COVER ABCD

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

COVER ABCD

• Circulation satisfactory: check pulse rate and character. Start CPR if indicated.

  Yes

  No

  N/A

• Check Colour: confirm saturation reading

  Yes

  No

  N/A

• Oxygen: check 100% oxygen is being delivered.

  Yes

  No

  N/A

• Oxygen analyser: check than oxygen is delivered as dialled on the anaesthetic machine.

  Yes

  No

  N/A

• Ventilate: hand ventilate to confirm airway patency and check lung compliance. Observe chest movement. Check capnograph.

  Yes

  No

  N/A

• Vaporiser: Confirm the vaporiser settings, that the vaporiser is full and well seated.

  Yes

  No

  N/A

• Endotracheal tube: consider kinks, obstructions, endobronchial intubation or removal. Consider suction catheter, replacing or removing.

  Yes

  No

  N/A

• Eliminate the circuit: change to a self-inflating bag with an alternative oxygen source.

  Yes

  No

  N/A

• Review monitors: check all monitors correctly applied and calibrated (eg arterial line, NMT monitor)

  Yes

  No

  N/A

• Review equipment: Check all equipment in contact with the patient including warmers, electrocautery, probes, retractors etc

  Yes

  No

  N/A

• Airway (not intubated): consider laryngospasm, foreign body, aspiration, regurgitation.

  Yes

  No

  N/A

• Breathing: check for hypoventilation, bronchospasm, pulmonary oedema, lobar collapse, pneumothorax, haemothorax.

  Yes

  No

  N/A

• Circulation: check pulse, peripheral perfusion, BP, rhythm, ECG. Check CVP/JVP, intrathoracic pressure (inadvertent PEEP). . Consider ischaemia.

  Yes

  No

  N/A

• Drugs: check correct drugs are being administered, iv lines are flowing. Check for unintended drug administration.

  Yes

  No

  N/A

A SWIFT CHECK

• Air embolus

  Yes

  No

  N/A

• Anaphylaxis

  Yes

  No

  N/A

• Air in the pleura

  Yes

  No

  N/A

• Awareness

  Yes

  No

  N/A

• Surgeon: vagal stimulation, caval compression, bleeding, cardiac manipulation

  Yes

  No

  N/A

• Sepsis

  Yes

  No

  N/A

• Wound: check trauma, bleeding, tamponade, retractors, pneumothorax

  Yes

  No

  N/A

• Water intoxication: check sodium, fluid overload.

  Yes

  No

  N/A

• Infarct: check for myocardial ischaemia

  Yes

  No

  N/A

• Insufflation: check for vagal responses or intravascular gas embolism.

  Yes

  No

  N/A

• Fat: poor oxygenation or hypotension due to positioning in obese patient

  Yes

  No

  N/A

• Full bladder

  Yes

  No

  N/A

• Trauma: consider undiagnosed traumatic injuries like spinal injury, intracranial injury, visceral injury

  Yes

  No

  N/A

• Tourniquet down: local anesthetic toxicity, failed block, bleeding

  Yes

  No

  N/A

• Cannula: leak, blocked, tissued, failure to deliver drugs

  Yes

  No

  N/A

• Chest drain: fallen out, blocked, organ injury during insertion, incorrectly connected, underwater seal problems

  Yes

  No

  N/A

• Cement: methylmethacrylate cement effect

  Yes

  No

  N/A

• Hyper or hypothermia

  Yes

  No

  N/A

• Hypoglycaemia

  Yes

  No

  N/A

• Embolus: fat, thrombus, amniotic fluid

  Yes

  No

  N/A

• Endocrine: thyroid, adrenal, pituitary, diabetes mellitus, diabetes insipidus, carcinoid syndrome

  Yes

  No

  N/A

• Check: old casenotes for preoperative status, diseases, drugs

  Yes

  No

  N/A

• K+: hypo or hyperkalaemia

  Yes

  No

  N/A

• Keep the patient asleep with propofol, benzodiazepine or ketamine until new machine ready.

  Yes

  No

  N/A