simulation in emergencies 24-25 may 2012

Simulation in Emergencies        

World Congress of Ophthalmic Anaesthesia Ankara/TURKEY, 24-25 May 2012

TURKISH RESUSCITATION SOCIETY

Prof Agah CERTUG Ege University, Turkey

Assoc Prof Handan BIRBICER Mersin University, Turkey

Assoc Prof Nurcan DORUK Mersin University, Turkey

Assoc Prof Pinar ZEYNELOGLU Baskent University, Turkey

Assoc Prof Sule AKIN Baskent University, Turkey

World Congress of Ophthalmic Anaesthesia Ankara/TURKEY, 24-25 May 2012

Anaphylaxis

Simulation in Emergencies        

Acute Coronary Syndrome

Trauma

World Congress of Ophthalmic Anaesthesia Ankara/TURKEY, 24-25 May 2012

Anaphylaxis

Simulation in Emergencies        

World Congress of Ophthalmic Anaesthesia Ankara/TURKEY, 24-25 May 2012

Anaphylaxis

A 62-year-old man

Cataract surgery

Monitored Anesthesia Care

Midasolam (2mg)

Retrobulbar block

Local anesthetic injection (Bupivacaine, 0.5%, 25mg)

World Congress of Ophthalmic Anaesthesia Ankara/TURKEY, 24-25 May 2012

Anaphylaxis

Oxygen (Nasal cannula, 3 L/min)

SABP/DABP : 140/80 mmHg

HR: 86/min

SpO2: 97%

World Congress of Ophthalmic Anaesthesia Ankara/TURKEY, 24-25 May 2012

Anaphylaxis

Airway Complains of tightness in throat

Breathing RR 28 min-1, widespread wheeze

Circulation HR: 140 min-1, BP 80/60 mmHg

Disability Very anxious

Exposure Widespread urticaria, swollen eyes

World Congress of Ophthalmic Anaesthesia Ankara/TURKEY, 24-25 May 2012

Anaphylaxis

WHAT WILL WE DO NOW?

World Congress of Ophthalmic Anaesthesia Ankara/TURKEY, 24-25 May 2012

Anaphylaxis

ABCDE approach

Oxygen, IV access

Recognise anaphylactic reaction

Adrenaline 0.5 mg IM; or cautious diluted IV

IV fluids

Histamine antagonist; hydrocortisone; nebulised salbutamol

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World Congress of Ophthalmic Anaesthesia Ankara/TURKEY, 24-25 May 2012

Anaphylaxis

PATIENT COLLAPSES

Anaphylaxis

Confirm cardiac arrest

Call resuscitation team / help

2 min CPR (30:2)

Airway/ventilation/oxygen

Give adrenaline 1 mg iv

Recognize/treat reversible causes (hypoxia – intubation, hypovolemia – iv fluids)

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PEA

World Congress of Ophthalmic Anaesthesia Ankara/TURKEY, 24-25 May 2012

Anaphylaxis

Check monitor/confirm rhythm

1st shock at appropriate energy (150 J)

2 min CPR (30:2)

Check monitor/confirm rhythm

2nd shock at appropriate energy (max.:270 J)

2 min CPR (30:2)

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VF

World Congress of Ophthalmic Anaesthesia Ankara/TURKEY, 24-25 May 2012

VF

Anaphylaxis

Check monitor/confirm rhythm

Check patient (signs of life /pulse)

Investigations /Transfer to ICU

Post resuscitation care

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SR

World Congress of Ophthalmic Anaesthesia Ankara/TURKEY, 24-25 May 2012

World Congress of Ophthalmic Anaesthesia Ankara/TURKEY, 24-25 May 2012

Simulation in Emergencies        

Acute Coronary Syndrome

World Congress of Ophthalmic Anaesthesia Ankara/TURKEY, 24-25 May 2012

Acute Coronary Syndrome

A 55-year-old woman

Vitrectomy

DM, ASHD Plan: General anesthesia

Before anesthesia induction; chest pain

ST elevation on ECG

World Congress of Ophthalmic Anaesthesia Ankara/TURKEY, 24-25 May 2012

Oxygen (Face mask, 10 L/min)

SABP/DABP : 100/70 mmHg)

HR: 98/min

SpO2: 96%

Acute Coronary Syndrome

World Congress of Ophthalmic Anaesthesia Ankara/TURKEY, 24-25 May 2012

Airway Clear

Breathing RR 22 min-1

Circulation HR: 124 min-1, BP 80/60 mmHg

Disability Verbal response, anxious

Exposure Pale

Acute Coronary Syndrome

World Congress of Ophthalmic Anaesthesia Ankara/TURKEY, 24-25 May 2012

WHAT WILL WE DO NOW?

