Professional Flashcards
PROFESSIONALISM – INFORMED CONSENT
[21B09] Describe the elements of informed consent for anaesthesia (50%).
Discuss the informed consent process in the context of the following situations (50%):
- A 20yo primip in late first stage of labour requests epidural analgesia
- A 15yo is scheduled for posterior spinal instrumentation for severe idiopathic scoliosis.
PS 26
Element inf con
-legal requirement - consent - all med rx
- respect for auto and prov of rel info
3 important elements
1. Voluntary
2.** Informed**
BRAN
- **Capacity **
- presumed capacuty
- transient (sed/intox)
- not binary
documentation
Labour epidural
- pain distracting, not fully informed
*best to provide ifo, but cont with procedure
- offer revisit post
- document of discussion occurred
15yo spinal for scoliosis
- risk of GA (high risk surgery)
- use of morbidity/mortality calculators
- risk of prone (visual loss/nerve damage)
- consenting teenager / guardian issues
V I C
I BRAN
PROFESSIONALISM – Rational use of sugammadex
[21A07] Your department has exceeded its drug budget for the last financial year. You have been asked to develop a departmental policy document for the rational use of sugammadex.
Discuss the issues to be considered.
-
Clinical justification
a) PORC
b) rapid emergency reversal
- CICO
c) residual paralysis post neo
- TOF still < 2
d) neo CI
Abs - hypersen
Rel - peritonitis/mech obs
Cau - CAD, arry, ACS, MG, asthma, DMD -
Economic justification
- Waiting for TOF > 2
- Cost of NMT devices
Resource - justify on CLINICAL and ECON ground
PROFESSIONALISM - Fatigue
[20B13] You have been asked to formulate guidelines for your department on managing fatigue. a. List the hazards associated with fatigue in the practice of clinical anaesthesia.(30%)
b. Outline your guidelines and discuss the potential consequences of their implantation.(70%)
PS 43 - Fatigue
HAZARDS
1. Pt
2. Dr
Consequences
1. Indiv
- Org
Hazard: 1. pt 2. dr
Consequences: 1. Indiv 2. Org
PS43
(38.4%) The first part of the question required a list with consideration of both patient and doctor hazards.
The second part of the question required consideration of:
1. Practitioner and departmental/organisational responsibilities in managing fatigue.
2. Potential consequences of implementation of the guidelines for anaesthetists, patients and the organisation
Fatigue is an important issue and the subject of an ANZCA statement (PS43 Statement on Fatigue and the Anaesthetist) and AAGBI guidelines. Candidates are referred to the ANZCA statement and AAGBI guidelines for further reading.
PROFESSIONALISM – Substance abusing colleague
[20A07] You are concerned about the possibility of substance abuse by a consultant colleague. a. Describe the signs that are suggestive of substance abuse in a colleague.(50%)
b. Outline the steps that should be followed if this is suspected.(50%)
RD 20
Signs
1. Major
2. Circumstantial
Steps if suspected
Collect
Verification
Intervention
Treatment
RTW
RD20
CoVInTR
PROFESSIONALISM – Minimising surgical site infection
[19B10] Describe the role of the anaesthetist in minimising surgical site infection.
PG 28
1. Leaders - policy
2. Infection - pt / provider/ envir
3. Appr TIME and CHOICE
4. Avoid hypoT
PG28
(45.8%) The following points required consideration in an answer to achieve a pass mark:
1. Anaesthetists are leaders in observing policy/protocol on institutional infection control 2. Infection risk is broken down into patient/provider/environmental reservoirs
3. Appropriate choice and timing of antibiotic prophylaxis
4. Avoidance of patient hypothermia
It is of note that some candidates answered in relation to infection in general rather than surgical site infection which may reflect not reading the Q carefully.
PROFESSIONALISM - Debriefing
[19B05] A patient dies soon after induction of anaesthesia. As a senior clinician you are asked to arrange a debriefing. Outline the considerations.
RD 05
Answer
When arranging a debriefing after a critical incident like a patient death post-induction, use the DEBRIEF mnemonic to ensure comprehensive support and systemic learning:
Dedicated Environment
- Provide a private, confidential space for discussion (mandatory for psychological safety).
- Offer immediate relief from clinical duties to affected staff.
Emotional & Psychological Support
- Acknowledge the “second victim” phenomenon (severe emotional impact on clinicians).
- Involve trained psychologists, mentors, or empathetic colleagues to address guilt, insomnia, or PTSD risks.
- Normalize accessing support to reduce stigma (e.g., departmental education).
Breach Prevention (Confidentiality)
- Strictly limit disclosures to those directly involved.
- Avoid discussing details with uninvolved personnel, despite curiosity.
Root Cause Analysis (RCA)
- Initiate RCA to identify systemic contributors (e.g., equipment failure, communication gaps).
- Share RCA findings with the team to contextualize errors and reduce blame.
Individual vs. Team Needs
- Individual: Customize debriefing (e.g., mentor sessions, psychological support).
- Team: Prioritize groups with established working relationships (ad hoc teams benefit less).
- Allow participants to opt out of group sessions if uncomfortable.
Expert Facilitation
- Use trained debriefers (e.g., hospital CIS personnel, psychologists).
