Management of anaphylactic shock evaluated using a full-scale anaesthesia simulator

Background: The diagnosis of an anaphylactic reaction during anaesthesia is not the first consideration for the anaesthetist and might be missed. The aim of this study was to describe anaesthetists' management of an anaphylac tic reaction concerning diagnosing, treatment and application of anaesthesi a crisis resource management (ACRM) in a full-scale anaesthesia simulator. Methods: Forty-two anaesthetists in teams of two attended training sessions with a critical incident of anaphylactic shock in a full-scale simulator. Trained observers from the study group evaluated the medical treatment acco rding to a treatment sequence developed from the literature and graded the ACRM performance on a five-point scale where 1 is bad and 5 is best. Results: None of the teams made the correct diagnosis within 10 min and tre atment according to the treatment sequence was not initiated. Only 6/21 tea ms considered the right diagnosis but first after hints from the instructor 15 min after the start of the incident. Evaluation of the use of the total ACRM concept (that is the use of all of the ACRM expressions seen in a tot al connection: called general impression) gave a median value of 2.0 with a range of (1-3). Conclusion: Anaphylactic shock was difficult to diagnose and no structured plans were used for the treatment in the simulated incident in this study.