手术室麻醉危机处理培训(斯坦福大学)
http://player.youku.com/player.php/sid/XMzA2MzEzODA4==.html美国斯坦福大学的一个手术室麻醉危机处理培训的课程，通过手术室突发心跳骤停的模拟危机演练培训麻醉医生的危机处理能力，非常值得参考借鉴。
美国斯坦福大学关于Anesthesia Crisis Resource Management (ACRM)的介绍：
Development of the ACRM Concept
http://med.stanford.edu/VAsimulator/images/ACRM.jpgCrisis management skills are exercised during ACRM training
Based on experiments performed by the Laboratory for Human Performance in Health Care (LHPHC) -- see annotated bibliography for listing of earlier studies on clinical decision-making) and by others in the 1980s, LHPHC faculty began to develop a model of the cognition (thinking processes) of anesthetists. From this model, they began to realize that the performance of both novice and experienced anesthesiologists was limited in certain ways. For example, certain abnormal situations were not recognized quickly, or else the response to them on discovery was haphazard and slow. Also, even when the anesthetist knew what needed to be done, they could not always work effectively with other personnel (surgeon and nurses) to get things done in time. The LHPHC analysis of anesthesia training revealed several gaps. It was assumed that during training anesthesia residents would learn "by osmosis" to recognize abnormal situations and to deal with them. There was no systematic training in handling critical events, and no reference source for such information. Every other work environment in which critical events must be handled appropriately and quickly relies on manuals of emergency procedures to prepare personnel in advance and to support them as they manage crisis situations. Three LHPHC faculty wrote a Catalog of Critical Events in Anesthesiology which is the manual of emergency procedures for anesthesia. Using this catalog as a reference resource it was hoped that anesthesiologists could prepare in advance to recognize events and to treat them with logical, efficient plans.
The second, even bigger, gap in training was that no one was taught how to act in managing a critical event or crisis. Sound medical and technical knowledge is not enough. Anesthesiologist need to know how to manage a variety of resources effectively, bringing them together in concert as necessary to deal with the situation. These behaviors have been studied very carefully in aviation and special training courses in "Cockpit Resource Management" (CRM) have became standard for major air carrier pilots. The LHPHC team adapted many CRM concepts to anesthesiology, developing an approach termed "Anesthesia Crisis Resource Management" (ACRM). There are several key behaviors principles in ACRM
http://med.stanford.edu/VAsimulator/images/Comm.jpg
Team work and effective communication are exercised during ACRM
[*]Anticipation and Planning[*]Communication Leadership and Assertiveness[*]Use of all available resources[*]Anesthesia resident utilizing a cognitive aid during ACRM training[*]Distribution of Workload & mobilization of help[*]Re-evaluation of situations[*]Use of all available information and cross checking of redundant data
Such behaviors are NOT taught in anesthesia training programs, although good practitioners have learned these behaviors from experience. However, every practitioner can improve at them, and many residents and practitioners are not skilled in these matters. The ACRM training program focuses on these types of generic crisis management behaviors, emphasizing teamwork and coordination of resources in a realistic and full-scale simulation environment. [*]Real anesthesia cart and real drugs are used during training[*]Trainees perform all anesthesia tasks, including charting during their ACRM training[*]"Crisis Management in Anesthesiology", a textbook incorporating didactic materials on crisis management behaviors as well as the Catalog of Critical Incidents in Anesthesiology (83 events). (Gaba DM, Fish KJ, Howard SK: Crisis Management in Anesthesiology. New York, Churchill Livingston, 1994)
http://med.stanford.edu/VAsimulator/images/WKLD.jpg
Three anesthesia residents distribute the workload during management of a patient crisis situation
Simulation-based training in anesthesia crisis resource management
(ACRM): A decade of experience
6分35秒的时候，术者居然用手碰面罩，看来胸外按压真的是很累人的事啊，居然无菌意识都不在乎了，不过人家的抢救药品真是好啊，都不用抽，直接对上就给，什么时候我们医院也能这样啊。 我国什么时候有那么好的条件常规培训我们的麻醉医师，我国的麻醉质量肯定能上一个台阶 条件好得很啊，特别是抢救药，乖乖啊，直接拧上就能用了，我们还得划，敲开，抽出来，才能给，浪费了不是一秒钟，有时有一秒钟就能决定成败了 全英文呢！看起来吃力 是啊英语水平有待提高啊听不懂哦 哎，人家有三个三通，咱就一路液体，要紧了再扎一路。
就是啊，穿帮了，手术医生的手污染了，后来继续做手术。哈哈 本帖最后由 jiahaipeng317 于 2011-10-12 16:01 编辑
人家的帽子不错啊，头发全挡住了，看看咱版主的头发，都达到T2了。全露出来了！
http://www.xqnmz.com/ucenter/avatar.php?uid=1&size=middle版主，你不会生气吧？别公报私仇啊，呵呵，开玩笑