麻醉期间的危机管理：栓塞
Crisis management during anaesthesia: embolism.
作者信息
Williamson J A, Helps S C, Westhorpe R N, Mackay P
机构信息
Australian Patient Safety Foundation, Adelaide, South Australia, Australia.
出版信息
Qual Saf Health Care. 2005 Jun;14(3):e17. doi: 10.1136/qshc.2002.004366.
BACKGROUND
Embolism with gas, thrombus, fat, amniotic fluid, or particulate matter may occur suddenly and unexpectedly during anaesthesia, posing a diagnostic and management problem for the anaesthetist.
OBJECTIVES
To examine the role of a previously described core algorithm "COVER ABCD-A SWIFT CHECK" supplemented by a specific sub-algorithm for embolism, in the management of embolism occurring in association with anaesthesia.
METHODS
The potential performance of this structured approach for each of the relevant incidents among the first 4000 reported to the Australian Incident Monitoring Study (AIMS) was compared with the actual management as reported by the anaesthetists involved.
RESULTS
Among the first 4000 incidents reported to AIMS, 38 reports of embolism were found. A sudden fall in end-tidal carbon dioxide and oxygen saturation were the cardinal signs of embolism, each occurring in about two thirds of cases, with hypotension and electrocardiographic changes each occurring in about one third of cases.
CONCLUSION
The potential value of an explicit structured approach to the diagnosis and management of embolism was assessed in the light of AIMS reports. It was considered that, correctly applied, it potentially would have led to earlier recognition of the problem and/or better management in over 40% of cases.
背景
在麻醉过程中，气体、血栓、脂肪、羊水或颗粒物栓塞可能突然意外发生，给麻醉医生带来诊断和处理难题。
目的
探讨一种先前描述的核心算法“COVER ABCD - A SWIFT CHECK”，辅以特定的栓塞子算法，在与麻醉相关的栓塞处理中的作用。
方法
将这种结构化方法对澳大利亚事件监测研究（AIMS）报告的前4000例相关事件中每例事件的潜在处理情况，与参与的麻醉医生报告的实际处理情况进行比较。
结果
在向AIMS报告的前4000例事件中，发现38例栓塞报告。呼气末二氧化碳和氧饱和度突然下降是栓塞的主要体征，各约在三分之二的病例中出现，低血压和心电图改变各约在三分之一的病例中出现。
结论
根据AIMS报告评估了一种明确的结构化方法在栓塞诊断和处理中的潜在价值。认为正确应用该方法可能会在超过40%的病例中更早地识别问题和/或更好地进行处理。
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