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Acute Resuscitation and Crisis Management

Acute Critical Events Simulation (ACES)

David T. Neilipovitz (Ed.)

Publication Year: 2005

While the management of critically ill patients has traditionally been an undeveloped area of medicine, recent advances in drugs, surgical techniques, and medical equipment now allow patients to survive illnesses and disorders that previously were uniformly fatal. Unfortunately, the knowledge and techniques that are required to do this are not traditionally taught in medical school. Thus, medical errors in this population group are not uncommon and are more likely to have adverse, often fatal, consequences.

In 2001, physicians responsible for the care of the critically ill were introduced to a new program providing them with the tools to significantly decrease the number and severity of medical errors: the Acute Critical Events Simulation (ACES) Program, an intensive and highly interactive course on the acute resuscitation of critically ill patients and the management of crisis situations.

This book is a compendium to the ACES Program, containing its important background information and reference material while serving as an independent reference source for physicians and other health care professionals. With contributions by recognized physicians from across Canada, it presents the specifics of acute resuscitation in the context of crisis resource management and teaches readers life-saving resuscitation skills in a way that allows them to use their medical training more effectively.

With increasing doctor shortages forcing more physicians to manage acutely ill patients, this book will aid physicians looking for a simple yet useful text to help them manage critically ill patients in connection with the ACES Program. While the intended audience for the course is primarily emergency room doctors, family physicians, and senior medical residents, this collection is also applicable to nurses, paramedics, respiratory therapists, and medical students.

Published by: University of Ottawa Press

Table of Contents

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pp. ix-xii


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Chapter 1 Approach to the Critically III Patient

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pp. 3-10

The patient described above is obviously very sick and needs treatment quickly before he gets worse. The traditional approach 1 of taking a detailed history, performing a physical exam, ordering investigations and then deciding therapy is inappropriate. Time does not permit this approach since a patient's condition could irreparably worsen if treatment is delayed...

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Chapter 2 Crisis Resource Management

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pp. 11-16

Education in the acute management of critically ill patients is an evolving field. Reviews of medical emergencies in the operating room (OR) during the 1980s reveal that physician error is a significant contributing factor in over half the cases. 1 Lack of medical knowledge was found to be an uncommon reason for such errors. Skills beyond medical...

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Chapter 3 Simulation and Medical Education

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pp. 17-26

The use of simulators in the instruction of crisis resource management dates back to the 1920s, with the use of rudimentary flight simulators.1 Computer assisted simulation was developed in the 1950s to make simulations more like real-life aviation. Simulation has now been widely incorporated by the airline, aerospace and nuclear power industries as a mandatory component of training and advancement...

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Chapter 4 Medical Errors

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pp. 27-33

Headlines were made around the world when the Institute of Medicine estimated that up to 98 000 people die each year in the United States as direct result of medical errors.1 Dramatic analogies to a 747 jetliner full of patients dying daily2 or a major motor company losing an employee every day3 were used to describe a problem of astonishing proportions. Not surprisingly, the topic of medical errors has now...


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Chapter 5 Basic Airway Management

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pp. 37-44

One of the most important but unnerving situations is having to secure a patient's airway. Many questions come to mind. Will I be able to secure the airway? What drugs should I use? What will happen if I am unable to do it? The goal of this and the following chapters is to prepare you for this scenario, by...

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Chapter 6 Advanced Airway Management

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pp. 45-54

Basic airway management skills are some of the most important skills one can develop. Unfortunately, there are occasions when these skills will be insufficient to manage a patient's airway. Many different devices are available to facilitate intubation and airway management when the basic skills are not sufficient. A complete review of these devices is not feasible here...

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Chapter 7 Medications for Airway Management

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pp. 55-64

The above patient obviously requires respiratory assistance. He is unlikely to be a candidate for noninvasive ventilation since he is uncooperative and hemodynamically unstable. Thus, he needs the institution of positive pressure ventilation via an endotracheal tube. The problem will be to get him to allow you to place the tube. Invariably, there is a need...

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Chapter 8 Rapid Sequence Intubation

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pp. 65-75

The patient in this scenario presents the physician with many conflicting problems: The patient is hemodynamically unstable and needs further fluid resuscitation. The patient, however, may aspirate and suffer adverse pulmonary consequences if his airway is not secured immediately. The high likelihood of impending aspiration drastically decreases the time...

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Chapter 9 Difficult Mask Ventilation and Difficult Intubation

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pp. 77-83

Airway management is usually the first fundamental act in the care of the critically ill patient. It is a process that represents a continuum of evaluation and concurrent management, in which the goal is to preserve oxygen delivery to end organ systems. The American Society of Anesthesiologists (ASA) Closed Claims Project of anesthesia related morbidity and mortality, has revealed a frighteningly high incidence...


