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Ch 24 · Perioperative Care

Topics for Discussion

Scenarios and decision-points from the Stanford CA-1 mentorship curriculum.

5 min read

Key Points

  • These prompts mirror real-world judgment calls — answer them with your mentor or use the AI assistant.
  • When in doubt, prioritize the patient's airway, oxygenation, and circulation — communication and documentation come after.
  • If a colleague behaves unprofessionally, address it directly or escalate via the chief, attending, or ombudsperson.
  • Disclose medication errors immediately — to the patient, the attending, the QI team. The patient comes first.

01Scenarios to Work Through

  1. Your IV infiltrates during induction. What are your options?
  2. You get stuck with a needle. How do you protect yourself and the patient?
  3. You can't deliver positive pressure. What are your next steps?
  4. You witness an unprofessional exchange between a surgeon and a nurse / med student / resident. Who should you talk to?
  5. You encounter an unanticipated difficult airway. You know to CALL FOR HELP. Who do you call and what do you ask for?
  6. You inadvertently administer the wrong medication. What should you do and who should you tell?
  7. Your patient tells you that they want only the attending to perform invasive procedures. How do you respond?
  8. The surgeon insists the patient is not relaxed enough — but you re-dosed a NDMB 5 minutes ago. What are your options?
  9. You administer antibiotics after induction. An hour later, incision still hasn't happened. What should you do?
  10. The surgeon appears to be struggling and the patient is rapidly losing blood. The surgeon insists they don't need help. What should you do?

02How to Approach Them

  • Slow down, identify the problem clearly. Pause and articulate what's happening before acting.
  • Use a structured framework: ABC (airway, breathing, circulation) → call for help → buy time → diagnose → treat.
  • Communicate clearly — close-loop with surgeons and nurses. "I need a 7.0 ETT" not "can you grab a tube?"
  • Document events truthfully and in real time after the crisis is over.
  • Debrief with the team and your mentor; learning from a near-miss is as valuable as from a complication.
  • For interpersonal and ethical situations, follow your institution's escalation pathway (chief resident → program director → ombudsperson → professionalism committee).

03Use the AI Assistant

Try pasting any of the scenarios above into the AI Assistant to get a structured discussion you can review with your mentor. Sample prompts:

  • "Walk me through how to handle an unanticipated difficult airway during routine GA induction. Who do I call and what equipment do I get?"
  • "I gave the wrong medication. The patient is stable. What should I do, in what order, and who should I notify?"
  • "Surgeon is struggling, blood loss is escalating. Surgeon insists they don't need help. How do I navigate this?"

Always remember: AI is a brainstorming partner, not a substitute for clinical judgment or your attending.

References & Further Reading

  1. 1
    Textbook

    Adriano A, Morris R, eds. 2021 CA-1 Tutorial Textbook (15th Ed.). Stanford University Medical Center, Department of Anesthesiology.

  2. 2
    WebOpen source

    Stanford Anesthesia Cognitive Aid Group. Stanford Anesthesia Emergency Manual. emergencymanual.stanford.edu.

Citations are provided to direct further study. Always check the most current edition of guidelines and society recommendations — the information in this chapter is a teaching summary, not primary source material.

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