
(DAS guidelines) |
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Tachycardia |
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Airway Fire |
Remove heat source Disconnect from machine and circuit; Stop the flow of all gases Ventilate with self inflating Bag mask Extinguish fire : Pour saline or water into airway Remove ETT if not difficult AW
Reestablish BMV avoid supplemental oxygen / N2O Examine the tracheal tube for fragments Consider rigid bronchoscopy to look for tracheal tube fragments, assess injury, and remove residual debris. Assess the patient’s status and devise a plan for ongoing care. |
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Aspiration |
Call for help Head down/lateral Remove airway & cricoid (if not vomiting) Oral suction +/- Sux Laryngoscopy & suction Intubate and suction catheter trachea Ventilate 100% O2 Brochoscopy NGT |
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Local anaesthetic toxicity |
Stop injection Call for help ALS/CPR if arrest Airway - consider intubation IV access Monitoring Terminate seizure (midazolam) Intralipid (1.5mL/kg + 15mL/kg/hour repeat bolus after 5 mins x2 and double rate, max 12mL/kg) Consider bypass |
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Malignant Hyperthermia |
Initial management
Declare emergency Call for help & allocate roles Stop agent, don't change circuit,remove vaporiser Hyperventilate with 15L/min 100% O2 Get crisis box & cards and refrigerated supplies IV dantrolene (2.5mg/kg) TIVA (propofol TCI 4mcg/ml)
Assign task cards
1. Anaesthetist 1: Resus, TIVA, Rx -K, arrhythmia , acidosis, renal protection 2. Anaes assistant : help with setup, restock 3. Dantrolene (3 ppl) : 2.5mg/kg every 10-15 mins, 60ml sterile water per 20mg vial 4. Anaesthetist 2: A and CVC lines and Ix: ABG, UEC, Coags, CK, Myoglobin 5. Cooling: Ice, cold IV fluids, insulin, bring defib 6. Logistics: call more anaesthetists , Dantrolene ,ICU & monitor for recurrence 7. Surgical team: stop surgery , IDC, exposure |
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Transfusion reaction |
Cease blood Notify team & call for help ABC - bronchospasm - maintain BP Monitor for complications - DIC - renal (fluids, diuresis) Steroids Return blood to blood bank |
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Nerve injury |
Prevent further injury & exclude ongoing causes e.g. compartment Hx/Ex Inform surgeon Consult neurologist Disclosure |
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Neonatal resus |
Dry, warm and stimulate (if prem - wrap not dry) CPAP if respiratory distress Increase O2 after 3 minutes or if CPR CPR if HR < 60 (1:3 x 100) if HR < 100 or ineffective effort then ventilate (5cmH2O/30cmH2O) Preterm weight - 1kg at 27 weeks, 1.5kg at 30 weeks, 2.5kg at 35 weeks, 3.5kg at term |
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Laryngospasm |
Cease stimulation 100% O2 Remove airway devices & suction CPAP and jaw thrust/Larson's point Deepen anaesthesia (propofol) If severe: Suxamethonium (0.5-1mg/kg or 2-4mg/kg IM) Intubate Complications Hypoxia Bradycardia Negative pressure pulmonary oedema Vocal cord trauma |
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High airway pressure |
1. Visual scan monitor/machine/patient (EtCO2 shape, depth/relaxation) 2. Hand ventilate and check circuit/connections 3. Examine patient (ETT/LMA position/kink, laryngospasm, bronchospasm, pneumothorax, laparoscopy) 4. Self-inflating bag directly to LMA or ETT - (if persists it's either patient or device) - call for help at this point 5. Suction ETT or remove LMA and replace with ETT 6. Bronchoscopy Causes: Patient - laryngospasm, bronchospasm, autoPEEP, pulmonary oedema, pneumothorax/haemothorax, chest wall rigidity/lack of paralysis, chronic pathology (e.g. fibrosis) Airway - kink, occlusion (sputum, cuff, biting), dislodgement Circuit - kink, HME blockage, valve, APL, inappropriate ventilator settings |
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Maternal arrest |
ALS plus: Left lateral tilt 15-30 degrees Early intubation Pads AP Deliver after 4 minutes if ≥ 20 weeks Chest tube 1-2 spaces higher Consider - haemorrhage, pre-eclampsia & complications, PE, AFE, uterine rupture, total spinal, LAST |
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Anaphylaxis |
Remove stimulus (colloid? chlorhex? latex? dyes?) Call for help IF arrest - ALS IM adrenaline 0.5mg (0.3mg <12 yrs, 0.15mg < 6 years) Airway - early intubation Breathing - 100% O2, long exp time (bronchospasm) Circulation - IV access, fluids 20mL/kg Adrenaline - 0.25-1mcg/kg IV bolus, infusion 0.1-0.5mcg/kg/min Norad, Vasopressin 1-2 units then 2 units/hour Bypass Hydrocortisone 2-4mcg/kg, antihistamine ICU Tryptases |
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Post Crisis Management |
Patient and relative (RD10) STRIKES (setting, team, relatives, information, knowledge transmission, empathy, summarise) Anaesthesia and environment Equipment, documentation, medico-legal Treating team and individual (RD05) debrief, counselling, MDO, team Root Cause Analysis/institutional review |
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Trauma call |
Roles, equipment, radiology & pathology, blood bank Simultaneous assessment and mnagement Primary survey - Simultaneous assessment and management Airway & C spine Breathing Circulation & control haemorrhage, FAST Disability Exposure but minimise heat loss Identify & control life threatening injuries Secondary survey |
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Mandatory reporting |
intoxication sexual misconduct impairment causing potential harm to public significant departure from standards with potential to harm injured parties may sue for paediatric abuse suspicion or evidence of abuse neglect causing harm may beg prosecuted by state |
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Sentinel Events |
infrequent clear cut events independent of condition unneccesary outcomes for patient reflect system wide deficiencies wrong site or part inpatient suicide retained instruments gas embolism haemolytic transfusion/ABO medication error resulting in morbidity maternal m/m incorrect infant discharge |
