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⼿术室应急⼿册围⼿术期紧急事件认知辅助2016,V3.0中⽂第⼆版斯坦福⿇醉⼿术室应急⼿册创作⼩组紧急电话：⾼级⽣命⽀持（⽤于围⼿术期）⼼脏骤停………………………………………1⼼动过缓–不稳定……………………………2⽆脉电活动……………………………………3室上性⼼动过速–稳定……………………4室上性⼼动过速–不稳定………………………5VF/VT…………………………………………6⼲义鉴别诊断低⾎压…………………………………………15低氧⾎症………………………………………16特殊紧急事件⽺⽔栓塞………………………………………7过敏反应………………………………………8⼼脏骤停………………………………………1⼼动过缓–不稳定……………………………2⽀⽓管痉挛……………………………………9苏醒延迟………………………………………10未预料的困难⽓道……………………………11⽓道着⽕………………………………………12病⼈着⽕………………………………………13⼤出⾎…………………………………………14低⾎压…………………………………………15低氧⾎症………………………………………16局⿇药毒性反应………………………………17恶性⾼热………………………………………18⼼肌缺⾎………………………………………19供氧故障………………………………………20⽆脉电活动……………………………………3⽓胸……………………………………………21停电……………………………………………22室上性⼼动过速－稳定……………………4室上性⼼动过速－不稳定…………………5全脊髓⿇醉……………………………………23输⾎反应………………………………………24静脉空⽓栓塞…………………………………25危机资源管理…………………………………26通讯录…………………………………………27 *CoreStanfordAnesthesiaCognitiveAidGroupcontributorslistedhereinrandomorderSteveHoward,LarryChu,SaraGoldhaber-Fiebert,DavidGaba,KyleHarrisonSee:ThisEmergencyManualhasalonghistory,evolvingfromdecadesofpriorworkonbothCrisisResourceManagement(CRM)conceptsandcognitiveaidsforcriticalincidents.The1994bookentitled‘CrisisManagementinAnesthesiology’byDr.DavidGaba,Dr.StevenHoward,andDr.KevinFishprovidedtheinitialfoundationsforthisproject.TheirsimulationgrouphasbeeninvolvedindevelopingcognitiveaidsforoperatingroomsinthePaloAltoVAandthenanationalVAproject,eachwithbulletedpointsformanycriticalevents.Observingthatpractitionersoftenmisskeyactionsunderstress,Drs.HarrisonandGoldhaber-FiebertalongwithDr.GeoffLighthall,Dr.RuthFanning,Dr.Howard,andDr.Gabadevelopedseveraliterationsofpocketcardsforperioperativecriticalevents,includingsomewithrhythmstrips,icons,andcolordesign.In2004,Dr.LarryChuconceivedofadaptingcrisismanagementcognitiveaidstoamorevisuallystrikingformatforanewbookheenvisionedfortoday’shighlyvisualmillenniallearners.ThisbecameTheManualofClinicalAnesthesiology,publishedin2011.TocreatethecurrentEmergencyManual,theStanfordAnesthesiaCognitiveAidGroupwasformed.Allteammembershavehadintegralroles.Dr.LarryChu,whodirectstheStanfordAIM(AnesthesiaInformaticsManagement)labprovidedthenewgraphicsandlayout,applyinghisdesignskillsandanunderstandingofuserinterfacetomakethecontentmoreeasilyusable.Drs.SaraGoldhaber-Fiebert,KyleHarrison,StevenHoward,andDavidGabaworkedjointlytoprovidethecontent,includingexactphrasing,ordering,andemphasis,aswellasiterativesimulationtestingtorevisebothcontentanddesignelements.Observinghowcognitiveaidsareusedbyteamsduringhundredsofsimulatedcriseshasbeencrucialforpilottestingthroughout.WehopethatthisEmergencyManualwillsupportbotheducationandpatientsafetyefforts.Effectiveusehasincludedpre-eventreview,post-eventteamdebriefing,and‘during’criticaleventmanagement—thelatterparticularlyafteradequatehelphasarrivedorwhenthepatientissufficientlystableforacliniciantopausefromacutecareactions.WeencouragetheuseofthisManualandwelcomefeedbackfromallpractitioners.Acknowledgments:Fortheirextensivefeedback,wedeeplyappreciatethefacultyandresidentsatStanfordandVAPaloAltoanesthesiadepartments,especiallyDrs.JustinPollock,BeckyWong,ChrisMiller,andTammyWang.FortheireffortsinimplementationatStanford,wethanktheentireORleadershipofnursing,surgery,andanesthesia.Wearegratefultoourchair,Dr.RonPearl,forhelpingusmakethisprojectareality.TheimplementationoftheEmergencyManualatStanfordhasbeenfacilitatedbyDr.SaraGoldhaber-Fiebert,MaryLouJackson,DianeAlejandro,Dr.BryanBohman,andAmirRubin,amongmanyothers.Referencesarenotwrittenoneacheventforspacereasons.Wehavetriedtointegratethemostpertinentclinicalinformationfrompublishedliteratureforeachevent,includingpracticalpublicationse.g.A-ACLSmodificationstoAHAACLSalgorithms,ASAdifficultairwayalgorithms,ASRALASTguidelines,MHAUSposter.Wearegratefultothemanypeoplewhodevelopedthesetools.YoucanfindreferencesforeachEMeventandmoreinthe2ndeditionofCrisisManagementinAnesthesiology,expectedinfall2014.Finally,wethankallourcolleaguesfromtheEmergencyManualImplementationCollaborative(EMIC),aglobalgroupfosteringthedissemination,implementation,andeffectiveuseofemergencymanualstoenhancepatients’safety.WithEMICcollaborators,wehaveappreciatedsynergisticandsometimesparallelthreadsofdevelopment,research,implementation,anduse–wethankyouall.JoinEMICat*.EmergencyManual:Cognitiveaidsforperioperativeclinicalevents.See(creativecommons.org/licenses/by-nc-nd/3.0/legalcode).*Corecontributorsinrandomorder:HowardSK,ChuLK,Goldhaber-FiebertSN,GabaDM,HarrisonTK