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作者: xyz-cn99 时间: 2011-9-22 18:29
美国斯坦福大学关于Anesthesia Crisis Resource Management (ACRM)的介绍：
Development of the ACRM Concept
Crisis 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 [now Crew] 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
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)
Three anesthesia residents distribute the workload during management of a patient crisis situation
作者: xyz-cn99 时间: 2011-9-22 18:36
Simulation-based training in anesthesia crisis resource management
(ACRM): A decade of experience
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Simulation-based training in anesthesia crisis resource management.pdf
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作者: 其实我是医师 时间: 2011-9-25 14:11
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。
作者: zcf0103 时间: 2011-9-25 22:40
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
作者: xxfx007 时间: 2011-9-26 17:40
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
作者: wyl206206 时间: 2011-10-2 08:33
全英文呢！看起来吃力
作者: 我是麻醉师 时间: 2011-10-6 17:24
是啊 英语水平有待提高啊 听不懂哦
作者: jiahaipeng317 时间: 2011-10-12 15:23
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
作者: jiahaipeng317 时间: 2011-10-12 15:26
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！
[img][/img]版主，你不会生气吧？别公报私仇啊，呵呵，开玩笑
作者: 蚂蚁120 时间: 2011-10-17 16:38
要是有生产商，把抢救药品都生产成注射器就好了，不用抽了，直接使用。。
作者: zhujiang23 时间: 2011-10-23 20:11
顶楼上的！
希望各位麻醉的专家给厂家提意见，是好的我们就应该拿来用嘛！
紧急的时候真希望抢救药品是人家的样式。
作者: wenweihua1981 时间: 2011-10-26 23:02
那抢救药是蛮好的
作者: 秀丽 时间: 2011-11-8 23:09
全英文呀！有点吃力。
作者: xfw19840818 时间: 2011-11-16 17:22
全英文呀！:funk:
作者: xfw19840818 时间: 2011-11-16 17:23
:dizzy:全英文呀！
作者: ybhzrl 时间: 2011-11-29 09:59
全英文呢！看起来吃力
作者: lky20022002 时间: 2011-12-14 16:49
什么时候能有中文字幕
作者: lky20022002 时间: 2011-12-14 16:49
谢谢版主 。什么时候能有中文字幕
作者: 马杰爱你 时间: 2011-12-19 19:49
英文呀，不懂！不过人家的各种设备药品的确很牛，人家舍得投资，我们医院，问院长要了五年了，瑞芬太尼说太贵不让进，药品上不行，手术间还不是层流，也没有铅墙，人家居然刚安装了一个中央监护系统，真他妈的粉刺！可想而知，在我们医院我们的地位有多差了！
作者: a9shizuki 时间: 2011-12-20 16:25
认真看，认真听，谢谢分享
作者: teluoy 时间: 2011-12-25 12:17
没学到东西，就看热闹了，哈哈
作者: notowait 时间: 2011-12-25 18:07
有个小问题 ，因为是英文，不清楚做什么手术，但是开始病人的确是俯卧位，当情况出现时大家开始抢救，医生好像没有给病人翻身就胸外按压了，怎么做到的？:L
作者: anesthesia 时间: 2012-1-5 08:17
条件好，需要经济实力支撑，天朝现在还比不得米国
作者: 小蚂蚁 时间: 2012-1-5 21:10
可以下载么版主:loveliness:
作者: 15965818730 时间: 2012-1-11 18:58
我们医院心外手术不多，不过看过很受益，推荐多看几遍，特别是现场操作一段
作者: 果冻dong 时间: 2012-1-12 19:27
英语有待提高，收藏起来好好看看。谢谢分享！
作者: 歪头 时间: 2012-1-27 18:23
可惜是英文的,看不太懂,非常好的东西!
作者: xuefeng120120 时间: 2012-2-2 21:14
翻译成中文就好了
作者: zxw103 时间: 2012-2-4 21:20
全英文！看起来吃力
作者: 康04010216 时间: 2012-2-10 10:52
没翻译？:dizzy:
作者: hxjzzl123 时间: 2012-2-12 19:26
把抢救药品都生产成注射器就好了，不用抽了，直接使用,抢救成功率就高了啊!
作者: 心雨 时间: 2012-2-28 14:29
全英文版的，听不懂哦！:funk:
作者: xiesuyong 时间: 2012-2-28 20:59
要是有生产商，把抢救药品都生产成注射器就好了，不用抽了，直接使用。。
WO TONGYI
作者: wuxianabcd 时间: 2012-3-2 11:10
看后真的受益匪浅！
作者: alisee 时间: 2012-3-6 15:32
全英文呀，有点可惜！:L
作者: 散落在天涯 时间: 2012-3-11 12:38
自认为英文还可以 碰到实战版的就不行了
不过从画面中还是可以学到很多东西的
作者: fangchenxu 时间: 2012-3-18 23:02
能不能搞个中文版的啊？
作者: 芳芳 时间: 2012-4-2 15:22
没怎么听明白
回家苦练英语去
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