Crisis management:

**NEEDS WORK**

Principles:

Spiel

· Most likely cause is…

· Things I would want to rule out are…

· Systematic approach to other causes

Breaking the rules

· Must not follow protocol when counterproductive

Examples:

· Arrest due to large vessel injury -> stop CPR to fix

· Arrest due to hypoxia -> stop CPR to intubate

· Agitated trauma patient -> ketamine before primary survey

· Child with full stomach -> inhalational induction if no other choice

Bleeding

Preparation:

· Access: big IV, A-line

· Warming: air, liquid

· Products: cross-match, cell-saver

Approach:

· Haemostasis: stop bleeding, promote clotting

· Resuscitation: ensure oxygen delivery

Foetal distress

Interventions:

· Left lateral

· Fluid

· Vasopressor

· Tocolytic

Monitoring:

· Maternal vital signs

· CTG

· Scalp lactate

Total spinal

· A: jaw thrust

· B: 100% O2, bag and mask

· C: left lateral, fluid, pressor

· D: N.B. patient is likely conscious

· F: intra-uterine resus

Patient and family	· Medical care · Open disclosure · Support system referral
Anaesthetist	· Death certificate · Notify MDO
Team	· Optional debrief · Offer to send them home · Call head of department · Call hospitals co-ordinator
Quality improvement	· ISR 4 (near miss / no harm) -> department M&M · ISR 2-3 (i.e. mild-mod harm) -> hospital M&M · ISR 1 (i.e. severe harm or death) -> state