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

By John G. Brock-Utne

All anesthesiologists ultimately face the terror of a “near miss,” whilst a patient’s existence has been placed at risk.  studying from the event is important to professionalism and the continuing improvement of craftsmanship. Drawing on forty-plus years of perform in significant metropolitan hospitals within the usa, Norway, and South Africa, John Brock-Utne, MD provides eighty rigorously chosen situations that offer the root for classes and the way to hinder capability catastrophe.  The instances emphasize problem-centered studying and span a huge variety of topics—from a plague of working room an infection (could it's the anesthesia equipment?),  complications of fiberoptic intubations,  and issues of epidural drug pumps, to appearing an pressing tracheostomy for the 1st time, operating with an competitive medical professional, and what to do whilst a sufferer falls off  the working desk in the course of surgery.  80 true-story scientific “near misses” by no means sooner than released, perfect for problem-centered studying, suggestions, references, and discussions accompany so much circumstances, wealthy foundation for instructing discussions either in or out of the working room, settings comprise subtle in addition to rudimentary anesthetic environments, enhances the author’s different case publication, medical Anesthesia: close to Misses and classes discovered (Springer, 2008).

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De Souza DG, Gaugen CL. Aspiration risk after esophagectomy. Anesth Analg. 2009; 109:1352. Black DR, Thangathurai D, Senthikumar N, Roffey P, Mikhail M. High risk of aspiration and difficult intubation in postesophagecotmy patients. Acta Anaesthesiol Scand. 1999;43:687. Jankovic ZB, Miklosavljevic S, Stamenkovic D, Stojakov D, Sabjljak P, Pesko P. High risk of aspiration and difficult intubation in post-esophagectomy patients. Acta Anaesthesiol Scand. 2000;44:899–900. Brock-Utne JG, Jaffe RA.

However, preoperative antacid should be given and may be beneficial. Recommendation In these cases, an awake fiberoptic induction, with the patient in the sitting position, may be the best option (See more discussion in case 20). De Souza DG, Gaugen CL. Aspiration risk after esophagectomy. Anesth Analg. 2009; 109:1352. Black DR, Thangathurai D, Senthikumar N, Roffey P, Mikhail M. High risk of aspiration and difficult intubation in postesophagecotmy patients. Acta Anaesthesiol Scand. 1999;43:687.

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. 6 mmol/L. There are at least two cases reporting an increase in serum K after the infusion of Amicar [1, 2]. One case [2] was so refractory to the above treatment, including 30 mg of polystyrene sulphonate (kayexalate) as a retention enema that the patient had to be treated with hemodialysis.

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