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Continuing professional development (CPD): EMERGENCY RESPONSES

The following emergency responses learning resources have been selected by the CPD Committee in collaboration with special interest groups of the College in order to provide CPD participants with support resources when undertaking emergency responses activities.  The resources are not created and accredited by the College but they are linked to below for your convenience. Where usernames and passwords are required for access, CPD participants should use the contact details on the relevant websites in order to gain access.

Management of can’t intubate can’t oxygenate (CICO)

​Recognised emergency algorithms

At this stage, ANZCA does not exclusively endorse any one emergency algorithm for CICO situations but recognises the need for clinicians to be familiar with at least one. The following algorithms are suitable for use in infraglottic airway access/ front-of neck access and should be read in conjunction with the accompanying background articles:

Australian and New Zealand College of Anaesthetists. PS61 Guidelines for the Management of Evolving Airway Obstruction: Transition to the Can’t Intubate Can’t Oxygenate Airway Emergency: Background Paper [Internet]. 2017. From: http://www.anzca.edu.au/documents/ps61bp-2017. Accessed August 20 2018. 

ANZCA Airway Management Working Group. Transition from supraglottic to infraglottic rescue in the “can’t intubate can’t oxygenate” (CICO) scenario [Internet]. 2014. From: http://www.anzca.edu.au/documents/report-from-the-anzca-airway-management-working-gr.pdf. Accessed August 20 2018. 

Australian and New Zealand College of Anaesthetists. PS61 Guidelines for the Management of Evolving Airway Obstruction: Transition to the Can’t Intubate Can’t Oxygenate Airway Emergency [Internet]. 2017. From: http://www.anzca.edu.au/documents/ps61-2017. Accessed August 20 2018. 

Chrimes N, Fritz P. The vortex approach: management of the unanticipated difficult airway [Internet]. 2013. Smashwords Edition [Internet]. From: https://rollcagemedic.com/resources/Archived_newsletters/the-vortex-approach-management-of-the-unanticipated-difficult-airway.pdf. Accessed August 20 2018.

Sabato SC, Long E. An institutional approach to the management of the 'Can't Intubate, Can't Oxygenate' emergency in children. Paediatr Anaesth 2016;26(8):784-793. [Internet]. From: http://onlinelibrary.wiley.com.ezproxy.anzca.edu.au/doi/epdf/10.1111/pan.12926. Accessed August 20 2018. 

Heard A. Percutaneous Emergency Oxygenation Strategies in the ‘Can’t Intubate, Can’t Oxygenate’ Scenario. Smashworks Editions, 2013. [Ebook] 

Greenland KB, Acott C, Segal R, Goulding G, Riley RH, Merry AF. Emergency surgical airway in life-threatening acute airway emergencies - why are we so reluctant to do it? Anaesth Intensive Care 2011;39(4):578-584. [Internet]. From: http://aaic.net.au.ezproxy.anzca.edu.au/PMID/21823373. Accessed August 20 2018. 

Management of anaphylaxis

Participants may complete of the Perioperative Anaphylaxis Response course as it has been developed specifically to meet the requirements of the anaphylaxis emergency response standard. 

EducationPerioperative Anaphylaxis Response course, access through Networks. (Only available to FANZCA, FFPM and participants of the ANZCA and FPM CPD program. 

Recognised emergency algorithms and guidelines 

ANZCA recognises that several published algorithms exist for the treatment of anaphylaxis.  Many of these involve the treatment of anaphylaxis in settings other than a highly monitored critical care environment and are intended for use by noncritical care specialists.  

ANZCA has co-badged the second version the Australian and New Zealand Anaesthetic Allergy Group (ANZAAG) Anaphylaxis Management Guidelines for the management of perioperative anaphylaxis in settings where medical professionals with experience titrating intravenous adrenaline provide continuous monitoring of physiological parameters. 

For the treatment of other anaphylaxis outside of these settings, Australian Society of Clinical Immunology and Allergy (ASCIA) Acute Management of Anaphylaxis Guidelines should be followed. The New Zealand Resuscitation Council also provides algorithms for the management of anaphylaxis in adults and children.

The algorithms can be accessed via the links below: 

WebsiteANZAAG

WebsiteASCIA

WebsiteNZRC

Recommended readings:

Australian and New Zealand College of Anaesthetists (ANZCA) and Australian and New Zealand Anaesthetic Allergy Group (ANZAAG). Perioperative Anaphylaxis Management Guidelines. 2016. [Internet] . Accessed August 23 2018. 

Australian and New Zealand College of Anaesthetists (ANZCA) and Australian and New Zealand Anaesthetic Allergy Group (ANZAAG). Perioperative Anaphylaxis Management Guidelines: Background Paper. 2016. [Internet] . Accessed August 23 2018.

Management of cardiac arrest

Recognised emergency algorithms

ANZCA exclusively endorses the ALS guidelines of the Australian Resuscitation Council and the New Zealand Resuscitation Council.  Specialists with specific sub-specialty practice, or specialists resident in other countries, should contact the CPD team to ascertain if alternative guidelines are recognised for their individual circumstances.

Management of major haemorrhage

Participants may complete either, or both, of the BloodSafe elearning Australia’s online modules as each of these have been recognised as a Major Haemorrhage activity. 
EducationCritical Bleeding, based on the National Blood Authority's Patient Blood Management Guidelines: Module 1 Critical Bleeding/Massive Transfusion. 
EducationObstetrics and Maternity, based on the National Blood Management Guidelines: Module 5 Obstetrics and Maternity. 

Recognised algorithms and guidelines 
ANZCA does not exclusively endorse any one algorithm or guideline for the management of major haemorrhage but recognises the need for clinicians to be familiar with at least one. The following guidelines are recognised as being suitable for use in this module: 

EducationNational Blood Authority of Australia. Patient Blood Management Guidelines: Module 1 Critical Bleeding/Massive Transfusion. 2011. [Internet] Accessed August 23 2018.

Australian and New Zealand Society of Blood Transfusion (ANZSBT). Guidelines for the Administration of Blood Products. 2018. [Internet] . Accessed August 23 2018. 

Kozek-Langenecker SA, Afshari A, Albaladejo P, Santullano CA, De Robertis E, Filipescu DC, et al. Management of severe perioperative bleeding: guidelines from the European Society of Anaesthesiology. Eur J Anaesthesiol 2013:34(6):270-382. [Internet] . Accessed August 23 2018. 

Mavrides E, Allard S, Chandraharan E, Collins P, Green L, Hunt BJ, et al. on behalf of the Royal College of Obstetricians and Gynaecologists. Prevention and management of postpartum haemorrhage. BJOG 2016;124:e106–e149. [Internet] . Accessed August 23 2018.

Cannon JW, Khan MA, Raja AS, Cohen MJ, Como JJ, Cotton BA, et al. Damage control resuscitation in patients with severe traumatic haemorrhage: a practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg 2017;82(3):605-17. [Internet] . Accessed August 23 2018.

This article is also suggested as recommended reading:
Blain S, Paterson N. Paediatric massive transfusion. BJA Educ 2015;16(8):269-75. [Internet] .  Accessed August 23 2018.