ANESTHESIA EMERGENCY? CONSULT THE ULTIMATE GUIDEBOOK…

Consider the following situations:

  1. You’re an anesthesia professional, and your patient has a sudden unexpected complication (think unstable cardiac rhythm, unanticipated difficult airway, anaphylaxis, hypotension, hypoxemia, malignant hyperthermia, local anesthetic toxicity, or transfusion reaction) in the operating room or Post Anesthesia Care Unit. You react quickly to support Airway –Breathing- Circulation and apply all your knowledge of the appropriate diagnostic and therapeutic action steps. Will you perform perfectly? Will you remember every detail without fail?
  2. It’s the day before your American Board of Anesthesiology oral board exam, you’re completing your final review, and you’re looking for comprehensive listings of how to manage the array of medical emergencies the Board Examiners may present to you.
  3. You’re a Medical Director or medical educator, and you’re scheduled to deliver a lecture on the management of two or three common operating room emergencies. You’re searching for a concise and accurate listing of the management such emergencies.
  4. You’re an expert witness or a member of your hospital’s Quality Improvement committee, charged with reviewing the unfortunate outcome of an operating room medical complication. You’re searching for an algorithm listing the standard of care in managing that specific emergency.

What do you do in situations 1 – 4 above?

I recommend you consult a new publication, the Emergency Manual of Cognitive Aids for Perioperative Critical Events.

Anesthesia practice is described as 99% boredom and 1% panic. In those emergency moments which coincide with the 1% panic, anesthesiologists must respond with exacting skill. My colleagues at Stanford University have developed the Emergency Manual of Cognitive Aids for Perioperative Critical Events, a useful adjunct in managing critical events during the perioperative period. This Manual is described in detail on the website http://emergencymanual.stanford.edu, and the Manual is available for free download at this location.

I had no role in authoring the Manual—my message here is to inform you that an important new medical reference guide exists, and to convince you to acquire it and use it. I can attest that the Manual is comprehensive, accurate, and valuable for education, preparation, and as a source of real-time checklists during perioperative emergencies that leave little room for error and little time to consult reference textbooks.

This emergency Manual evolved from decades of prior work on both Crisis Resource Management (CRM) concepts and cognitive aids for critical incidents. Dr. David Gaba, Dr. Steven Howard, and Dr. Kevin Fish of Stanford authored a 1994 book entitled Crisis Management in Anesthesiology, and their work and publications involving teaching via an anesthesia simulator led to the development of cognitive aids for operating rooms in the Palo Alto VA Hospital and also a national VA project.

Drs. Kyle Harrison, Sara Goldhaber-Fiebert, Geoff Lighthall, Ruth Fanning, Steven Howard, and David Gaba observed during simulator sessions that practitioners often missed key actions under stress. They developed several versions of pocket cards for perioperative critical events. In 2004 Dr. Larry Chu, also at Stanford, conceived of adapting crisis management cognitive aids into a new book. This became The Manual of Clinical Anesthesiology, published in 2011.

To create the current Emergency Manual of Cognitive Aids for Perioperative Critical Events, the Stanford Anesthesia Cognitive Aid Group was formed. Dr. Larry Chu, director of the Stanford Anesthesia Informatics Management (AIM) lab, provided the graphics and layout. Drs. Sara Goldhaber-Fiebert, Kyle Harrison, Steven Howard, and David Gaba worked together to provide the content, including the exact phrasing, ordering, and emphasis, as well as simulation testing to revise both content and design elements. The Stanford Anesthesia Cognitive Aid Group observed how teams of anesthesiologists used cognitive aids during hundreds of simulated crises. These simulator sessions were crucial for pilot testing of the algorithms in the emergency Manual. Stated goals of the Manual are to support education and patient safety efforts in pre-event review, post-event team debriefing, and during actual critical event management.

The content of the Manual is exhaustive, covering treatment for Advanced Cardiac Life Support (ACLS) arrhythmias as well 18 non-ACLS critical events including unanticipated difficult airway, anaphylaxis, hypotension, hypoxemia, malignant hyperthermia, local anesthetic toxicity, and transfusion reaction.

