Anesthesia — Core of Discipline

C5 Initiating and leading resuscitation for unstable patients in the perioperative period.

- This EPA focuses on initiating resuscitation for unstable patients, during the perioperative period, following the principles of crisis resource management. This includes conditions occurring in the preop, intraop, or in the immediate postop phase (i.e. PACU).
- This EPA recognizes that resuscitation and action may be required with limited information and resources.
- This EPA recognizes that resuscitation in OR is ongoing and must be aligned with the additional physiologic changes provoked by the surgery itself.
- Examples of perioperative conditions include: sepsis, shock, cardiac arrest, unstable arrhythmias, polytrauma, massive hemorrhage, severe burns, etc.
- This EPA may be observed in adult or pediatric patients.
- Relation with other EPAs:
- Managing resuscitative efforts in the ICU, ward or ER is the focus of EPA COD # 22. Managing
- resuscitative efforts in the parturient is the focus of EPA COD # 8

Form

F1: Observation

Milestones

• ME 2.1. Consider clinical urgency, feasibility, availability of resources, and comorbidities in determining priorities to be addressed

• ME 2.2. Use information from ongoing monitoring, and interpret their results for the purpose of diagnosis and management

• ME 2.1. Prioritize issues to be addressed

• ME 2.4. Recognize possibility of unknown diagnosis and unpredictable clinical course and take actions to avoid or mitigate potential problems

• COL 3.2. Demonstrate safe handover of care, both verbal and written

• ME 1.4. Act decisively and maintain control of critical situations

• ME 1.6. Seek assistance in situations that are complex or new

• ME 2.2. Recognize when ongoing resuscitation efforts are no longer effective and should be discontinued

• ME 2.4. Provide concurrent treatment and ongoing assessment of the patient’s clinical condition

• ME 2.4. Reassess clinical status and response to treatment, to re-evaluate and adjust resuscitative and diagnostic efforts as appropriate

• ME 3.4. Competently perform resuscitation protocols

• ME 5.2. Demonstrate situational awareness, avoiding fixation errors

• COM 5.1. Document clinical encounters to adequately convey clinical reasoning and the rationale for decisions

• COL 1.2. Delegate tasks and direct team members to aid in resuscitation

• COL 1.3. Communicate with the health care team using closed loop communication and clear language

• L 4.2. Establish clear leadership in resuscitative efforts, supporting others when needed

• P 4.1. Demonstrate the ability to remain calm and professional in stressful situations

Context Variables

No context variables defined.

Requirements

• Direct observation by supervisor
• Form collects information on:
• Type of patient: adult; pediatric
• Setting: OR; PACU
• Type of condition [select all that apply]: cardiac arrest; unstable arrhythmia; polytrauma; massive hemorrhage; severe burn; sepsis, shock; other condition
• Collect observations from a large breadth of training experiences including major polytraumatic injury, with the expectations not all will be achieved, with a minimum of 6 observations of achievement.