HELPER - A CRITICAL EVENTS PROMPTER FOR UNEXPECTED EMERGENCIES

Objective. The medical practitioner is faced with an increasing list o f protocols and algorithms related to patient care. These recommendati ons are often difficult to recall, particularly in stressful emergency situations. Using advanced cardiac life support (ACLS) protocols, we built a computer-based system to exhibit precompiled response plans fo r medical emergencies. To validate the usefulness of this prompting de vice, we tested application of two of the nine ACLS algorithms, pulsel ess ventricular fibrillation/ventricular tachycardia (Vfib/Vtach) and bradycardia, in a simulated operating room (OR) environment. Methods. The system utilized the software authoring system IconAuthor (Aimtec I nc., Nashua, NH) and a touch-screen monitor (DiamondScan, Microtouch, Methuen, MA). Prior to testing our system, all 39 subjects were given time to familiarize themselves with its operation. Subsequently, all s ubjects were videotaped while managing a standard simulated anesthetic . During the anesthetic, the subjects were presented with two emergenc y scenarios, not viewed during the familiarization period. The electro cardiographic (EKG) signals for normal sinus rhythm, ventricular fibri llation, and second-degree heart block were presented. By random selec tion, the prompter was available to half of the subjects for help with arrhythmia management (experimental group), while to half it was not (control group). Results. A total of 39 subjects completed the exercis e. Use of the prompter enabled significantly more subjects to administ er correct drugs and dosages during ventricular fibrillation. The corr ect lidocaine dose was chosen more often by the experimental group tha n by the control (p = 0.015); similarly MgSO4 was appropriately ordere d more often in the experimental group (p = 0.003). During second-degr ee heart block, atropine was correctly followed with a dopamine infusi on (p = 0.004), and epinephrine infusion was ordered for refractory br adycardia (p = 0.002) more often in the experimental than the control group. Conclusions. These data demonstrate the value of a prompting de vice at the anesthesia workstation. We foresee the use of such prompte rs in many areas of medicine.