Each page of the Manual presents an algorithm printed in a prominent font containing, for example, SIGNS, TREATMENT, DIFFERENTIAL DIAGNOSES, and POST EVENT checklists. In an era when pre-operative surgical Time Outs are mandated and the best-selling book The Checklist Manifesto by Dr. Atul Gawande touts the value of checklists in medical care, the Emergency Manual of Cognitive Aids for Perioperative Critical Events is a valued addition to quality care for your surgical patients.

On their website, the authors cite the following Reasons for Implementing an Emergency Manual:

  1. In simulation studies, integrating emergency manuals results in better management during operating room critical events. NOTE: Familiarization and training in why and how to use EMs appears to be key for success.
  2. Pilots and nuclear power plant operators use similar cognitive aids for emergencies and rare events, with training on why & how to use them.
  3. During a critical event, relevant detailed literature is rarely accessible.
  4. Memory worsens with stress & distractions interrupt planned actions.

Expertise requires significant repetitive practice, so none of us are experts in every emergency.

A hard copy of the Emergency Manual of Cognitive Aids for Perioperative Critical Events hangs in the central operating room hallway at the surgery center in Palo Alto where I am the Medical Director. A copy of the Manual hangs in every operating room at Stanford Hospital.

I carried a copy of The Washington Manual of Medical Therapeutics in the pocket of my white coat for three years while I was an internal medicine resident at Stanford. My Washington Manual became dog-eared, underlined, and worn because I knew it was an invaluable resource. The Stanford Manual now occupies this role for the management of perioperative emergencies.

I recommend the Emergency Manual of Cognitive Aids for Perioperative Critical Events at the highest level of enthusiasm. It will help guarantee excellence of care for your patients. It’s free, and the benefit/risk ratio of consulting this Manual approaches infinity.

Download it now at http://emergencymanual.stanford.edu

Appropriate citation of this Emergency Manual:

Stanford Anesthesia Cognitive Aid Group*. Emergency Manual: Cognitive aids for perioperative critical events. See http://emergencymanual.stanford.edu for latest version. Creative Commons BY-NC-ND. 2014 (Version 2) (http://creativecommons.org/licenses/by-nc-nd/3.0/legalcode). 
*Core contributors in random order: Howard SK, Chu LF, Goldhaber-Fiebert SN, Gaba DM, Harrison TK.

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Introducing …,  THE DOCTOR AND MR. DYLAN, Dr. Novak’s debut novel, a legal mystery. Publication date September 9, 2014 by Pegasus Books.

On October 2, 2014 THE DOCTOR AND MR. DYLAN became the world’s  #1 bestselling anesthesia Kindle book on Amazon.com.

The first four chapters are available for free at Amazon. Read them and you’ll be hooked! To reach the Amazon webpage, click on the book image below:

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Stanford professor Dr. Nico Antone leaves the wife he hates and the job he loves to return to Hibbing, Minnesota where he spent his childhood. He believes his son’s best chance to get accepted into a prestigious college is to graduate at the top of his class in this remote Midwestern town. His son becomes a small town hero and academic star, while Dr. Antone befriends Bobby Dylan, a deranged anesthetist who renamed and reinvented himself as a younger version of the iconic rock legend who grew up in Hibbing. An operating room death rocks their world, and Dr. Antone’s family and his relationship to Mr. Dylan are forever changed.

Equal parts legal thriller and medical thriller, The Doctor and Mr. Dylan examines the dark side of relationships between a doctor and his wife, a father and his son, and a man and his best friend. Set in a rural Northern Minnesota world reminiscent of the Coen brothers’ Fargo, The Doctor and Mr. Dylan details scenes of family crises, operating room mishaps, and courtroom confrontation, and concludes in a final twist that will leave readers questioning what is of value in the world we live in.

REVIEWS:

5.0 out of 5 stars The Doctor and Mr Dylan, March 3, 2015
By
prabha venugopal (chicago, il USA) – See all my reviews
Verified Purchase(What’s this?)
Gripping from the beginning to the end. Very well written, bringing to the forefront all the human emotions seen in an operating room spill over into real life. I cannot wait for Dr. Novak to wrote another book! As another physician in the same profession, my admiration for his book knows no limits.

