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:
|
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 |