Anesthesia — Core of Discipline

C8 Initiating resuscitation and providing anesthetic management for unstable parturients

- This EPA focuses on managing serious or life-threatening conditions including intra-uterine resuscitation if appropriate.
- This EPA focuses on patient management in scenarios of clinical uncertainty and instability, and urgent and emergent situations. Timely management of the clinical situation is a key component of this EPA.
- This includes parturients presenting with shock, eclampsia, HELLP syndrome, or polytrauma.

Form

F1: Observation

Milestones

• ME 1.6. Adapt care as the patient’s clinical condition evolves

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

• ME 2.1. Consider clinical urgency, feasibility, availability of resources, comorbidities and the second patient (fetus) in determining priorities to be addressed

• ME 2.1. Prioritize issues to be addressed

• ME 2.2. Focus the clinical encounter, performing it in a time-effective manner, without excluding key elements

• 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 3.1. Integrate appropriate monitoring, including monitoring of the fetus, into global assessment and management plans

• ME 3.4. Competently perform resuscitation protocols, including intra-uterine resuscitation

• ME 3.4. Perform the management and all related technical procedures in a skillful and safe manner

• ME 5.2. Demonstrate situational awareness, avoiding fixation errors

• COM 3.1. Share information and explanations that are clear, accurate and timely while checking for patient and family understanding

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

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

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

• L 4.2. Apply the principles of crisis resource management

• 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 or indirect observation by supervisor
• Type of condition: hemorrhagic shock; sepsis; other shock; embolic event; eclampsia; HELLP syndrome; trauma; other issue
• Collect observations from a large breadth of training experience with the expectations not all will be achieved, with a minimum of 2 observations of achievement