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Emergencies

An Introduction to Anaesthesia 2019. Emergencies. Dr Dermot McGuckin SpR in Anaesthesia UCL Hospitals. E is for Emergencies. An introduction to crisis management. Anaesthetic emergencies & critical incidents Human Factors & Crisis Resource Management

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Emergencies

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  1. An Introduction to Anaesthesia 2019 Emergencies Dr Dermot McGuckin SpR in Anaesthesia UCL Hospitals

  2. E is for Emergencies An introduction to crisis management Anaesthetic emergencies & critical incidents Human Factors & Crisis Resource Management Strategies for prevention & management

  3. AAGBI.org

  4. Simulation video

  5. Ann Intern Med 2005; 142(9):756-764.

  6. Crises & emergencies in Anaesthesia • Unexpected, rapidly-evolving events requiring immediate intervention to prevent disaster • Simple / Complex • Challenging & stressful situations • Interplay of patient, anaesthetic & surgical factors • May be attributable to characteristics of the human condition • Prevention better than cure

  7. “The important question isn't how to keep bad physicians from harming patients; it's how to keep good physicians from harming patients.” Atul Gawande Complications: A Surgeon’s Notes on an Imperfect Science

  8. “Miracle on the Hudson”

  9. Flight 1549 video

  10. Crew Resource Management • CRM training has its origins in the late 1970s following a string of serious aviation accidents • Incidents were more frequently related to pilots' non-technical & communication skills rather than technical flying abilities or aircraft malfunctions

  11. Crew Resource Management Chest 2009;136(3):910-17

  12. SOS COVER ABCD – A SWIFT CHECK • Stop • Oxygen • Shout for help • Circulation, Capnograph & Colour (saturation) • Ventilation & Vapourisation • Endotracheal tube & Eliminate machine • Review monitors & equipment • Airway • Breathing • Circulation • Drugs (consider all given & not given) • Be Aware - Allergy, Air • SWIFT CHECK of patient, surgeon, process, responses

  13. Error classification system from CRM principles Chest 2009;136(3):910-17

  14. Elaine Bromily video

  15. Fixation Error

  16. Fixation Error Anaesthesia 2010;65(1):61-69

  17. Das.uk.com

  18. Anaesthesia & Patient Safety • Risk assessment & stratification and pre-operative optimisation • Safety science • Simulation-based education & training • Development, implementation & promotion of checklists • Debriefing colleagues after they have experienced such challenging events • Challenging authority & speaking up in the OR environment • National audits, reporting & learning • Black-box recording in the OR • Impact of fatigue

  19. E is for Emergencies Take home messages: Crisis management resources on AAGBI.org Build CRM principles into your practice to improve performance & reduce error Get skilled at Human Factors: guidelines & protocols, courses, simulation & team training, checklists, incident reporting, alerts and M&M An introduction to crisis management • Special thanks to Dr Jane Lowery (Consultant Anaesthetist, RFH) and colleagues from Central London School of Anaesthesia

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