The document discusses simulation training for medical emergencies. It describes three case studies: an anaphylaxis reaction during cataract surgery treated with epinephrine and oxygen; a woman experiencing chest pain during eye surgery who was treated for acute coronary syndrome with oxygen, aspirin, and nitroglycerin; and a boy injured in a traffic accident who developed pneumothorax during eye surgery repair and was treated with oxygen, IV fluids, and a decompression procedure. The document outlines the ABCDE approach and treatment protocols for anaphylaxis, acute coronary syndrome, and trauma-related emergencies. It emphasizes simulation training to help medical professionals properly assess and respond to such critical situations.

1. Simulation in Emergencies
World Congress of Ophthalmic Anaesthesia Ankara/TURKEY, 24-25 May 2012
TURKISH RESUSCITATION SOCIETY
Prof Agah CERTUG Ege University, Turkey
Assoc Prof Handan BIRBICER Mersin University, Turkey
Assoc Prof Nurcan DORUK Mersin University, Turkey
Assoc Prof Pinar ZEYNELOGLU Baskent University, Turkey
Assoc Prof Sule AKIN Baskent University, Turkey

2. World Congress of Ophthalmic Anaesthesia Ankara/TURKEY, 24-25 May 2012
Anaphylaxis
Simulation in Emergencies
Acute Coronary Syndrome
Trauma

3. World Congress of Ophthalmic Anaesthesia Ankara/TURKEY, 24-25 May 2012
Anaphylaxis
Simulation in Emergencies

4. World Congress of Ophthalmic Anaesthesia Ankara/TURKEY, 24-25 May 2012
Anaphylaxis
 A 62-year-old man
 Cataract surgery
 Monitored Anesthesia Care
 Midasolam (2mg)
 Retrobulbar block
 Local anesthetic injection (Bupivacaine, 0.5%, 25mg)

5. World Congress of Ophthalmic Anaesthesia Ankara/TURKEY, 24-25 May 2012
Anaphylaxis
 Oxygen (Nasal cannula, 3 L/min)
 SABP/DABP : 140/80 mmHg
 HR: 86/min
 SpO2: 97%

6. World Congress of Ophthalmic Anaesthesia Ankara/TURKEY, 24-25 May 2012
Anaphylaxis
Airway Complains of tightness in throat
Breathing RR 28 min-1, widespread wheeze
Circulation HR: 140 min-1, BP 80/60 mmHg
Disability Very anxious
Exposure Widespread urticaria, swollen eyes

7. World Congress of Ophthalmic Anaesthesia Ankara/TURKEY, 24-25 May 2012
Anaphylaxis

8. World Congress of Ophthalmic Anaesthesia Ankara/TURKEY, 24-25 May 2012
Anaphylaxis
ABCDE approach
Oxygen, IV access
Recognise anaphylactic reaction
Adrenaline 0.5 mg IM; or cautious diluted IV
IV fluids
Histamine antagonist; hydrocortisone; nebulised salbutamol
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9. World Congress of Ophthalmic Anaesthesia Ankara/TURKEY, 24-25 May 2012
Anaphylaxis
PATIENT COLLAPSES

10. Anaphylaxis
Confirm cardiac arrest
Call resuscitation team / help
2 min CPR (30:2)
Airway/ventilation/oxygen
Give adrenaline 1 mg iv
Recognize/treat reversible causes
(hypoxia – intubation, hypovolemia – iv fluids)
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PEA
World Congress of Ophthalmic Anaesthesia Ankara/TURKEY, 24-25 May 2012

11. Anaphylaxis
Check monitor/confirm rhythm
1st shock at appropriate energy (150 J)
2 min CPR (30:2)
Check monitor/confirm rhythm
2nd shock at appropriate energy (max.:270 J)
2 min CPR (30:2)
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VF
World Congress of Ophthalmic Anaesthesia Ankara/TURKEY, 24-25 May 2012
VF

12. Anaphylaxis
Check monitor/confirm rhythm
Check patient (signs of life /pulse)
Investigations /Transfer to ICU
Post resuscitation care
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SR
World Congress of Ophthalmic Anaesthesia Ankara/TURKEY, 24-25 May 2012

13. World Congress of Ophthalmic Anaesthesia Ankara/TURKEY, 24-25 May 2012
Simulation in Emergencies
Acute Coronary Syndrome

14. World Congress of Ophthalmic Anaesthesia Ankara/TURKEY, 24-25 May 2012
Acute Coronary Syndrome
 A 55-year-old woman
 Vitrectomy
 DM, ASHD Plan: General anesthesia
 Before anesthesia induction; chest pain
 ST elevation on ECG

15. World Congress of Ophthalmic Anaesthesia Ankara/TURKEY, 24-25 May 2012
 Oxygen (Face mask, 10 L/min)
 SABP/DABP : 100/70 mmHg)
 HR: 98/min
 SpO2: 96%
Acute Coronary Syndrome

16. World Congress of Ophthalmic Anaesthesia Ankara/TURKEY, 24-25 May 2012
Airway Clear
Breathing RR 22 min-1
Circulation HR: 124 min-1, BP 80/60 mmHg
Disability Verbal response, anxious
Exposure Pale
Acute Coronary Syndrome

