Management of Operating Room Critical Events, An Issue of Anesthesiology Clinics

1st Edition, Volume 38-4 - November 10, 2020
Editor: Alex Hannenberg
Language: English
Hardback ISBN:
9 7 8 - 0 - 3 2 3 - 7 6 1 2 8 - 4
eBook ISBN:
9 7 8 - 0 - 3 2 3 - 7 6 1 2 9 - 1

This issue of Anesthesiology Clinics, guest edited by Dr. Alexander A. Hannenberg, focuses on Management of Critical Events. This is one of four issues each year selected by the… Read more

Management of Operating Room Critical Events, An Issue of Anesthesiology Clinics

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This issue of Anesthesiology Clinics, guest edited by Dr. Alexander A. Hannenberg, focuses on Management of Critical Events. This is one of four issues each year selected by the series consulting editor, Dr. Lee Fleisher. Articles in this issue include, but are not limited to: Why We Fail to Rescue from Critical Events; High Fidelity Simulation Training; Alternatives to High Fidelity Simulation Training; Tools to Improve our Capacity to Rescue; Use of Cognitive Aids to Improve Management of Critical Events; Real-time debriefing after critical events: Exploring the Gap between Principle and Reality; Mass Casualty Events; Obstetrical Hemorrhage; Intraoperative cardiac arrest; The Lost Airway; The Septic Patient and Oxygen Supply Failure.

Cover image
Title page
Table of Contents
Copyright
Contributors
Forthcoming Issues
Foreword
Preface
SECTION I: Crosscutting Issues
Why We Fail to Rescue During Critical Events
Key points
Introduction
The event
The individual
The team
The environment and available resources
Discussion
Summary
High-Fidelity Simulation Education and Crisis Resource Management
Key points
Anesthesiology leadership in crisis management and high-fidelity simulation
Managing anesthesia crises
Crisis resource management principles
Know the environment
Anticipate and plan
Situation awareness
Call for help early
Designate leadership
Followership
Use all available information
Establish role clarity
Allocate attention wisely
Distribute the workload
Mobilize resources
Communicate effectively
Use cognitive aids
Establish situational awareness and a shared mental model
High-fidelity simulation and crisis management
Adult learning theory and high-fidelity simulation
Principles of simulation education
Simulation and performance improvement
Characteristics of scenarios for use in crisis resource management training
Foundations of behavioral change
Anesthesiology leadership in performance improvement
The American Society of Anesthesiologists
The American Board of Anesthesiology
Medical malpractice
Simulation and future research
Summary
Alternatives to High-Fidelity Simulation
Key points
Introduction
Barriers to simulation-based education
Alternatives to high-fidelity simulation
Alternatives to expert onsite facilitation
Future directions for alternatives to high-fidelity simulation in critical event training
Opportunities to Improve the Capacity to Rescue: Intraoperative and Perioperative Tools
Key points
Introduction
Intraoperative failure to rescue
Failure to rescue in the postanesthesia care unit
Failure to rescue in the perioperative period
Postdischarge failure to rescue
Summary
Clinics care points
Cognitive Aids in the Management of Critical Events
Key points
Background
Experience
Evidence
Effective use
Training
Implementation
Sustaining use
Summary
Real-Time Debriefing After Critical Events: Exploring the Gap Between Principle and Reality
Key points
Introduction
Part I: the potential benefits from debriefing
Part II: the landscape and scarcity of this practice after actual critical events
Part III: the bridge between principle and reality: strategies to offer opportunities for reflection on actual critical events
Lessons from the implementation of crisis checklists and emergency manuals
Summary
SECTION II: Clinical Management of Specific Critical Events
Preparing for Mass Casualty Events
Key points
Introduction
Types and characteristics of mass casualty victims
Departmental preparedness
Individual knowledge
Immediate responders
Prehospital mass trauma
Stop the Bleed
Casualty behavior
Communication
Crisis leadership
Departmental planning and training
Hospital-level preparedness
Early interventions
Support services
Staffing issues
Nontraditional roles of anesthesiologists
Nontraditional roles
Special populations: pediatrics and obstetrics
Nuclear/radiological events
Chemical events
Biological events
Evacuation and interfacility transfers
Resilience and recovery: postevent considerations
Follow-up: transmitted diseases, ophthalmic, auditory, and psychological injuries
Psychological preparedness/bereavement/debriefing
Summary
Obstetric Hemorrhage
Key points
Introduction
Epidemiology
Management strategies unique to peripartum hemorrhage
Antepartum maternal hemorrhage
Postpartum maternal hemorrhage
Summary
Intraoperative Cardiac Arrest
Key points
Introduction
Incidence, outcomes, and risk factors of perioperative cardiac arrest
Unique contributors to perioperative cardiac arrest
Recognition of perioperative crisis
Stepwise approach to the perioperative patient in crisis
Unique features of perioperative cardiac arrest
Summary and future directions
Clinics care points
The Lost Airway
Key points
Introduction
Incidence of the failed airway
Management of the failed airway
Invasive airway access
Human factors and training issues
The Septic Patient
Key points
Introduction
Source control
Induction of the critically ill
Monitoring
Pulse pressure variation and stroke volume variation
Tissue oxygenation/perfusion
Fluid resuscitation
Cardiomyopathy in sepsis
Optimal perfusion pressure and pressors
Ventilatory strategies
Metabolic acidosis and use of sodium bicarbonate
Steroids/vitamin C/thiamine
Hyperglycemia
Transport to intensive care unit
Summary
Failures of the Oxygen Supply
Key points
Introduction
Oxygen storage and delivery
Safety mechanisms
Simulation and crisis management
Failure modalities and management

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Alex Hannenberg