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

Anaphylaxis
Acute Coronary Syndrome
Trauma

Anaphylaxis

Anaphylaxis
 A 62-year-old man
 Cataract surgery
 Monitored Anesthesia Care
 Midasolam (2mg)
 Retrobulbar block
 Local anesthetic injection (Bupivacaine, 0.5%, 25mg)

Anaphylaxis
 Oxygen (Nasal cannula, 3 L/min)
 SABP/DABP : 140/80 mmHg
 HR: 86/min
 SpO2: 97%

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

Anaphylaxis

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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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

Anaphylaxis
Check monitor/confirm rhythm
1st shock at appropriate energy (150 J)
2 min CPR (30:2)
2nd shock at appropriate energy (max.:270 J)
2 min CPR (30:2)
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VF
VF

Anaphylaxis
Check patient (signs of life /pulse)
Investigations /Transfer to ICU
Post resuscitation care
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SR

 A 55-year-old woman
 Vitrectomy
 DM, ASHD Plan: General anesthesia
 Before anesthesia induction; chest pain
 ST elevation on ECG

 Oxygen (Face mask, 10 L/min)
 SABP/DABP : 100/70 mmHg)
 HR: 98/min
 SpO2: 96%

Airway Clear
Breathing RR 22 min-1
Disability Verbal response, anxious
Exposure Pale

ABCDE approach
Oxygen, IV access
Recognise acute coronary syndrome/blood samples
Morphine
Aspirin, 300mg, p.o.
Nitrate
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PATIENT COLLAPSES

Check monitor/confirm rhythm/CHECK PULSE
1st 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
VT

3rd shock (270 J)
2 min CPR (30:2)
Give adrenaline, 1mg iv
Give amiodarone, 300 mg iv
4th shock (270 J)
2 min CPR (30:2)
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VF
VF
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Check patient (signs of life / pulse)
Investigations /Transfer to ICU
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SR

Trauma

Trauma
 A 12-year-old boy (BW:35 kg)
 Traffic accident
 Scleral perforation repair
 Emergent case
 Plan: General anesthesia

Trauma
 Oxygen (Face mask 8 L/min)
 HR: 132/min
 SpO2: 92% After Intubation:
 HR: 144/min
 SpO2: 89%

Airway Endotracheally intubated
Breathing RR 24 min-1
Disability Under anesthesia
Exposure Cyanotic
Trauma

Trauma

ABCDE approach
Oxygen, IV access
Recognise pneumothorax on right side (oscultation)
IV fluids
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Trauma

PATIENT COLLAPSES
Trauma

Check monitor/confirm rhythm/check pulse
2 min CPR (30:2)
Give adrenaline 0.5mg iv
Treat reversible causes
Call for expert help
Decompressive thoracostomy
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ASYSTOLE
ASYSTOLE
Trauma

2 min CPR (30:2)
2 min CPR (30:2)
Give adrenaline 0.5 mg iv
2 min CPR (30:2)
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ASYSTOLE
ASYSTOLE
Trauma
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Check patient (signs of life / pulse)
Investigations/Transfer to ICU
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SR
Trauma

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

Simulation in emergencies 24-25 may 2012

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