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Chapter 10 Physiology of Gas Exchange

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pp. 87-91

Oxygen is obviously essential for survival. Problems with oxygenation are however quite common but have numerous possible etiologies. In this chapter, we will briefly review how oxygen is transported to the cells. We will also discuss hypoxia and hypoxemia along with mechanisms that lead to them. We will...

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Chapter 11 Early Management of Respiratory Failure

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pp. 93-105

The patient, Mr. Puffer, certainly appears to be quite sick. Several questions about what to do for him are apparent. Does Mr. Puffer have acute respiratory failure? What are your immediate concerns? What are your initial management goals and how will you accomplish them? The goal of this chapter is to use...

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Chapter 12 Introduction to Mechanical Ventilation

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pp. 107-122

Clearly, the use of mechanical ventilators has saved the lives of countless patients. Mechanical ventilation is used in respiratory failure to oxygenate and ventilate the patient. Unfortunately, there are many different "modes" of ventilation, all with different names and initials, which can make it very...

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Chapter 13 Respiratory Mechanics

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pp. 123-131

Troubleshooting a mechanical ventilator requires an understanding of respiratory mechanics. The compliance of the lung, both static and dynamic, is a crucial element that influences respiratory mechanics. We will discuss this, along with other factors that contribute to resistance to air flow. Our goal is to illustrate how these components of the...

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Chapter 14 Practical Approach to Mechanical Ventilation

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pp. 133-141

Mechanical ventilation is used to help provide oxygenation and ventilation for patients with respiratory failure. Unfortunately, mechanical ventilation can cause lung injury, hemodynamic instability and patient distress if not applied carefully and appropriately. The goal of this chapter is to discuss ventilator-induced lung injury and present...


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Chapter 15 Management of Shock

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pp. 145-154

The patient above is clearly not doing well. Aside from her significant neurologic problems, she appears to have impaired circulation. Is she in shock? John Collins Warren described shock as "... a momentary pause in the act of death." 1 Although this pragmatic definition aptly describes a potential outcome despite therapy, it fails to assist the physician...

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Chapter 16 Fluid Resuscitation: Theory and Practice

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pp. 155-165

The overall purpose of fluid resuscitation in the critically ill is simple: namely, to prevent premature death. However, there are numerous controversies surrounding the putative benefits and detriments of various fluid types. The absence of a "one-treatment-fits-all" approach or universal...

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Chapter 17 Blood Products in Critically Ill Patients

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pp. 167-177

Amongst all of the recent advances in the care of the critically ill, the field of transfusion medicine has experienced some of the most dramatic. The tendency to liberally transfuse in an effort to normalize hemoglobin, platelets or coagulation indices is simply no longer appropriate, necessarily safe, or even justified by science...

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Chapter 18 Vasoactive Medications

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pp. 179-186

Vasopressors or inotropes? Dopamine or norepinephrine? These are questions physicians ask themselves when confronted with the need for vasoactive medications. Unfortunately, anxiety and confusion with these drugs can cause delays with...

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Chapter 19 Hemodynamic Monitoring

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pp. 187-203

One of the most important principles when treating patients is a thorough and accurate physical exam. Unfortunately critical illness may make the interpretation of physical findings —and even a seemingly simple procedure such as blood pressure measurement—difficult. As such, technology is often applied to determine not only blood pressure but...


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Chapter 20 Sepsis: New and Emerging Therapies

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pp. 207-226

Sepsis is a syndrome of systemic inflammatory response related to infection. Sepsis is unfortunately a common, often fatal disorder whose incidence is increasing. The mortality rate associated with severe sepsis is around 50% in most studies.1 The estimated costs related to sepsis are staggering...

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Chapter 21 Critical Points in Infectious Diseases

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pp. 227-235

An important element in the approach to treating patients who are acutely ill from an infection, begins with looking at the host. Having knowledge of the antibiotics is often not as important as understanding the person infected. The first aspect to look at, once you have initiated proper oxygen and hemodynamic...

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Chapter 22 Fever in Critically III Patients

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pp. 234-245

Fever is a common problem in critically ill patients. It is estimated that one-third of all medical patients will experience a fever at some point during their hospitalization.1 The figure is even higher in the critically ill population. Studies indicate an incidence of fever as high as 70% within 24 hours of admission...

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Chapter 23 Antimicrobial Therapy

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pp. 247-263

Antimicrobial therapy that is both appropriate and timely is a crucial element in the chain of survival for patients with severe sepsis or septic shock, a chain that also includes prompt recognition of the presence of severe sepsis, rapid resuscitation where...


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pp. 265-275

E-ISBN-13: 9780776615349
E-ISBN-10: 0776615343
Print-ISBN-13: 9780776605975
Print-ISBN-10: 0776605976

Page Count: 300
Publication Year: 2005