Content area
Full Text
We report a real-life example of the benefits resulting from the use of emergency manuals to treat severe bronchospasm. This case demonstrated that the emergency manuals helped us respond to crises efficiently. Use of emergency manuals can save lives and improve patient safety.
KEY WORDS: Emergency manuals; checklists; emergency room; crisis; bronchospasm; simulation training.
On January 15, 2009, after a bird strike caused dual engine failure on U.S. Airways Flight 1549, Captain "Sully" Sullenberger ordered the first officer to read from the "dual engine failure" section of the emergency manual (EM) to ensure that they completed the necessary steps to be taken in the event of such a failure. The event resolved quickly and successfully. Cognitive aids (e.g., EMs) have been used in many highstakes industries, including medicine. A simulation-based trial reported that during a set of intraoperative emergency crises, teams missed 6% of critical steps when checklists were accessible versus 23% of critical actions when they were not.1 Now EMs are increasingly being adopted and implemented in operating rooms.
USE OF THE EMERGENCY MANUAL IN BRONCHOSPASM
Bronchospasm can be a serious, life-threatening anesthetic disaster. Rapid diagnosis and appropriate treatment are important for an uneventful patient outcome. EMs are an important tool to guide healthcare providers during operating room emergencies. Performing the right steps at the right time can be the difference between life and death in an OR emergency. One published report explains how a 4-month-old patient was saved from malignant hyperthermia with the guidance of an EM.2
We report a real-life example of the benefits resulting from the use of the EM. A 44-year-old man was scheduled for laparoscopic left hepatic lobectomy and cholecystectomy. The patient had been admitted to the hospital one year earlier with bronchitis, at which time he was treated with oxygen, antibiotics, and bronchodilators. He denied other significant medical histories. He had no known drug allergies and did not use any medications. He denied regular consumption of alcohol and had never smoked.
The preoperative CT scan showed a left extrahepatic bile duct stone, a common bile duct stone, and cholangitis. Preoperative examinations including echocardiogram and pulmonary functions tests were normal. Chest auscultation was normal...