Acute Coronary Syndrome

World Congress of Ophthalmic Anaesthesia Ankara/TURKEY, 24-25 May 2012

ABCDE approach

Oxygen, IV access

Recognise acute coronary syndrome/blood samples

Morphine

Aspirin, 300mg, p.o.

Nitrate

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Acute Coronary Syndrome

World Congress of Ophthalmic Anaesthesia Ankara/TURKEY, 24-25 May 2012

PATIENT COLLAPSES

Acute Coronary Syndrome

Check monitor/confirm rhythm/CHECK PULSECall resuscitation team / help1st shock at appropriate energy (150 J)

2 min CPR (30:2)

Check monitor/confirm rhythm/CHECK PULSE

2nd shock at appropriate energy (max.:270 J)

2 min CPR (30:2)

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VT

World Congress of Ophthalmic Anaesthesia Ankara/TURKEY, 24-25 May 2012

VT

Acute Coronary Syndrome

3rd shock (270 J)

2 min CPR (30:2)

Give adrenaline, 1mg ivGive amiodarone, 300 mg iv 4th shock (270 J)

2 min CPR (30:2)

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VF

World Congress of Ophthalmic Anaesthesia Ankara/TURKEY, 24-25 May 2012

VF

Acute Coronary Syndrome

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Check monitor/confirm rhythm

Check patient (signs of life / pulse)

Investigations /Transfer to ICU

Post resuscitation care

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SR

World Congress of Ophthalmic Anaesthesia Ankara/TURKEY, 24-25 May 2012

Acute Coronary Syndrome

World Congress of Ophthalmic Anaesthesia Ankara/TURKEY, 24-25 May 2012

Simulation in Emergencies        

Trauma

World Congress of Ophthalmic Anaesthesia Ankara/TURKEY, 24-25 May 2012

Trauma

A 12-year-old boy (BW:35 kg)

Traffic accident

Scleral perforation repair

Emergent case

Plan: General anesthesia

World Congress of Ophthalmic Anaesthesia Ankara/TURKEY, 24-25 May 2012

Trauma

Oxygen (Face mask 8 L/min)

SABP/DABP : 80/60 mmHg

HR: 132/min

SpO2: 92% After Intubation:

SABP/DABP : 65/30 mmHg

HR: 144/min

SpO2: 89%

World Congress of Ophthalmic Anaesthesia Ankara/TURKEY, 24-25 May 2012

Airway Endotracheally intubated

Breathing RR 24 min-1

Circulation HR: 144 min-1, BP 65/30 mmHg

Disability Under anesthesia

Exposure Cyanotic

Trauma

World Congress of Ophthalmic Anaesthesia Ankara/TURKEY, 24-25 May 2012

WHAT WILL WE DO NOW?

Trauma

World Congress of Ophthalmic Anaesthesia Ankara/TURKEY, 24-25 May 2012

ABCDE approach

Oxygen, IV access

Recognise pneumothorax on right side (oscultation)

IV fluids

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Trauma

World Congress of Ophthalmic Anaesthesia Ankara/TURKEY, 24-25 May 2012

PATIENT COLLAPSES

Trauma

Check monitor/confirm rhythm/check pulseCall resuscitation team / help2 min CPR (30:2)

Airway/ventilation/oxygen

Give adrenaline 0.5mg iv

Treat reversible causes

Call for expert helpDecompressive thoracostomy

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ASYSTOLE

World Congress of Ophthalmic Anaesthesia Ankara/TURKEY, 24-25 May 2012

ASYSTOLE

Trauma

2 min CPR (30:2)

Airway/ventilation/oxygen

2 min CPR (30:2)

Give adrenaline 0.5 mg iv

2 min CPR (30:2)

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ASYSTOLE

World Congress of Ophthalmic Anaesthesia Ankara/TURKEY, 24-25 May 2012

ASYSTOLE

Trauma

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Check monitor/confirm rhythm

Check patient (signs of life / pulse)

Investigations/Transfer to ICU

Post resuscitation care

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√

√

SR

World Congress of Ophthalmic Anaesthesia Ankara/TURKEY, 24-25 May 2012

Trauma

World Congress of Ophthalmic Anaesthesia Ankara/TURKEY, 24-25 May 2012

Simulation in Emergencies        

World Congress of Ophthalmic Anaesthesia Ankara/TURKEY, 24-25 May 2012

TURKISH RESUSCITATION SOCIETY

Prof Agah CERTUG Ege University, Turkey

Assoc Prof Handan BIRBICER Mersin University, Turkey

Assoc Prof Nurcan DORUK Mersin University, Turkey

Assoc Prof Pinar ZEYNELOGLU Baskent University, Turkey

Assoc Prof Sule AKIN Baskent University, Turkey

THANK YOU