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  • Always take history – if the patient cannot tell you, someone else may
  • Make rapid evaluation of collapsed patient
  • Follow with full, detailed examination to avoid missing anything important
  • Pre-existing medical conditions have profound influence on anesthesia, surgery: diabetes, anemia, lung disease
  • Low blood sugar is the main intra-operative risk from diabetes; monitor blood sugar levels, treat as necessary
  • Urgent surgery: use your skills to minimize harmful effects of pre-existing conditions
  • Events leading up to admission should be carefully considered: trauma, injury, etc.
    • What happened?
    • When did it happen?
    • Was the patient a passenger, driver or pedestrian?
    • Was there any blood loss? How much?
    • How far away did it occur?
    • How did the victim get to the hospital?
    • If unconscious now, was the patient conscious before?
  • Before starting clinical examination, make an “end-of-the-bed” examination:
    • Breathing pattern (flail segment, asymmetry, paradoxical movement, tachypnea, dyspnoea)
    • Position of patient (sitting up, lying down)
    • Position of arms and legs (limb, pelvic fracture)
    • Restlessness (pain, hypoxia, shock)
    • Dehydration (skin turgor, sunken eyes)
    • Distended abdomen
    • Scars of recent surgery, dressings covering wound not yet inspected
    • Blood stained clothes
  • Before starting any case, ask:
      - “Have I missed anything?”
      - “Will further investigation be useful?”
  • Talk to surgical colleagues to make sure everyone knows what others will do
  • However strong the indications may seem for using a particular technique, the best anaesthetic technique, especially in
    emergencies, will normally be one with which you are most experienced and confident. Emergency situations are not
    the right time to practice new techniques


    ✓Assistant available to help
    ✓Correct patient scheduled for correct operation on correct side
    ✓Patient properly prepared
    ✓Patient's progress throughout hospital course known thoroughly
    ✓Adequate intravenous access
    ✓Surgical table can be rapidly tilted in event of rapid hypotension, vomiting
    ✓Check equipment
    ✓Have clear plan before initiating anaesthesia
    ✓Oxygen available
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