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07 / Anaesthesia · Crisis drills

Crisis drills

13 algorithms in 5 groups, hidden one step at a time. Decide your move, then reveal the algorithm’s: reading one is not the same as being able to run one.

Airway
Breathing
Circulation
Drugs and reactions
Neuraxial

High or total spinal

An epidural top-up into a catheter that has migrated, or a spinal dose that spreads further than intended

Recognise it

  • Numbness or weakness climbing into the hands and arms within minutes of a dose.
  • Difficulty breathing or speaking, a weak cough, then apnoea.
  • Bradycardia and hypotension as the cardioaccelerator fibres at T1 to T4 are blocked.
  • Loss of consciousness and dilated pupils as the local anaesthetic reaches the brainstem.

The usual mistake

Reassuring the patient who says they cannot breathe. A numb hand after an epidural top-up is a rising block until proven otherwise, and the next symptom is apnoea.

On the cart

EphedrinePhenylephrineAtropineAdrenaline

Do it in order

0/6

  1. 1Hidden until you have committed

  2. 2Hidden until you have committed

  3. 3Hidden until you have committed

  4. 4Hidden until you have committed

  5. 5Hidden until you have committed

  6. 6Hidden until you have committed

Decide your first move before you reveal it. Rehearsing the order is the whole point: in a real crisis the failure is jumping to step four.