Recognize & call
Emergencies
Your job in a crisis: notice early, say it clearly, get help, and do what you’re asked. These cards teach recognition — they are not treatment algorithms.
Malignant hyperthermia
Early signs
Unexplained rising ETCO₂ despite more ventilation, tachycardia, masseter or whole-body rigidity, hyperkalemia, arrhythmias. Hyperthermia is often LATE.
Key facts
Triggers: volatile anesthetics and succinylcholine. Treatment centers on stopping triggers and dantrolene 2.5 mg/kg (actual body weight), repeated. Ryanodex 250 mg/5 mL vs. Dantrium/Revonto 20 mg vials (≈ 60 mL water each) — the cart needs many hands.
Day one: ask your resident to show you the mh cart location.
Local anesthetic systemic toxicity (LAST)
Early signs
Perioral numbness, metallic taste, tinnitus, agitation → seizures → arrhythmias and cardiovascular collapse. Can follow any block or large infiltration.
Key facts
Stop injecting, call for help, manage the airway, treat seizures. Lipid emulsion 20%: 100 mL over 2–3 min if > 70 kg (1.5 mL/kg if < 70 kg), then an infusion. Reduced-dose epinephrine.
Day one: ask your resident to show you the lipid emulsion location.
Anaphylaxis
Early signs
Hypotension, bronchospasm (rising peak pressures), falling ETCO₂, tachycardia. Rash may be hidden under drapes or absent.
Key facts
Common culprits: neuromuscular blockers, antibiotics (cefazolin), chlorhexidine, sugammadex, latex, dyes. Epinephrine is first-line; the team leads.
Day one: ask your resident to show you the anaphylaxis kit location.
Laryngospasm
Early signs
At emergence: stridor or a silent chest, can’t ventilate, falling SpO₂.
Key facts
Recognize and call out. The team treats (jaw thrust, CPAP with 100% O₂, deepen anesthesia, ± succinylcholine).
Hypoxemia
Early signs
Falling SpO₂ with or without capnography changes.
Key facts
Report value, trend and waveform quality. The team works from patient to machine: FiO₂, ventilation, tube position, circuit, bronchospasm, PE, equipment.
Airway / OR fire
Early signs
Flash, smoke, odor, unexpected heat — oxygen-enriched environment near cautery.
Key facts
Announce “FIRE.” The team stops gas flow and removes burning material. Know where the extinguisher is.
Day one: ask your resident to show you the extinguisher location.
