Crisis in Remote Areas Is Not a Remote Problem: In-situ Crisis Management Training for Procedures Outside the O.R

Authors: Jeff Simmons, M.D. et al

ASA Monitor 05 2016, Vol.80, 16-18.

Scenario: You have just performed the most altruistic act in the practice of anesthesia: giving a lunch break to someone in the GI lab. Of course, the ERCP is just getting started and the morbidly obese patient has just been positioned prone. He is sedated on a propofol drip, mouth stretched open with a green plastic ring, oxygen saturations holding steady at 95 percent for the moment. The procedure begins and the advancing endoscope does its job inciting gagging and coughing, necessitating a pause in the surgery as propofol is titrated. Unfortunately, this patient’s physiology is not accepting of the combined insult of surgery, breathing spontaneously and intravenous sedation. Airway maneuvers performed have minimal effect. Then the moment declares itself and crisis is upon you. Within seconds, the stable patient has become the opposite and all eyes are on you to reverse the situation. Instantly, you realize how unfamiliar you are with the patient and surroundings. You call for help, but none comes immediately. The personnel in the room that could help are either unaware of your needs or cannot read your un-verbalized racing thoughts. The mentality of “only being here for a break” is now being tested to its fullest as you cannot find equipment necessary to correct worsening hypoxia. Confusion and stress abound until you can finally get enough hands to flip the patient supine, thrust his jaw forward and provide bag-mask ventilation. The patient is saved with no harm. You leave the GI lab frustrated, chalking the incident up as unfortunate timing.