If they give the drug after they have been informed that the patient is SEIZING they have to recognize the seizure and then treat it – They have not recognized the seizure and they are using the drug as titrating to effect as a sedative needed) They are propofol to induce anesthesia and the seizures are controlled ACCEPTABLE Asks the surgeon to stop the procedure so that they can get control of the situation. Asks the surgeon to stop the procedure because it is unsafe to proceed. Requests surgeon to stop procedure Asks the surgeon to stop the procedure because the patient is unstable. UNACCEPTABLE Asks the surgeon to stop during initial handover to get control of the case ACCEPTABLE: Actually administers phenylephrine in a reasonable dose (<200 mcg Administers initially per administration) small doses of a vasopressor (e.g; Actually administers ephedrine in a reasonable dose (<10 mg per phenylephrine administration) ≤ 200mcg, ephedrine < Gives a reasonable alternative (e.g., 1–2 U of vasopressin). 25mg, epinephrine < STANDARDIZATION NOTE: If they give a drug stating the drug 50 mcg) name but do not verbalize the dose then the confederates should query or ask them for a dose then mark as present. ACCEPTABLE: Verbally requests that the crash cart be brought into the room for crash cart STANDARDIZATION NOTE: In some centers the crash cart is and/or defibrillator already present in the room, the participant will have to ask for the crash cart to be brought closer to the bedside ACCEPTABLE: Talks to the surgeon about the diagnosis being LAST States that the problems or patient’s current condition is due to the local anesthetic getting into the blood stream Discusses clinical UNACCEPTABLE: concerns with surgeon States that the problems are due to the (without being specific) unless immediately asks for lipid emulsion … States that the problem is due to the local anesthetic (without being specific as to how) unless immediately asks for lipid emulsion. …
titrating to effect as needed) If they give the drug after they have been informed that the patient is SEIZING – they have to recognize the seizure and then treat it They have not recognized the seizure and they are using the drug as a sedative They are propofol to induce anesthesia and the seizures are controlled Requests surgeon to stop procedure ACCEPTABLE Asks the surgeon to stop the procedure so that they can get control of the situation. Asks the surgeon to stop the procedure because it is unsafe to proceed. Asks the surgeon to stop the procedure because the patient is unstable. UNACCEPTABLE Asks the surgeon to stop during initial handover to get control of the case Administers initially small doses of a vasopressor (e.g; phenylephrine ≤ 200mcg, ephedrine < 25mg, epinephrine < 50 mcg) ACCEPTABLE: Actually administers phenylephrine in a reasonable dose (<200 mcg per administration) Actually administers ephedrine in a reasonable dose (<10 mg per administration) Gives a reasonable alternative (e.g., 1–2 U of vasopressin). STANDARDIZATION NOTE: If they give a drug stating the drug name but do not verbalize the dose then the confederates should query or ask them for a dose then mark as present. for crash cart and/or defibrillator ACCEPTABLE: Verbally requests that the crash cart be brought into the room STANDARDIZATION NOTE: In some centers the crash cart is already present in the room, the participant will have to ask for the crash cart to be brought closer to the bedside Discusses clinical concerns with surgeon ACCEPTABLE: Talks to the surgeon about the diagnosis being LAST States that the problems or patient’s current condition is due to the local anesthetic getting into the blood stream UNACCEPTABLE: States that the problems are due to the (without being specific) … unless immediately asks for lipid emulsion States that the problem is due to the local anesthetic (without being specific as to how) … unless immediately asks for lipid emulsion.
ALN_2017_05_15_WEINGER_ALN-D-16-01184_SDC4.docx