Please use this identifier to cite or link to this item: http://hdl.handle.net/2440/17178
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Type: Journal article
Title: Crisis management during anaesthesia: pneumothorax
Author: Bacon, A.
Paix, A.
Williamson, J.
Webb, R.
Chapman, M.
Citation: Quality and Safety in Health Care, 2005; 14(3):e18/WWW 1-WWW 5
Publisher: British Med Journal Publ Group
Issue Date: 2005
ISSN: 1475-3898
1475-3901
Statement of
Responsibility: 
A K Bacon, A D Paix, J A Williamson, R K Webb, M J Chapman
Abstract: Objectives: To examine the role of a previously described core algorithm "COVER ABCD–A SWIFT CHECK", supplemented by a specific sub-algorithm for pneumothorax, in the management of pneumothorax occurring in association with anaesthesia. Methods: Reports of pneumothorax were extracted and studied from the first 4000 incidents reported to the Australian Incident Monitoring Study (AIMS). The potential performance of the structured approach, using the combination of algorithims described above for each of the relevant incidents, was compared with the actual management as reported by the anaesthetists involved. Results: Pneumothorax was noted as a possible diagnosis in 65 reports; 24 cases had a confirmed pneumothorax, of which 17 were in association with general anaesthesia. It was considered that, correctly applied, the application of the algorithms would have led to earlier recognition of the problem and/or better management in 12% of cases. Conclusion: Any pneumothorax may become a dangerous tension pneumothorax with the application of positive pressure ventilation. Limited access to the chest during anaesthesia may compromise the diagnosis. Recognition of any preoperative predisposition to a pneumothorax (for example, iatrogenic or traumatic penetrating procedures around the base of the neck) and close communication with the surgeon are important. Aspiration diagnosis in suspected cases and correct insertion of a chest drain are essential for the safe conduct of anaesthesia and surgery.
Keywords: pneumothorax; anaesthesia complications; crisis management; central venous catheter complications; tracheostomy complications; syringe aspiration test; diagnostic algorithm
Description: © 2005 BMJ Publishing Group Ltd.
RMID: 0020050562
DOI: 10.1136/qshc.2002.004424
Published version: http://qshc.bmj.com/cgi/content/abstract/14/3/e18
Appears in Collections:Anaesthesia and Intensive Care publications

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