ALERT/READY Call for help/trolleys (1), (2)

C O V E R    A B C D     A     SWIFT CHECK

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C

Circulation: If there is an impending arrest allocate the "circulation" task (1) and ask for the arrest trolley to be fetched.

Colour:: If the oximeter is suspect, resite or replace it and/or do an arterial blood gas. Consider inserting an arterial line.

O

Oxygen: If adequate saturation cannot be confirmed, administer 100% oxygen. Plan how to provide analgesia and anaesthesia.

Oxygen Analyser: Confirm that the gas in the inspired limb of the breathing circuit is 100% oxygen.

V

Ventilation: Allocate the "airway and breathing" task (1). Ventilate with a self-inflating bag. See Person 1 below.

Vaporisers: Turn the vaporiser off if there is cardio-respiratory compromise. Check vapor analyser readout.

                    Plan how to provide analgesia and  anaesthesia.

E

Endotracheal tube or laryngeal mask airway: Allocate the "equipment" task (1). If suspicious, prepare to remove and change the tube or LMA.

Eliminate: Prepare & check the correct function of an alternate breathing system and separate oxygen source.

R

Review monitors: Recheck, correlate and record all readouts and trends. Call for additional monitors as necessary.

Review equipment: Remove or replace suspect equipment. Bring in additional emergency equipment as appropriate.

A

Airway: Adjust head and neck, attempt gentle chin lift. Prepare for pharyngoscopy; if suspicious, go to airway obstruction.

B

Breathing: Expose the chest and abdomen. Repeat SCAN and CHECK whilst comparing L & R sides. Consider causes.

C

Circulation:   Check IV access. Secure additional access (venous & arterial) as necessary. Prepare to transfuse.

D

Drugs:   Allocate the "drugs" task (1).& (2). Check all drugs & infusions & the entire IV apparatus. Draw up, check & label drugs that may be needed.

A

AAAA:  Decide whether Awareness, Air (or other) embolism, Air in pleura (pneumothorax), Allergy and Anaphylaxis are possible causes of the problem, and act accordingly (see Algorithms).

SWIFT CHECK

SWIFT CHECK: Make another assessment of the general situation, of the patient, of the activities of the surgeon and other personnel, and of the possible effects of the operation and/or any drugs or infusions.

NOTES:

(1) Call for Help - Allocate Tasks

TASKS: Airway (A), Breathing (B), Circulation (C), Drugs (D), Equipment (E).

PERSON 1: Initially the anaesthesiologist - to look after A, B, overall coordination and cycling through COVER and the appropriate Algorithm/s. When skilled assistance is available the anaesthesiologist may delegate A, B, and concentrate on coordinating activities and checking Algorithms.

PERSON 2: The anaesthetic assistant. This person should be primarily responsible for D, E, although may be deployed by the anaesthesiologist to other tasks.

PERSON 3: This person should look after C. If there is a cardiac arrest, this person should be responsible for ECC.

PERSON 4: To be deployed by the anaesthesiologist. If there is a cardiac arrest, this should be the second person looking after C, ensuring good intravenous access, injection of intravenous drugs, and ensuring they are flushed through.

PERSON 5: This person and any other available people should be deployed by the anaesthesiologist. It is most important that each person be given a specific task, eg. "Can you independently assess the situation, go through COVER and sub-algorithms X and Y, and check that all is going to plan"? OR "Please help the anaesthetic assistant getting drug Z ready", OR " Please help Person 3 (or 4) get the defibrillator ready".
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(2) Emergency Equipment & Drug Trolleys

Standard sets of equipment and drugs should be available on trolleys which can be brought in, or in drawers on the anaesthetic machine. The following should be available:

Airway Equipment I (Standard)
Airway Equipment II (Difficult intubation)
Breathing Equipment I (Standard)
Breathing Equipment II (Pleural drainage / bronchoscopy)
Circulatory Equipment I (Standard)
Circulatory Equipment II (Cardiac Arrest)
Drugs - Emergency I (Standard)
Drugs - Emergency II (For unusual problems)
Equipment Extras I (Spare set of monitors)
Equipment Extras II (For unusual problems)

The contents of a typical Emergency Trolley are provided in the Appendix 4

Dosages of drugs in mg/kg and/or mcg/kg used in adults and in children are provided
     in the Appendices 1-3.

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