Case Studies of Near Misses in Clinical Anesthesia by John G. Brock-Utne

By John G. Brock-Utne

All anesthesiologists finally face the terror of a close to omit, while a sufferer s existence has been placed in danger. studying from the event is essential 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 rigorously chosen situations that supply the foundation for classes and tips on how to hinder strength catastrophe. The situations emphasize problem-centered studying and span a vast diversity of issues from a scourge of working room an infection (could or not it's the anesthesia equipment?), problems of fiberoptic intubations, and issues of epidural drug pumps, to appearing an pressing tracheostomy for the 1st time, operating with an competitive doctor, and what to do while a sufferer falls off the working desk in the course of surgery.80 true-story medical close to misses by no means ahead of released, excellent for problem-centered studying, options, references, and discussions accompany such a lot circumstances, wealthy foundation for instructing discussions either in or out of the working room, settings comprise refined in addition to rudimentary anesthetic environments, enhances the writer s different case ebook, "Clinical Anesthesia: close to Misses and classes Learned" (Springer, 2008)."

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The endotracheal tube (ETT) is loaded on the fiberscope and a long catheter is inserted through the forceps port of the fiberscope. This catheter is used to administer local anesthesia on the vocal cords should that be needed. Excellent local anesthesia and sedation is achieved, without the use of the long catheter. The fiberscope and the ETT are easily inserted into the trachea. The cuff on the ETT is blown up. The patient remains comfortable and shows little sign of distress with the ETT in the trachea.

The correct placement of the ETT is confirmed with auscultation and end-tidal CO2 waveform. The patient is then ventilated using an Apollo machine (Drager Medical, Telford, PA) with a tidal volume of 8–10 mg/kg and at a rate of 10–12 bpm. This Apollo machine can generate pressure volume (P/V) curves that can be visualized on the machine display. 5%. You are concerned that pneumoperitoneum ­cannot be adequately maintained since no muscle relaxation is used. However, this proves to be no problem [3].

An endotracheal tube, PA catheter, and a TEE are all placed successfully. m. The patient’s vital sign remains stable. 5 mmol/L. 4 mmol/L. You note that the urine output has been 200 mL since the start of surgery. The amount of IV NaCl is 1,200 mL. No potassium or blood products have been given. The blood sugar is normal. Question What will you do and what can be the problem? G. 1007/978-1-4419-1179-7_5, © Springer Science+Business Media, LLC 2011 15 16 5 Case 5: Hyperkalemia During Coronary Artery Bypass Graft Solution Slowly administer calcium chloride 500 mg and frusemide 5 mg, 10 units of IV insulin, and one ampoule of 50% dextrose solution.

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