CCT in Anaesthetics - Core Level Training

Published: 14/08/2019

Critical incidents

Many of the critical incidents listed are found elsewhere in the Core level section of the curriculum. Given the importance of the recognition and management of them, they are all included under this one heading for clarity

Whilst trainees may come across the critical incidents listed below during the course of clinical practice, it is anticipated that many will not be encountered in this way and as a result, the use of simulation to assist teaching and assessment is expected

Core clinical Learning Outcomes: 

  • To gain knowledge of the principle causes, detection and management of critical incidents that can occur in theatre
  • To be able to recognise critical incidents early and manage them with appropriate supervision
  • To learn how to follow through a critical incident with reporting, presentation at audit meetings, and discussions with patients
  • To recognise the importance of personal non-technical skills and the use of simulation in reducing the potential harm caused by critical incidents

 NB: All competencies annotated with the letter ‘E’ can be examined in any of the components of the Primary examination identified in the FRCA examination blueprint on page B-99 or in the Final examination identified in the Final FRCA blueprint on page C72 of Annex C.

Knowledge
Recall/describes the causes, detection and management of the following:
Competence Description Assessment Methods GMP

CI_BK_01

Cardiac and/or respiratory arrest 

A,C,E,S

1

CI_BK_02

Unexpected  fall in SpO2with or without cyanosis

A,C,E,S

1

CI_BK_03

Unexpected increase in peak airway pressure

A,C,E,S

1

CI_BK_04

Progressive fall in minute volume during spontaneous respiration or IPPV

A,C,E,S

1

CI_BK_05

Fall in end tidal CO2

A,C,E,S

1

CI_BK_06

Rise in end tidal CO2

A,C,E,S

1

CI_BK_07

Rise in inspired CO2

A,C,E,S

1

CI_BK_08

Unexpected hypotension

A,C,E,S

1

CI_BK_09

Unexpected hypertension

A,C,E,S

1

CI_BK_10

Sinus tachycardia 

A,C,E,S

1

CI_BK_11

Arrhythmias: 

  • ST segment changes
  • Sudden tachyarrythmias 
  • Sudden bradycardia 
  • Ventricular ectopics 
  • Broad complex tachycardia 
  • Ventricular Fibrillation 
  • Atrial fibrillation 
  • Pulseless electrical activity [PEA]

A,C,E,S

1

CI_BK_12

Convulsions

A,C,E,S

1

Recalls/describes the causes, detection and management of the following specific conditions:
Competence Description Assessment Methods GMP

CI_BK_13

Difficult/failed mask ventilation

A,C,E,S

1

CI_BK_14

Failed intubation

A,C,E,S

1

CI_BK_15

Can’t intubate, can’t ventilate

A,C,E,S

1

CI_BK_16

Regurgitation/Aspiration of stomach contents

A,C,E,S

1

CI_BK_17

Laryngospasm

A,C,E,S 

1

CI_BK_18

Difficulty with IPPV, sudden or progressive loss of minute volume

A,C,E,S

1

CI_BK_19

Bronchospasm

A,C,E,S

1

CI_BK_20

Pneumothorax and tension pneumothorax

A,C,E,S

1

CI_BK_21

Gas / Fat/ Pulmonary embolus

A,C,E,S

1

CI_BK_22

Adverse drug reactions

A,C,E,S

1

CI_BK_23

Anaphylaxis

A,C,E,S

1

CI_BK_24

Transfusion reactions, transfusion of mis-matched blood or blood products

A,C,E,S

1

CI_BK_25

Inadvertent intra-arterial injection of irritant fluids

A,C,E,S

1

CI_BK_26

High spinal block 

A,C,E,S

1

CI_BK_27

Local anaesthetic toxicity 

A,C,E,S

1

CI_BK_28

Accidental decannulation of tracheostomy or tracheal tube

A,C,E,S

1

CI_BK_29

Coning due to increased intracranial pressure 

A,C,E,S

1

CI_BK_30

Malignant hyperpyrexia

A,C,E,S

1

Discusses the importance of understanding the need for the following attitudes and behaviours:
Competence Description Assessment Methods GMP

CI_BK_31

Awareness of human factors concepts and terminology and the importance of non-technical skills in achieving consistently high performance such as: effective communication, team-working, leadership, decision-making and maintenance of high situation awareness

A,C,E,S

1,2,3,4

CI_BK_32

Awareness of the importance and the process of critical incident reporting

A,C,E,S

1,2,3,4

CI_BK_33

Acceptance that it can happen to you; the unexpected can happen to anyone

A,C,E,S

1,2,3,4

CI_BK_34

To practice response protocols in resuscitation room or in simulation with other healthcare professionals as appropriate

C,D,S

1, 2,3,4

CI-BK_35

The need to follow through a critical incident with proper reporting, presentation at morbidity meetings and warning flags as necessary, with appropriate supervision

A,C,E,S

1,2,3,4

CI_BK_36

The provision of information to the patient and where necessary ensuring they get the appropriate counselling and advice, with appropriate supervision

A,C,E,S

1,2,3,4

 

Skills
Competence Description Assessment Methods GMP

CI_BS_01

Demonstrates good non-technical skills such as: effective communication, team-working, leadership, decision-making and maintenance of high situation awareness

A,C,D,S

1,2,3,4

CI_BS_02

Demonstrates the ability to recognise early a deteriorating situation by careful monitoring

A,C,D,S

1,2,3,4

CI_BS_03

Demonstrates the ability to respond appropriately to each incident listed above 

A,C,D,S

1,2,3,4

CI_BS_04 Shows how to initiate management of each incident listed above A,C,D,S 1,2,3,4
CI_BS_05 Demonstrates ability to recognise when a crisis is occurring A,C,D,S 1,2,3,4
CI_BS_06 Demonstrates how to obtain the attention of others and obtain appropriate help when a crisis is occurring A,C,D,S 1,2,3,4