在控制或一起乘坐? 麻醉师从空中交通管制的教训
Keith J Ruskin1, Richard P Dutton2, Anna Clebone Ruskin1
1Department of Anesthesia and Critical Care, University of Chicago, Chicago, Illinois.
Current opinion in anaesthesiology
|August 8, 2023
概括
麻醉专业人员必须适应复杂,不可预测的手术室环境. 了解复杂的适应性系统和培养性是改善患者安全和预防麻醉护理错误的关键.
科学领域:
- 麻醉学 麻醉学
- 医疗保健系统科学 医疗保健系统科学
- 患者安全 患者安全
背景情况:
- 手术室是一个不可预测的,快速变化的环境,需要快速诊断和管理关键事件.
- 传统上被视为一个决定性系统,最近的研究表明,手术室的功能是一个复杂的适应性系统,事件在其中不可预测地相互作用.
- 随着医疗保健复杂性的增加,消除人为错误变得不可能,诸如高工作量和压力等因素会导致错误.
研究的目的:
- 探索从决定性观点向复杂的适应性系统视角的转变,在周围操作环境中.
- 突出复杂的适应性系统理论对麻醉实践和患者安全的影响.
- 强调弹性和适应能力在麻醉中管理不可预测事件时的重要性.
主要方法:
- 关于医疗保健中复杂适应性系统理论的最新研究的综述.
- 对安全的传统方法与复杂的自适应系统方法的分析.
- 讨论在复杂的临床情况下导致错误的因素.
主要成果:
- 手术室环境表现出复杂的适应性系统的特征,而不是决定性系统.
- 人类错误在复杂的医疗保健环境中是固有的风险,原因是工作量,压力和协调问题.
- 一种强调灵活性,适应性,报告能力和从错误中学习的安全文化至关重要.
结论:
- 了解自动化,复杂性和弹性对于安全麻醉实践至关重要.
- 将重点从严格的标准化转向适应性,可以在不可预测的环境中提高安全性.
- 促进强大的安全文化对于减轻麻醉中复杂的适应性系统相关的风险至关重要.
相关概念视频
01:22Cardiopulmonary Resuscitation II: ACLS Airway Management
20
Airway management is a key skill in emergency and critical care settings, as maintaining a clear airway is essential for adequate oxygenation and ventilation.Head Tilt-Chin Lift TechniqueThe head tilt-chin lift maneuver is an essential technique primarily used in patients without suspected cervical spine injuries. To perform this maneuver, one hand is placed on the patient’s forehead, and gentle pressure is applied backward to tilt the head. The fingertips of the other hand are positioned...
20
01:20Inhalational Anesthetics: Overview
339
Inhalation anesthetics are drugs that induce general anesthesia upon inhalation. They work by increasing the sensitivity of GABAA receptors or inhibiting NMDA receptors, leading to a decrease in central nervous system activity. The depth of anesthesia can be rapidly adjusted by changing the concentration of the inhaled gas. Some common examples of inhalational anesthetics include volatile liquids like isoflurane, desflurane, sevoflurane and gases like xenon and nitrous oxide. Isoflurane, a...
339
01:24General Anesthesia: Overview
242
Anesthesia is a medical procedure that uses drugs for CNS suppression to enable painless surgeries and procedures. The selection of anesthetics is influenced by their pharmacokinetic properties, side effects, and patient characteristics. Various types of anesthesia include general, local, regional, spinal, and inhalational.
General anesthesia induces unconsciousness in the whole body, while the others target specific areas or sensations. It is administered to minimize adverse effects, maintain...
General anesthesia induces unconsciousness in the whole body, while the others target specific areas or sensations. It is administered to minimize adverse effects, maintain...
242
01:22Stages of General Anesthesia
500
Various sedation levels offer significant advantages in facilitating procedural interventions for patients undergoing medical or invasive surgical procedures. These levels span from anxiolysis to general anesthesia, providing a spectrum of sedative effects to cater to specific patient needs. Anxiolysis reduces anxiety and is achieved through minimal sedation, enabling patients to remain awake and responsive while feeling more at ease during the procedure. This level can benefit minor...
500
01:30Cardiopulmonary Resuscitation V: Advanced Airway Management Techniques
20
Airway management is essential in emergency and surgical medicine, ensuring ventilation and oxygenation in patients who cannot maintain their own airway. Clinicians use a range of techniques and devices to secure the airway, depending on the patient’s condition and the clinical context. Key methods include endotracheal intubation, rapid sequence intubation (RSI), supraglottic airway devices, and advanced visualization aids. In cases where these approaches fail, surgical airway...
20
01:26Endoscopic Studies II: Thoracocentesis
333
Thoracentesis(Thoracocentesis), commonly known as pleural tap, is a medical procedure where a 22 gauge needle is inserted into the pleural space, the area between the lung and chest wall. This procedure is commonly performed to diagnose or treat various respiratory disorders.
Description
Excess pleural fluid or air may accumulate in some respiratory disorders in the thoracic cavity. To treat pleural effusion, a physician conducts thoracentesis by carefully piercing the chest wall and entering...
Description
Excess pleural fluid or air may accumulate in some respiratory disorders in the thoracic cavity. To treat pleural effusion, a physician conducts thoracentesis by carefully piercing the chest wall and entering...
333