Emergency Manual
Crisis cards designed for the OR. Single-page, scannable, with doses, sequenced steps, and the pitfalls that catch teams off guard. Built to be used at the head of the bed when seconds count.
These are cognitive aids — not a substitute for institutional protocols. Practice them before you need them.
Malignant Hyperthermia
Hypermetabolic crisis triggered by halogenated volatiles or succinylcholine.
Call MHAUS — 1-800-MH-HYPER (1-800-644-9737)
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Local Anesthetic Systemic Toxicity (LAST)
Lipid emulsion is the antidote. Modified ACLS — small epi doses, avoid vasopressin.
Lipid emulsion 20% — 1.5 mL/kg bolus → 0.25 mL/kg/min infusion
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Anaphylaxis
Stop trigger, 100% O₂, fluid bolus, EPINEPHRINE. NMBAs cause >50% of intraoperative cases.
Epinephrine 10–100 mcg IV bolus (titrate); 0.3–0.5 mg IM thigh if no IV
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Cannot Intubate, Cannot Ventilate
Oxygenation is paramount. Default to whatever works. Surgical airway last but don't delay.
Call for help · Get the difficult airway cart · Prepare for surgical airway
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Massive Transfusion
Balanced 1:1:1 resuscitation, TXA within 3 h, calcium for citrate, warm the patient.
Activate Massive Transfusion Protocol (MTP) early — don't wait for labs
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Laryngospasm
Larson's maneuver + CPAP. Sux 10–20 mg IV breaks refractory cases.
Pressure on Larson's notch + jaw thrust + CPAP 40 cmH₂O
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Code Blue / Adult ACLS
High-quality CPR. Reversible causes (Hs and Ts). Epi q3–5 min. Defibrillate shockable rhythms.
Call code, start CPR, rhythm check at 2 min
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