simulation in emergencies 24-25 may 2012
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Simulation in emergenciesTRANSCRIPT
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