- Include legal/patient liaison teams if open disclosure to families is required.
Follow-Up & Legal Safeguards
- Document: Record facts (not opinions), notify medical defence organisations (MDOs), and retain copies.
- Long-term: Offer repeated check-ins, even after initial refusal.
- Legal: Guide clinicians on apology wording (e.g., “I regret this happened,” avoiding fault admission).
Key Considerations from RD 05:
- Avoid mandatory single-session debriefing (linked to negative outcomes in pre-existing PTSD).
- Address potential long-term consequences (substance abuse, career withdrawal) proactively.
- Ensure RCA outcomes lead to systemic improvements (e.g., protocol updates).
This structured approach balances immediate emotional needs, confidentiality, systemic learning, and medico-legal protection.
Citations:
[1] https://ppl-ai-file-upload.s3.amazonaws.com/web/direct-files/49558506/c5dc741b-41c9-4007-94c2-fc138298d2e4/RD_05_Critical_Incident_Support_2016.pdf
Answer from Perplexity: pplx.ai/share
PROFESSIONALISM – MRI scanner
[19B04] Describe the requirements for establishing an anaesthetic service for a neurosurgical theatre with a magnetic resonance imaging scanner.
PS55 app 1 - emerg meds
PS07 PAC
PS04 PACU
- Consultation
- Design
- Location
- Equipment
- MRI safe equipment
- Emerg meds
- Staff training
- Pt screening
- Contrast
To establish an anaesthetic service for a neurosurgical theatre with an intraoperative MRI scanner, the following requirements must be addressed:
MRI-Compatible Equipment
- Anaesthesia machines and monitors must be MR-safe (e.g., GE Aestiva/5MRI™, Draeger Fabius™) or MR-conditional (e.g., Truphatek™ laryngoscopes)[2][4].
- Infusion pumps, ventilators, and physiological monitors (ECG, pulse oximetry, blood pressure) must function safely within the magnetic field[2][4].
- Avoid MR-unsafe items (e.g., standard laryngoscopes, ferromagnetic equipment) in Zone IV (MRI scanner area)[2][5].
Safety Protocols
- Implement MRI safety checklists to verify removal of incompatible devices before scanning[2][3].
- Define zoning protocols (e.g., Zones II–IV) to restrict equipment and personnel access based on magnetic field exposure[2][5].
Staff Training
- Conduct simulated drills for emergencies (e.g., quench, cardiac arrest) and routine workflows[2][3].
- Train staff on MRI safety principles, including projectile risks and device compatibility[2][5].
Infrastructure Design
- Dedicate an anaesthesia induction/emergence bay outside the MRI suite to minimize magnetic field interference during critical phases[5].
- Ensure adequate space for anaesthesia equipment and patient transfer between surgical and MRI areas[5].
Emergency Preparedness
- Maintain MRI-safe resuscitation equipment (e.g., non-ferromagnetic defibrillators) in Zone IV[2][3].
- Establish protocols for rapid patient evacuation during scanner malfunctions[2].
Collaboration and Workflow
- Involve anaesthetists in planning room layout to optimize patient flow and equipment placement[5].
- Coordinate with MRI safety experts to validate equipment compatibility for the specific scanner[3][5].
Mnemonic: MRI SAFE
- MRI-compatible equipment
- Regular safety drills
- Infrastructure zoning
- Safety checklists
- Anaesthesia bay setup
- Field-specific equipment testing
- Emergency protocols
These steps ensure patient safety, compliance with guidelines, and seamless integration of anaesthetic services in a high-field MRI neurosurgical environment[2][3][5].
Citations:
[1] https://academic.oup.com/bjaed/article/12/3/140/258564
[2] https://pmc.ncbi.nlm.nih.gov/articles/PMC6004746/
[3] https://pmc.ncbi.nlm.nih.gov/articles/PMC7616168/
[4] https://touchneurology.com/brain-trauma/journal-articles/anaesthetic-concerns-for-patients-undergoing-neurosurgical-procedures-utilising-intra-operative-magnetic-resonance-imaging/
[5] https://pubmed.ncbi.nlm.nih.gov/19224077/
[6] https://snacc.org/wp-content/uploads/2018/11/SNACC-Quiz-44-Anesthesia-for-MRI-Final-2.pdf
[7] https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/958486/MRI_guidance_2021-4-03c.pdf
[8] https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/anae.14578
[9] https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Premedication_for_anaesthesia/
[10] https://www.nationalauditprojects.org.uk/NAP5Doc_AAGA_during_induction_of_anaesthesia_and_transfer_into_theatre?fn=chapter8.pdf&mime=application%2Fpdf&pureFn=chapter8.pdf
[11] https://airr.anzca.edu.au/anzcajspui/bitstream/11055/956/1/Australasian%20Anaesthesia%202015.pdf
Answer from Perplexity: pplx.ai/share
PROFESSIONALISM – PACU / discharge criteria
[19A06] Describe your responsibilities as the anaesthetist before you leave your patient in the post anaesthesia care unit (PACU). (50%)
Your patient has been in the PACU for an hour. The nurse asks you to change the discharge criteria so the patient can be discharged to the ward. Discuss your decision making process following this request. (50%)
PS53 - ho resp
PS04 - PACU
