ANS 5160 Intro to Clinical Anesthesia (Lecture
10)
Physicians: anesthesiologist, anesthesiology fellow, anesthesiology residents
Anesthetists: CAA, SAA, CRNA, SRNA
Who is responsible for pre- MDA and CAA/CRNA
anesthetic evaluation of the
patient?
Who is responsible for MDA
prescribing the anesthetic
plan?
Who is responsible for CAA/CRNA
management of the anesthetic?
Who is responsible for post- MDA
anesthesia care?
Who is responsible for MDA
anesthesia consultation?
CAAs are not "supervised" they medically directed
are ___________
physical proximity that allows anesthesiologist to re-
Definition of "immediately
available" establish direct contact with pt to meet medical needs and
urgent/emergent clinical problems
More than of errors in 70%
medicine can be
attributed to human factors,
not knowledge or practical
skills
Goal of CRM coordinate, use, & apply all resources to protect and help pt
Know the environment concepts available resources (personnel, supplies, equipment)
- consider requirements
Anticipate and plan concepts - anticipate unexpected
- stay ahead
, - know your limitations
Call for help early concepts - trying to handle everything is dangerous
- triggers to call for help
- task saturated
- situation catastrophic
Triggers to call for help:
- problem getting worse or not responding
- don't know what is going on
- planning, deciding, distributing tasks
Leadership concepts
- NOT knowing more than anyone else
- listen to leader and do what is neede
Followership concepts
- NOT turning off your brain
- leader distributes
Distribute the workload concepts - team leader remains free of tasks
- observe, gather information, delegate tasks
"10 seconds for 10 minutes" slow down for rational decision-making
- use everyone / everything to deal w problem
Mobilize ALL available resources
concepts - not a weakness to ask for help
- turn off music
Communicate effectively - be open to what others suggest
concepts - let team members know what you think
Primary information (immediately patient, monitors, anesthesia record
available)
Secondary information chart, cognitive aids, anesthesiologist, internet, surgeon, OR staff
- correlate information from different sources
- review completed steps & upcoming steps
Cross-check and double check
- 3 ind sources of info about HR (ECG, pulse ox, IBP)
concepts
- 2 ind sources of info about ECG (ECG, pulse ox)
- checklists, handbooks, calculators
Cognitive aids concepts
- memory is vulnerable to errors
Re-evaluate repeatedly medicine is dynamic
- look out for each other
Implement principles of good - closed-loop communication
teamwork - coordinate activities
- human attention limited and multitasking is difficult
Allocate attention wisely - focus on details vs focus on big picture
concepts - offload tasks to other team members
- dynamic situations require dynamic measures
Set priorities dynamically - what was right before may not be right now
- what was wrong before may not be wrong now
As soon as you notice a inform team, call for help, code chart
problem...
CPR 100, 2
> ___ compressions/min and > ___"
deep
CPR minimal
You want_breaks in CPR
10)
Physicians: anesthesiologist, anesthesiology fellow, anesthesiology residents
Anesthetists: CAA, SAA, CRNA, SRNA
Who is responsible for pre- MDA and CAA/CRNA
anesthetic evaluation of the
patient?
Who is responsible for MDA
prescribing the anesthetic
plan?
Who is responsible for CAA/CRNA
management of the anesthetic?
Who is responsible for post- MDA
anesthesia care?
Who is responsible for MDA
anesthesia consultation?
CAAs are not "supervised" they medically directed
are ___________
physical proximity that allows anesthesiologist to re-
Definition of "immediately
available" establish direct contact with pt to meet medical needs and
urgent/emergent clinical problems
More than of errors in 70%
medicine can be
attributed to human factors,
not knowledge or practical
skills
Goal of CRM coordinate, use, & apply all resources to protect and help pt
Know the environment concepts available resources (personnel, supplies, equipment)
- consider requirements
Anticipate and plan concepts - anticipate unexpected
- stay ahead
, - know your limitations
Call for help early concepts - trying to handle everything is dangerous
- triggers to call for help
- task saturated
- situation catastrophic
Triggers to call for help:
- problem getting worse or not responding
- don't know what is going on
- planning, deciding, distributing tasks
Leadership concepts
- NOT knowing more than anyone else
- listen to leader and do what is neede
Followership concepts
- NOT turning off your brain
- leader distributes
Distribute the workload concepts - team leader remains free of tasks
- observe, gather information, delegate tasks
"10 seconds for 10 minutes" slow down for rational decision-making
- use everyone / everything to deal w problem
Mobilize ALL available resources
concepts - not a weakness to ask for help
- turn off music
Communicate effectively - be open to what others suggest
concepts - let team members know what you think
Primary information (immediately patient, monitors, anesthesia record
available)
Secondary information chart, cognitive aids, anesthesiologist, internet, surgeon, OR staff
- correlate information from different sources
- review completed steps & upcoming steps
Cross-check and double check
- 3 ind sources of info about HR (ECG, pulse ox, IBP)
concepts
- 2 ind sources of info about ECG (ECG, pulse ox)
- checklists, handbooks, calculators
Cognitive aids concepts
- memory is vulnerable to errors
Re-evaluate repeatedly medicine is dynamic
- look out for each other
Implement principles of good - closed-loop communication
teamwork - coordinate activities
- human attention limited and multitasking is difficult
Allocate attention wisely - focus on details vs focus on big picture
concepts - offload tasks to other team members
- dynamic situations require dynamic measures
Set priorities dynamically - what was right before may not be right now
- what was wrong before may not be wrong now
As soon as you notice a inform team, call for help, code chart
problem...
CPR 100, 2
> ___ compressions/min and > ___"
deep
CPR minimal
You want_breaks in CPR
