(Cognitive Aids + Cart Readiness)
To ensure rapid recognition and standardized management of malignant hyperthermia (MH) in any anesthetizing location (OR/NORA/PACU-equivalent), including immediate availability and readiness of an MH cart, timely administration of dantrolene, supportive treatment (hyperventilation, cooling, treatment of acidosis/hyperkalemia), escalation pathways, and post-event care—supporting standardized perioperative safety processes. (istitlaa.ncc.gov.sa)
Applies to all anesthesia professionals, perioperative staff, PACU staff, and procedural teams in OR, NORA, and any area where triggering agents may be administered. (mhaus.org)
Post MH algorithm/checklist in: every OR core area, anesthesia workroom, NORA control points, PACU, and inside the MH cart top drawer. (mhaus.org)
To standardize prevention readiness and emergency response for LAST, ensuring immediate availability of a LAST rescue kit, rapid airway/ventilation support, seizure and cardiovascular management, and timely administration of 20% lipid emulsion per ASRA checklist. (ASRA Pain Medicine)
Applies to all locations where local anesthetics are used: OR, block areas, PACU, NORA, ED procedure areas (if applicable), including peripheral nerve blocks, neuraxial anesthesia, infiltration by surgeons, and topical local anesthetic use.
Use ASRA checklist dosing approach: (ASRA Pain Medicine)
To ensure immediate recognition and standardized management of perioperative anaphylaxis, including early epinephrine use, airway/ventilation support, rapid fluid resuscitation, identification/removal of triggers, structured documentation, post-event investigation planning, and kit readiness using established perioperative anaphylaxis guidance. (ANZCA)
Applies to all anesthesia/sedation locations (OR, NORA, PACU) and all staff involved in perioperative medication administration (anesthetics, antibiotics, neuromuscular blockers, antiseptics, latex exposure).
Consider anaphylaxis when rapid onset of airway/breathing/circulation compromise occurs, often with hypotension, bronchospasm, edema, rash (may be absent), and difficulty ventilating after exposure to likely triggers. (resus.org.uk)
To standardize rapid recognition and response to major hemorrhage, including timely activation of the Massive Transfusion Protocol (MTP), coordinated communication with blood bank, balanced component therapy, physiologic resuscitation (warming, calcium management, correction of coagulopathy), and safe escalation/transfer pathways, aligned with evidence-based best practices. (ACS)
Applies to all surgical/procedural areas (OR/NORA/PACU) and any location where life-threatening bleeding can occur, including obstetric, trauma, vascular, GI bleeding procedures, and postoperative hemorrhage.
Post the MTP activation steps and phone/pager numbers in OR core, PACU, NORA control areas, and on the hemorrhage cart.
Activation should be based on clinical judgment and objective triggers (e.g., hemorrhagic shock, rapid ongoing blood loss, expected large transfusion requirement; trauma services may use scoring such as ABC in their system). (ACS)
Blood bank delivers products per MTP pack design. Balanced component strategies are widely recommended; trauma best practices commonly support plasma:RBC ratios between 1:1 and 1:2 with platelet support incorporated by protocol design. (ACS)
Define termination criteria to stop MTP when bleeding controlled and physiology stabilizing. (ACS)
Calcium monitoring/replacement, warming strategy, antifibrinolytic use (e.g., TXA) when indicated by local guideline, and management of hypocalcemia/hyperkalemia as clinically indicated.
Rapid infuser/blood warmer access, pressure bags, large-bore cannulas, Level 1/rapid warming supplies, point-of-care testing access (if used), and MTP cognitive aid.
ICU transfer criteria, ongoing monitoring, documentation of total blood products and complications, debrief (I8), and data submission to MTP audit dashboard.
To standardize prevention and management of anticipated and unanticipated difficult airways, including early call for help, limited attempts, maintenance of oxygenation, structured escalation to supraglottic rescue and emergency front-of-neck access when required, and readiness of airway equipment carts and cognitive aids—aligned with major airway guidelines. (shanahq.com)
Applies to OR, NORA, PACU (re-intubation), ED resuscitation (if anesthesia responds), and critical airway events during transport. Applies to adult and pediatric patients, and to all anesthesia staff and supporting teams.
Identify predictors and decide airway approach (including consideration of awake techniques when appropriate), equipment selection, backup plans, and call-for-help triggers consistent with ASA guidance. (shanahq.com)
Use pediatric difficult airway cognitive aids (age-appropriate) and pediatric equipment; recognize rapid desaturation risk in children and ensure immediate escalation capability. (Difficult Airway Society)
Standardize cart contents (VL, SGA sizes, bougies, eFONA kit) and run daily seal checks + post-use restock.
Document airway difficulty details, devices used, number of attempts, complications, and create a “difficult airway alert” for future care. Debrief per I8.
To ensure effective response to clinical deterioration and cardiac arrest in perioperative locations through standardized activation, role assignment, high-quality CPR, defibrillation readiness, airway management, and post-ROSC care aligned with AHA 2025 guidelines, with consistent equipment readiness and debriefing. (cpr.heart.org)
Applies to OR, NORA, PACU, transport corridors during perioperative transfers, and PACU-equivalent recovery areas.
Activate Code Blue/RRT per hospital system immediately when criteria met.
OR roles: anesthesia typically leads airway/ventilation and rhythm management; nursing coordinates cart/meds; surgeon stops procedure and manages bleeding source if present.
Start high-quality CPR, attach defibrillator/monitor, follow AHA algorithm for shockable/non-shockable rhythms, and address reversible causes. (cpr.heart.org)
Early recognition and escalation; treat causes (hypoxia, hypotension, arrhythmia, hemorrhage, anaphylaxis, MH/LAST) and mobilize resources before arrest.
Stabilize airway/ventilation and hemodynamics; transfer to ICU per post-arrest pathway; document full timeline.
Daily seal check; monthly full inventory; defib functional check per biomedical schedule.
To prevent and manage surgical fires by standardizing risk assessment, control of the fire triad (oxidizers, ignition sources, fuels), safe oxygen delivery practices, laser/electrocautery precautions, and an immediate response algorithm for airway and field fires, supported by cognitive aids and readiness checks. (Anesthesia Patient Safety Foundation)
Applies to OR and procedural rooms (including NORA) where ignition sources (electrocautery/laser), fuels (drapes, alcohol prep), and oxidizers (oxygen, nitrous oxide) may coexist.
Confirm location and accessibility of CO₂ extinguisher and saline/water source; include fire cognitive aid in OR safety binder; drill at defined intervals.
Treat injuries, document, incident report, and debrief (I8). (PMC)
To ensure that every significant perioperative critical event (MH, LAST, anaphylaxis, hemorrhage/MTP, difficult airway, code blue, OR fire) triggers structured debriefing and documentation that supports patient safety, system learning, and staff wellbeing, incorporating immediate (hot) and delayed (cold) debriefing as recommended in modern resuscitation systems guidance. (cpr.heart.org)
Applies to OR, NORA, PACU, and transport-related critical events and near-misses, including events with high harm potential even if harm did not occur.
Code blue/peri-arrest, MH, LAST, anaphylaxis, major hemorrhage/MTP, unplanned re-intubation, CICO/eFONA, OR fire, unplanned ICU transfer from PACU, severe medication error, or any high-potential near-miss.
Offer peer support resources after distressing events; normalize emotional impact and provide follow-up routes. (PMC)