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Anaesthetics > Simulation Scenarios > Flashcards

Simulation Scenarios Flashcards

1
Q

Laryngospasm

A

Check circuit

Declare airway emergency
- likely laryngo spasm
Emergency buzzer

Pressure
Propofol 50-100ml
Paralysis - sux 100mg or roc 50mg

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2
Q

Intra op cardiac arrest

A

Check monitoring
Check CO
Declare cardiac arrest

Start CPR - take over 
Crash trolley
Pads - rhythm check ASAP
Airway - feel on bag then vent
H&T

Declare rhythm

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3
Q

Rhythm check

Shockable

A

Palpate central pulse
1st rhythm check shows
VT/VF

Handover defibrillation 
Charging cont CPR
Remove O2
Stop CPR
Clear, shocking, shocked 
Back on the chest

Time 2 minutes please
Drugs after 3rd shock
- 1mg adrenaline, 300mg amiodarone

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4
Q

Rhythm check

Non shockable

A

Palpate a central pulse
1st rhythm check shows
Asystole/ PEA

Back on chest
Time 2 mins please
1mg adrenaline and flush

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5
Q

ROSC

A

ABCDE
BOXES

Bloods, lines, art 
Obs 
X-ray 
ECG 
Somewhere safe 
Family
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6
Q

Hs

A

Hypoxia
Hypotension
Hyperkalaemia - other metabolic
Hypothermia

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7
Q

Tx

A

Tension
Thrombus
Toxin - drug chart, allergies
Tamponade - echo

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8
Q

CICO

A 
A: ETT
Cricoid, BURP
Runner - help, cMAC
Position, cMac, blade 
Declare - can’t intubate - help
Gentle ventilation

B: SGA (oxygenation)
IGel 4, size, LMA
declare failed supraglottic device

C: BVM
2 hand guedel, NP, APL
Paralyse - sux/roc 
Ambu Bag 
Declare CICO

D: front of neck
10blade, bougie, ETT size 6

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9
Q

CI can oxygenate

A

Place of safety

Options 
Wake patient up
Intubate via SAD 
Proceed without intubation 
Tracheostomy
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10
Q

RSI

Checklist

A 
Suction 
Personel; names, help
Equipment 
ETCO2 
Drugs
Bed; position, tilt
O2; etO2>90
Monitor
Brief: ABCD
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11
Q

Aspiration

A

Declare airway emergency
- patient aspirating

Head down
Suction 
Paralyse, sux/roc 
Intubate 
Ventilate 
Art line/bronch/ITU
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12
Q

LA toxicity

A

Declare anaesthetic emergency

  • likely LA toxicity
  • help, buzzer
Stop LA
100% O2
Tx seizure - Loraz 4mg/ propofol 
Tx Brady/tachyarrhythmia 
Tx intralipid 
- 1.5ml/kg bolus and 15ml/kg/hr infusion
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13
Q

Cricothyroidotomy

A 
Stand patient Left 
Laryngeal handshake
Identify landmark 
Stabilise 
10blade and twist inferior 
Switch hands 
Bougie ~10cm
ETT size 6
Inflate, ventilate
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14
Q

Massive haemorrhage

A

Declare massive haemorrhage
Buzzer, 2222, hand s

Definitive Tx?

2x wide bore cannula 
IV fluids
Shock pack, level 1 infuser
Cell salvage 
TXA 1g
Calcium chloride 10ml
Bloods/ Rotem 
Reverse hypothermia, acidosis, coagulopathy
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15
Q 
Blood goals in major haemorrhage and Tx 
Hb 
INR
Fibrinogen 
Plt
iCa
K
A 
Hb >70
INR <1.5 Tx FFP
Fibrinogen >1.5 Tx cryoprecipitate (2pools)
Plt >75 
iCa >1 (10ml CaCl)
K<5.5 (insulin dex)
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16
Q

Malignant hyperthermia

A 
Declare likely MH 
Stop all triggers
Help 
New breathing system 
100% O2, hyperventilate 
TIVA 
Stop surgery ASAP
Non depol NM blocker

Tx dantrolene: 2.5mg/kg
Monitor K, arrhythmia, acidosis, myoglobinaemia, coagulopathy

17
Q

Unstable arrhythmia

A

Declare emergency
Help

Shock+- sedation
Syncope
Ischaemia
Heart failure

Tx
Synchronised DC shock x3
Amiodarone 300mg repeat

18
Q

Stable narrow complex tachy

A

Regular

  • modified valsalva
  • adenosine 6,12,12

Irregular

  • metoprolol upto 5mg
  • digoxin
  • amiodarone ?flecainide
19
Q

Symptomatic bradycardia Tx

A 
Atropine 500mcg
Get pacing ready 
Sedation 
D/W cardiology Reg 
- transvenous pacing
20
Q

Tracheostomy issue

A

Assess: waters circuit, capnography
Breathing? CO?
Declare emergency, help

High flow O2 x2 
Remove inner tube 
Suction
Deflate cuff 
Remove tracheostomy 
BVM either tracheostomy or mouth
Intubate trache or orally
21
Q

Anaphylaxis

A 
Declare emergency, help
ABCDE
Adrenaline 0.5mg IM 1:1000
IV fluids 
?ETT
Hydrocortisone 200mcg 
Piriton 10mg IV 
Bloods mast cell tryptase
22
Q

Sepsis

A

ABCDE
Take 3: lactate, cultures, U/O
Give 3: O2, fluids, Abx

No response
?needs vasopressors
D/W ITU

23
Q

Coughed out tube

A

Check circuit
Feel bag
Declare airway emergency
Help, buzzer

?Deepen, paralyse
Look position (laryngoscope)
?Reposition 
Take it out
BVM, vortex

Safe place; options
Wake up, ETT, iGel

24
Q

Handover patient

A 
Age 
Operation, position 
HPC
BG 
Allergies, Medications 
Reflux, Fasted 
Airway assessment 
Cannula 
Drugs 
Issues so far?

Anaesthetics (5 decks)

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