Bang-Up Debut Novel, November 16, 2014

By Norm Goldman “Publisher & Editor of Bookpleasures”

This part legal and medical thriller is structured with a mixed bag of situations involving relationships, jealousy, evil, lies, courtroom drama, operating room mishaps as well as moments that engender conflicting and unexpected outcomes. Noteworthy is that as the suspense builds readers will become eager to uncover the truth involving a mishap concerning Nico and a surgical procedure that has unanticipated ramifications.

This is a bang-up debut from a writer who understands timing and is able to deliver hairpin turns, particularly involving the courtroom drama,that you would expect from a book of this genre.

TwinCities.com PIONEER PRESS Entertainment

by Mary Ann Grossman, Entertainment Editor, St. Paul Pioneer Press mgrossman@pioneerpress.com, January 4, 2015

“The Doctor & Mr. Dylan” by Rick Novak (Pegasus Books, $17.50)

Dr. Nico Antone doesn’t hide the fact he hates his wife, but he says he didn’t kill her during an operation. The authorities think otherwise and his trial is the riveting suspense in this novel that is part medical thriller, part legal thriller, part exploration of family relationships.

Nico is an anesthesiologist (as is the author) who leaves his wife, their plush life in California and his job at Stanford to move to his hometown of Hibbing so their son, Johnny, has a better chance of getting into a prestigious college. Johnny hates the idea of moving to a small, cold town, but he’s popular from the first day in school. Nico doesn’t do so well. He’s envied by Bobby, an anesthetist who’s jealous of the better-educated Nico. But it’s hard to take Bobby seriously, since he thinks he’s the young Bob Dylan and lives in the house where Bobby Zimmerman grew up. To complicate matters, Nico is attracted to the mother of the young woman his son is dating. When the two teens get in trouble, Nico’s furious, rich wife comes to Minnesota and needs an emergency operation that puts her on Nico’s operating table.

Novak grew up in Hibbing, where he worked in the iron ore mines and played on the U.S. Junior Men’s Curling championship teams of 1974 and ’75. After graduating from Carleton College, he earned a medical degree at the University of Chicago and spent 30-plus years at Stanford Hospital, where he was an associate professor of anesthesia and Deputy Chief of the Anesthesia Department. His courtroom scenes are based on his experiences as an expert witness.

The Physician’s Late-Night Reading List

Two Pritzker alums pen captivating tales

By Brooke E. O’Neill, University of Chicago Pritzker School of Medicine, editir, Medicine on the Midway Magazine

For most physicians, writing — patient notes, case histories, perhaps journal articles — is part of the job. But for anesthesiologist-novelist Rick Novak, MD’80, and neurosurgeon-memoirist Moris Senegor, MD’82, it’s a second career that consumes early morning hours long before they step into the OR.

Fans of John Grisham will find a kindred spirit in Novak, whose fast-paced medical thriller, The Doctor & Mr. Dylan (Pegasus Books, 2014), transports readers to rural Northern Minnesota, where an accomplished physician and a deranged anesthetist who thinks he’s rock legend Bob Dylan see their worlds collide in the most unexpected ways.

Delivering real-life twists and turns — and a love letter to the Bay Area — is Senegor’s Dogmeat: A Memoir of Love and Neurosurgery in San Francisco (Xlibris, 2014), a coming-of-age tale chronicling the author’s away rotation with renowned neurosurgeon Charles Wilson, MD, at the University of California, San Francisco. Brutally honest, it spares no details of a time Senegor, who also served as a resident under the University of Chicago’s famed neurosurgery chair Sean Mullan, MD, describes as “one of the biggest failures of my life.”

One a vividly imagined nail-biter, the other an intimate peek into the surgical suite, both books deliver an ample dose of intensity and drama.

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The Doctor and Mr. Dylan (Pegasus Books, 2014) by Rick Novak, MD’80

“I thought it was a novel way of killing someone,” said Rick Novak, deputy chief of anesthesiology at Stanford University, describing the imagined hospital death that was the genesis of his dark thriller The Doctor & Mr. Dylan. A huge Bob Dylan fan — the rock icon was born in Novak’s hometown of Hibbing, Minnesota, where the story takes place — he then dreamed up a possible culprit: a psychotic anesthetist who thinks he’s Dylan.

