title: Management of anaphylactic shock evaluated using a full-scale anaesthesia simulator.
abstract: 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 anaphylactic reaction concerning diagnosing, treatment and application of anaesthesia 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 according 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 treatment according to the treatment sequence was not initiated. Only 6/21 teams 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 total connection: called general impression) gave a median value of 2.0 with a range of (1-3).
  
  
  CONCLUSIONS
  Anaphylactic shock was difficult to diagnose and no structured plans were used for the treatment in the simulated incident in this study.
authors.affiliation: Department of Anaesthesiology, Herlev Hospital, University of Copenhagen, Denmark.
authors.forename: J
authors.initials: J
authors.lastname: Jacobsen
authors.forename: A L
authors.initials: AL
authors.lastname: Lindekaer
authors.forename: H T
authors.initials: HT
authors.lastname: Ostergaard
authors.forename: K
authors.initials: K
authors.lastname: Nielsen
authors.forename: D
authors.initials: D
authors.lastname: Ostergaard
authors.forename: M
authors.initials: M
authors.lastname: Laub
authors.forename: P F
authors.initials: PF
authors.lastname: Jensen
authors.forename: N
authors.initials: N
authors.lastname: Johannessen
mesh_terms: D000707:Anaphylaxis / Q000175:diagnosis / Q000628:therapy*; D000758:Anesthesia / Q000009:adverse effects*; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D016544:Patient Simulation