Cardiac Arrest. Perioperative. Summary of case. Length minutes

Transcription

1 scenario overview Summary of case This 45-year-old obese patient is positioned on the OR table for left inguinal hernia repair. New Anesthesia Provider comes to the ED to relieve the current Anesthesia Provider. The patient experiences cardiac arrest after intubation but before incision is made. End point is recovery from ventricular fibrillation after CPR, defibrillation and epinephrine. Progressive Complexity Difficult airway Patient develops a blocked rhythm requiring pacing Potential Systems Explored Response time of emergency team Quality of CPR Accessibility and use of defibrillator Crisis resource management skills Use of defibrillator Length minutes Target group Multidisciplinary OR team Anesthesia Provider (MD and/or CRNA) Surgeon Surgical Assistant Circulating nurse Scrub Tech Additional team members: Anesthesia Tech, Charge Nurse, PACU RN, RT perioperative scenario 2 page 1

2 LEARNING OBJECTIVES General Learning Objectives Communicate effectively with patient/family Communicate effectively with team using crisis resource management skills Demonstrate safety initiatives including medication safety practices Demonstrate safety initiatives including workplace safety practices Maintain infection control standards Scenario Specific Objectives Recognize ventricular fibrillation Activate emergency response team in the perioperative setting Demonstrate effective CPR skills Demonstrate appropriate use of medications Demonstrate appropriate use of defibrillator Follow appropriate ACLS VF algorithm Debriefing Overview Review learning objectives Review teamwork skills Review management of the patient in cardiac arrest Review communication skills including use of SBAR What went well? What might have been done differently/better? Share key assessments and interventions/events What was learned that can be taken back to the real workplace? perioperative scenario 2 page 2

3 learner preparation Pre-session activity Review American Heart Association ACLS algorithm Briefing (patient story) The patient is a 45-year-old obese male, positioned on OR table for a left inguinal hernia repair. He has an IV of LR at 125 ml/ hr in his right arm. Initial dose of antibiotic is hanging. Three weeks ago, while patient was moving bricks, he felt something give in his left groin. Pt. immediately felt dull aching. A small, reducible 3 cm mass is noted at the left groin. Additional Information, Medical History Allergies: NKDA Medications: none Wt: 84.6 kg; 186 lbs Past Surgical History: none Glucose: 84 Hgb 11 Hct 49 Plt: 235,000 WBC 10,000 CXR normal EKG: NSR with occasional PVC Type and Cross for 2 units of packed red blood cells Social History: Single; denies use of recreational drugs; drinks 6-8 beers on weekends; non-smoker perioperative scenario 2 page 3

4 Equipment Preparation Equipment Instrument trays for inguinal hernia repair Anesthesia cart Intubation equipment Crash cart with defibrillator IV and IVPB solutions IV pump Step stool Backboard Medications Antibiotics Benzodiazepine Anesthesia Induction Agent Narcotic (Fentanyl) Non-depolarizing agent Depolarizing agent Desflurane/anesthesia gas Vasopressor (epinephrine/vasopressin) Room Preparation OR Set up for inguinal hernia repair operation Simulator Preparation SimMan 3G dressed in hospital gown, ID and allergy band IVLR right arm infusing at 125 ml/hr IVPB with antibiotic infusing Surgical site initialed by patient and surgeon Standard ASA monitors perioperative scenario 2 page 4

5 Events / Proposed Correct Treatment Documentation: Electronic Patient Record Identify problem Communicate effectively with team Request crash cart Maintain perioperative safety initiatives Anesthesia Induction Benzodiazepine Anesthesia induction agent (Propofol) Narcotic (Fentanyl) Non-depolarizing agent Depolarizing agent Desflurane/anesthetic gas Intubate Verify placement Secure airway adjunct Connect ventilator Quality CPR Defibrillate Vasopressor Epinephrine Communicate effectively with patient/family perioperative scenario 2 page 5

6 PerioPerative algorithm Start HR 66 RR 12 BP 118/68 T 37.1 (98.9) SpO2 98%-100% with pre O2 Expected Pathway Caution/review Induction/intubation Ventricular Tachycardia with PVC to Coarse Ventricular Fibrillation Quality CPR Defi brillate CorreCt interventions WitHiN 3 MiNUteS DeLaYeD/iNCorreCt interventions Coarse Ventricular Fibrillation Fine Ventricular Fibrillation Quality CPR Vasopressor Defi brillate Quality CPR Vasopressor Defi brillate CorreCt interventions WitHiN 10 MiNUteS DeLaYeD/iNCorreCt interventions CorreCt interventions WitHiN 5 MiNUteS DeLaYeD/iNCorreCt interventions Sinus bradycardia Trend over 2 minutes HR 70 RR ventilated per anesthesia BP 110/60 Asystole perioperative scenario 2 page 6