Interactive decision-tree walkthroughs. Free. Optional Kokoro voice walkthrough for paid users. Education only — not a substitute for clinical judgment.
Hypermetabolic crisis triggered by volatile anesthetics or succinylcholine in genetically susceptible patients (RYR1, CACNA1S). Treat with dantrolene immediately.
IgE-mediated (or pseudo-allergic) hemodynamic collapse from drug, latex, or transfusion exposure. Most common triggers in OR: NMBAs (rocuronium, succinylcholine), antibiotics, latex.
Rare, often fatal obstetric emergency — anaphylactoid syndrome of pregnancy. Sudden hemodynamic collapse, hypoxemia, and DIC during labor, delivery, or postpartum (within 30 min).
Cardiovascular and CNS toxicity from inadvertent IV injection or systemic absorption of local anesthetic. Bupivacaine highest cardiotoxicity. Ropivacaine + lidocaine slightly safer.
Reflex closure of the vocal cords from light-anesthesia airway stimulation. Common in pediatrics, recent URI, and emergence. Untreated → hypoxia → bradycardia → arrest.
Cephalad spread of neuraxial local anesthetic causing apnea + cardiovascular collapse. Most common with epidural-to-subarachnoid migration in OB.
Sudden ↑PA pressure → RV failure → cardiovascular collapse. May be thrombus, fat (long-bone fracture, IM rod), gas (laparoscopy CO₂, sitting craniotomy), or amniotic.
DAS 2015 / ASA 2022 unanticipated difficult airway algorithm. Failed mask + failed SGA + failed intubation → emergency front-of-neck access.
ACLS adapted for the operating room: anesthetic depth, surgical bleeding/positioning/embolism are reversible causes the medicine code team won't think of first.
Three-element fire: oxidizer (O₂/N₂O) + fuel (drape, ETT, sponge, hair) + ignition (ESU, laser, fiberoptic). Greatest risk: head/neck surgery with open O₂.
One-way air leak into pleural space → mediastinal shift → ↓venous return → cardiovascular collapse. Suspect with central line attempt, brachial plexus block, trauma, or sudden ↑PIP under PPV.
Patient consciousness during surgery, with explicit recall after. Highest-risk groups: cardiac surgery, OB GA, trauma, NMBA paralysis with light anesthetic.
Pediatric arrest is most often respiratory in origin. Highest-quality CPR + addressing airway/breathing precedes rhythm management. Asystole/PEA is the most common arrest rhythm in children.
Pre-operative airway exam predicts difficulty. ASA Difficult Airway Algorithm 2022 emphasizes awake tracheal intubation when both ventilation and intubation are predicted difficult.
K+ >6.5 with ECG changes → CV collapse imminent. Calcium first (membrane stabilization), then drive K into cells, then remove from body. Common in ESRD, rhabdomyolysis, succinylcholine in burns/denervation, massive transfusion.
≥10 units PRBC in 24h or ≥4 units in 1h. Activate MTP early, give 1:1:1 ratio, treat lethal triad (hypothermia, acidosis, coagulopathy), use TXA within 3h, viscoelastic-guided component therapy.
Sudden ↑ peak airway pressure + wheezing + ↑ ETCO2 plateau slope. Treat by deepening anesthesia (volatile bronchodilation), beta-2 agonist, and adjuncts. Avoid agents that worsen bronchospasm.
BP fails to respond to escalating norepinephrine + fluids. Consider vasopressin, methylene blue, hydroxocobalamin, hydrocortisone, and specific etiology (anaphylaxis, vasoplegia, ACEi-related, sepsis, addisonian).
ST changes + hemodynamic instability + elevated troponin in OR. Optimize supply (O2, CPP) and demand (HR, contractility, afterload). Cardiology + cath lab consult; revascularization if STEMI.
Most common cause of maternal mortality worldwide. 4 T's: Tone (atony 70%), Trauma (laceration), Tissue (retained placenta), Thrombin (coagulopathy). Stage-based response: massage → uterotonics → balloon → surgical.
Pregnancy-induced hypertension + end-organ dysfunction. Mag for seizure prophylaxis, BP control to 140-160/90-110, deliver if severe features. Eclampsia = seizure → mag + airway + delivery.
Air entry through open venous sinuses with patient above heart. Sudden ↓ ETCO2, hypoxemia, hypotension, mill-wheel murmur. Notify surgeon, flood field, support hemodynamics, aspirate via PAC or central line.