“A SWIFT CHECK” (the checklist arising from the mnemonic need not be memorised but should be immediately available in the operating theatre)
| Condition | Comments | |
|---|---|---|
| If the problem has not been solved, direct the available resources to its solution. Get skilled and experienced help. Work from first principles. | ||
| A | Air embolus | Hypotension, hypocarbia |
| A | Anaphylaxis | Hypotension, bronchospasm, urticaria |
| A | Air in pleura | Pneumothorax, any unexpected circulatory or respiratory deterioration |
| A | Awareness | Consider dilution of anaesthetic gases, “resistant” patient |
| S | Surgeon/situation | Vagal stimulation, caval compression, bleeding, direct myocardial stimulation |
| S | Sepsis | Hypotension, desaturation, acidosis, hyperdynamic circulation |
| W | Wound | Trauma, bleeding, tamponade, pneumothorax, problems due to retractors |
| W | Water intoxication | Electrolyte disturbance, fluid overload |
| I | Infarct | Myocardial conduction or rhythm problem, hypotension, poor cardiac output |
| I | Insufflation | Vagal tone, reduced venous return, pulmonary venous or paradoxical arterial gas embolism |
| F | “Fat” syndrome | Desaturation and/or hypotension, especially after induction and in the lithotomy position including distended abdomen for any cause |
| F | Full bladder | May cause marked haemodynamic changes and/or sympathetic stimulation |
| T | Trauma | Consider spinal injury, undiagnosed sub- or diaphragmatic injury, ruptured viscus |
| T | Tourniquet down | Local anaesthetic toxicity or unseen bleeding |
| C | Catheter/IV cannula/chest drain problems | Leaks, failure to deliver, wrong drug or label, obstructed, wrong connected, wrong rate |
| C | Cement | Haemodynamic change with methylmethacrylate |
| H | Hyperthermia (hypothermia) | Tachycardia and hypercarbia/ECG changes, (poor perfusion, ECG changes) |
| H | Hypoglycaemia | Consider inappropriate or inadvertent insulin preoperatively, fasting and beta blockers, hepatic compromise and beta blockers |
| E | Embolus | Fat, thrombus, amniotic fluid; hypotension, hypocarbia, ECG changes |
| E | Endocrine | Hyperthyroid or hypothyroid/adrenal medullar or cortex/pituitary/diabetes/5-HT |
| C | Check | Right patient, right operation, right surgeon |
| C | Check | Case notes, preoperative status, preoperative drugs, preoperative diseases |
| K | K+ | Potassium and any other electrolyte abnormality (“hyper” or “hypo”), ECG changes, CNS signs |
| K | Keep | Keep the patient “asleep” until a new anaesthetic machine can be obtained (e.g. diazepam, ketamine) |