17. World Congress of Ophthalmic Anaesthesia Ankara/TURKEY, 24-25 May 2012
Acute Coronary Syndrome

18. World Congress of Ophthalmic Anaesthesia Ankara/TURKEY, 24-25 May 2012
ABCDE approach
Oxygen, IV access
Recognise acute coronary syndrome/blood samples
Morphine
Aspirin, 300mg, p.o.
Nitrate
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Acute Coronary Syndrome

19. World Congress of Ophthalmic Anaesthesia Ankara/TURKEY, 24-25 May 2012
PATIENT COLLAPSES
Acute Coronary Syndrome

20. Check monitor/confirm rhythm/CHECK PULSE
Call resuscitation team / help
1st shock at appropriate energy (150 J)
2 min CPR (30:2)
Check monitor/confirm rhythm/CHECK PULSE
2nd shock at appropriate energy (max.:270 J)
2 min CPR (30:2)
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VT
World Congress of Ophthalmic Anaesthesia Ankara/TURKEY, 24-25 May 2012
VT
Acute Coronary Syndrome

21. 3rd shock (270 J)
2 min CPR (30:2)
Give adrenaline, 1mg iv
Give amiodarone, 300 mg iv
4th shock (270 J)
2 min CPR (30:2)
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VF
World Congress of Ophthalmic Anaesthesia Ankara/TURKEY, 24-25 May 2012
VF
Acute Coronary Syndrome
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22. Check monitor/confirm rhythm
Check patient (signs of life / pulse)
Investigations /Transfer to ICU
Post resuscitation care
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SR
World Congress of Ophthalmic Anaesthesia Ankara/TURKEY, 24-25 May 2012
Acute Coronary Syndrome

23. World Congress of Ophthalmic Anaesthesia Ankara/TURKEY, 24-25 May 2012
Simulation in Emergencies
Trauma

24. World Congress of Ophthalmic Anaesthesia Ankara/TURKEY, 24-25 May 2012
Trauma
 A 12-year-old boy (BW:35 kg)
 Traffic accident
 Scleral perforation repair
 Emergent case
 Plan: General anesthesia

25. World Congress of Ophthalmic Anaesthesia Ankara/TURKEY, 24-25 May 2012
Trauma
 Oxygen (Face mask 8 L/min)
 SABP/DABP : 80/60 mmHg
 HR: 132/min
 SpO2: 92% After Intubation:
 SABP/DABP : 65/30 mmHg
 HR: 144/min
 SpO2: 89%

26. World Congress of Ophthalmic Anaesthesia Ankara/TURKEY, 24-25 May 2012
Airway Endotracheally intubated
Breathing RR 24 min-1
Circulation HR: 144 min-1, BP 65/30 mmHg
Disability Under anesthesia
Exposure Cyanotic
Trauma

27. World Congress of Ophthalmic Anaesthesia Ankara/TURKEY, 24-25 May 2012
Trauma

28. World Congress of Ophthalmic Anaesthesia Ankara/TURKEY, 24-25 May 2012
ABCDE approach
Oxygen, IV access
Recognise pneumothorax on right side (oscultation)
IV fluids
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Trauma

29. World Congress of Ophthalmic Anaesthesia Ankara/TURKEY, 24-25 May 2012
PATIENT COLLAPSES
Trauma

30. Check monitor/confirm rhythm/check pulse
Call resuscitation team / help
2 min CPR (30:2)
Airway/ventilation/oxygen
Give adrenaline 0.5mg iv
Treat reversible causes
Call for expert help
Decompressive thoracostomy
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ASYSTOLE
World Congress of Ophthalmic Anaesthesia Ankara/TURKEY, 24-25 May 2012
ASYSTOLE
Trauma

31. 2 min CPR (30:2)
Airway/ventilation/oxygen
2 min CPR (30:2)
Give adrenaline 0.5 mg iv
2 min CPR (30:2)
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ASYSTOLE
World Congress of Ophthalmic Anaesthesia Ankara/TURKEY, 24-25 May 2012
ASYSTOLE
Trauma
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32. Check monitor/confirm rhythm
Check patient (signs of life / pulse)
Investigations/Transfer to ICU
Post resuscitation care
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SR
World Congress of Ophthalmic Anaesthesia Ankara/TURKEY, 24-25 May 2012
Trauma

33. World Congress of Ophthalmic Anaesthesia Ankara/TURKEY, 24-25 May 2012

34. Simulation in Emergencies
World Congress of Ophthalmic Anaesthesia Ankara/TURKEY, 24-25 May 2012
TURKISH RESUSCITATION SOCIETY
Prof Agah CERTUG Ege University, Turkey
Assoc Prof Handan BIRBICER Mersin University, Turkey
Assoc Prof Nurcan DORUK Mersin University, Turkey
Assoc Prof Pinar ZEYNELOGLU Baskent University, Turkey
Assoc Prof Sule AKIN Baskent University, Turkey
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