By John G. Brock-Utne
All anesthesiologists finally face the terror of a “near miss,” while a patient’s existence has been positioned at risk. studying from the adventure is important to professionalism and the continued improvement of workmanship. Drawing on forty-plus years of perform in significant metropolitan hospitals within the usa, Norway, and South Africa, John Brock-Utne, MD offers eighty conscientiously chosen instances that supply the root for classes and the way to hinder strength catastrophe. The situations emphasize problem-centered studying and span a wide variety of topics—from a plague of working room an infection (could it's the anesthesia equipment?), complications of fiberoptic intubations, and issues of epidural drug pumps, to acting an pressing tracheostomy for the 1st time, operating with an competitive healthcare professional, and what to do while a sufferer falls off the working desk in the course of surgery. 80 true-story scientific “near misses” by no means ahead of released, excellent for problem-centered studying, suggestions, references, and discussions accompany such a lot situations, wealthy foundation for educating discussions either in or out of the working room, settings comprise refined in addition to rudimentary anesthetic environments, enhances the author’s different case publication, medical Anesthesia: close to Misses and classes realized (Springer, 2008).
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Additional resources for Case Studies of Near Misses in Clinical Anesthesia
You diagnose iatrogenic venous air embolism and ask the surgeon to flood the field while you drop the head of the patient. The surgeon shouts: “Stop. ” Question What is that the surgeon wants to do before you can place the patient in Trendelenburg? G. 1007/978-1-4419-1179-7_16, © Springer Science+Business Media, LLC 2011 43 44 16 Case 16: Shoulder Surgery – Watch Out! Solution It is very important to realize that the McConnell is attached to the sidebar of the operating room table. Since the patient’s arm is on the McConnell armrest, it is locked in too.
Since she has been in Trendelenburg position for most of that time, her face and neck are very swollen. You are reluctant to remove the endotracheal tube (ETT) at the end of the surgery, although the surgeon sees no problem. You perform a leak test. This is traditionally done by auscultating the presence of breath sounds after deflating the cuff and occluding the ETT. You have difficulty hearing if an audible leak is present at the mouth . You attempt the cuff-leak volume test (difference between inspiratory tidal volume and expiratory tidal volume while the cuff is deflated).
Anesth Analg. 2002;94:762. Chapter 16 Case 16: Shoulder Surgery – Watch Out! Today you are anesthetizing a 38 year old man (90 kg and 185 cm) for shoulder reconstruction. The patient is otherwise healthy and does not take any medication regularly. He has not had any surgery in the past. A surgeon, you have never worked with, is going to do the surgery. The patient is anesthetized in a routine manner with fentanyl, propofol, and rocuronium. The trachea is intubated using a #9 endotracheal tube (ETT).
Case Studies of Near Misses in Clinical Anesthesia by John G. Brock-Utne