From there, the words flowed. “I would write whenever I was with my laptop and had a free moment: in mornings, in evenings, in gaps between cases,” said Novak, who also blogs about anesthesia topics. “I don’t sleep much.”

After finishing the manuscript — one year to write, another to edit — came the challenge of finding a publisher. “In anesthesia, I’m an expert,” Novak said. “In the literary world, I’m an unknown.” After 207 responses of “no, thanks” or no answer at all, he landed an agent. Two months later, she informed him that Pegasus Books had bought his debut novel.

“I started crying,” Novak admits. “I have a third grader and at the time the big word the class was learning was ‘perseverance.’ That was it exactly.”

Dr. Joseph Andresen, Editor, Santa Clara County Medical Association Medical Bulletin, from the January/February 2015 issue:

BOOK REVIEW “THE DOCTOR AND MR. DYLAN”

This past month, Dr. Rick Novak handed me a hardbound copy of his debut novel The Doctor and Mr. Dylan. Rick and I go way back. It was my first week of residency at Stanford when we first met. A newcomer to the operating room, all the smells and sounds were foreign to me despite my previous three years in the hospital as an internal medicine resident. Rick, a soft spoken Minnesotan at heart, in his second year of residency, took me under his wing and guided me through those first few bewildering months, sharing his experience and wisdom freely.

Fast-forward 30 years later. Dr. Rick Novak, a novel and mystery author? This was new to me as I sat down and opened the first page of The Doctor and Mr. Dylan. I have to admit that I didn’t know what to expect. Few books highlight a physician/anesthesiologist as a protagonist, and few books feature a SCCMA member as a physician/author. However, a medical-mystery theme novel wasn’t at the top of my must read list. With my 50-hour workweek, living and breathing medicine, imagining more emotional stress and drama was the furthest thing from my mind. However, three days later, as I turned the last page, and read the last few words. “life is a series of choices. I stuck my forefinger into the crook of the steering wheel, spun it hard to the left and …” This completed my 72-hour journey of and free moments I had, completely immersed in this story of life’s disappointments, human imperfections, and simple joys.

Rick, I can’t wait for your next book. Bravo!

Hibbingite writes twisted medical tale

HIBBING — Readers who are looking for a whodunit that will keep them up all night are in for a treat.

Hibbing native Rick Novak recently released his first book “The Doctor and Mr. Dylan,” a fiction set in Hibbing that merges anesthesia complications, a tumultuous marriage and the legend of Bob Dylan.

“The dialogue is sometimes funny, and there are lots of plot twists,” he said.

Novak said the book will not only entertain readers, but teach them about anesthesiology, Dylanology, the stressful race for elite college admission, and life on the Iron Range.

“The book is very conversational and streamlined,” he said. “I try to write as one would tell a story out loud.”

Novak said “The Doctor and Mr. Dylan” took him three years to perfect. He is currently working on his second book.

5.0 out of 5 stars I Sense We Have Another F.Scott Fitzgerald Emerging on the Literary Scene, December 1, 2014
By
Deann Brady (Sunnyvale, CA USA) – See all my reviews
(REAL NAME)
I found Rick Novak’s first novel, “The Doctor and Mr. Dylan,” a most exciting combination of biting sarcasm, mystery and daily activity spun with fresh new phrases that made me turn my ear back to listen to the literary cadence of his words again and again even though, on the other hand, I was anxious to turn the pages to see what would happen next. His brilliant handling of scenes is reminiscent of The Great Gatsby by F. Scott Fitzgerald. A compelling read!Deany Brady, author of “An Appalachian Childhood”

By

allan mishra

This review is from: The Doctor and Mr. Dylan (Kindle Edition)

Just finished Dr. Novak’s delightful novel. I sincerely enjoyed his honest take about the pressures and values that exist within California’s Silicon Valley. He also brought the North Country of Minnesota to life with memorable characters and a twisting, addictive plot. Buried beneath the fun and funny story is a deeper message about how to best care for your kids, your relationships and yourself. Very well written and highly recommended.

Learn more about Rick Novak’s fiction writing at rick novak.com by clicking on the picture below:

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