Keith Ruskin

• Doctor of Medicine
• Professor of Anesthesia and Critical Care at University of Chicago

INTRODUCTION: High quality cardiopulmonary resuscitation and medical care in an emergency can save lives, especially when resources are limited, as when in flight on a commercial airplane. A medical student or resident may be the most qualified person to offer assistance during an in-flight cardiac arrest; however, he/she may not yet have experienc...

Anesthesia emergencies can happen in the operating room at any time or point in a procedure, even with proper procedures and preparation. The anesthesia provider needs to be able to anticipate and quickly respond to these emergencies for a successful outcome. Checklists and cognitive aids can assist in predicting and quickly responding to an emerge...

Purpose of review: Anesthesia professionals work in an unpredictable, rapidly changing environment in which they are quickly diagnose and manage uncommon and life-threatening critical events. The perioperative environment has traditionally been viewed as a deterministic system in which outcomes can be predicted, but recent studies suggest that the...

Although several studies have explored the effects of the pandemic on aviation, little remains known about whether members of the public are willing to fly again after they have been vaccinated. The current study uses the Health Belief Model (HBM) to fill this missing gap by manipulating the following variables: 1) whether or not the participant is...

Billions of travelers pass through airports around the world every year. Airports are a relatively common location for sudden cardiac arrest when compared with other public venues. An increased incidence of cardiac arrest in airports may be due to the large volume of movement, the stress of travel, or adverse effects related to the physiological en...

Purpose of the Research Modifiable and non-modifiable patient and hospital characteristics may affect willingness to undergo surgery during a pandemic. We hypothesized that vaccination of hospital staff and patients, type of surgery, and length of stay, would affect willingness to undergo a surgical procedure. 2006 adult participants in the United...

Background Urban Air Mobility aircraft (UAMs) have been proposed as a fast, efficient way to move people through congested areas. However, while nearly everyone is familiar with commercial airline operations and assume they are safe, UAMs remain a nascent product that have yet to be widely understood by the public. In this study, we identify factor...

Signals (alarms, alerts, and warnings) are essential for alerting air traffic controllers to potential collisions and other adverse events. Excessive or misleading signals can increase response times and decrease their response rates. We used reports from the Aviation Safety Reporting System and structured interviews to understand the complexity of...

Background Fear of illness, economic damage, and stigma have had a devastating impact on the travel industry and have caused a significant reduction in both business and leisure travel. This study examines passengers' social and emotional perspectives during and after the COVID-19 pandemic, building on a prior quantitative study that identified fac...

Ultrasound Guided Procedures and Radiologic Imaging for Pediatric Anesthesiologists is intended as a ready resource for both experts and novices. It will be useful to those with extensive training and experience as well as beginners and those with distant experience or training. A wealth of knowledge in the human factors of procedure design and use...

Clinicians who care for patients infected with coronavirus disease 2019 (COVID-19) must wear a full suite of personal protective equipment, including an N95 mask or powered air purifying respirator, eye protection, a fluid-impermeable gown, and gloves. This combination of personal protective equipment may cause increased work of breathing, reduced...

BACKGROUND: At sea level, performing chest compressions is a demanding physical exercise. On a commercial flight at cruise altitude, the barometric pressure in the cabin is approximately equal to an altitude of 2438 m. This results in a Po 2 equivalent to breathing an F I o 2 of 15% at sea level, a condition under which both the duration and qualit...

Purpose of review: The goal of automation is to decrease the anesthesiologist's workload and to decrease the possibility of human error. Automated systems introduce problems of its own, however, including loss of situation awareness, leaving the physician out of the loop, and training physicians how to monitor autonomous systems. This review will...

Background Prior research has examined consumer willingness to fly in a variety of situations, including during disease outbreaks. However, to date, no study that we know of has identified what type of person is willing to fly during the COVID-19 pandemic. Methods Six hundred and thirty-two participants from the United States were asked to complet...

Automated medical technology is becoming an integral part of routine anesthetic practice. Automated technologies can improve patient safety, but may create new workflows with potentially surprising adverse consequences and cognitive errors that must be addressed before these technologies are adopted into clinical practice. Industries such as aviati...

Synthetic torpor is an induced state of deep metabolic depression (MD) in an organism that does not naturally employ regulated MD. If applied to spaceflight crewmembers, this metabolic state may theoretically mitigate numerous biological and logistical challenges of human spaceflight. These benefits have been the focus of numerous recent articles w...

Purpose of review: Helicopter air ambulances are an integral component of modern trauma care, and are able to transport patients to facilities with greater capabilities, extract injured patients from hostile terrain, and speed transport to a trauma center. Recent findings: HAA transport does not reduce the total time required to transport a pati...

Introduction: Although cardiac arrest during airline flights is relatively uncommon, the unusual setting, limited resources, and the variability of the skills in medical volunteers present unique challenges. Survival in patients who suffer a witnessed arrest with a shockable rhythm who are treated promptly has improved since the advent of widely a...

Purpose of review: Deep vein thrombosis (DVT) and pulmonary embolus are major causes of hospital-related morbidity and mortality, and are recognized as complications in patients with traumatic injury. Despite the significant morbidity and mortality associated with DVTs, prophylaxis and treatment are still not well understood and remain the subject...

Long duty periods and overnight call shifts impair physicians' performance on measures of vigilance, psychomotor functioning, alertness, and mood. Anesthesiology residents typically work between 64 and 70 hours per week and are often required to work 24 hours or overnight shifts, sometimes taking call every third night. Mitigating the effects of sl...

Despite improving patient safety in some perioperative settings, some checklists are not living up to their potential and complaints of “checklist fatigue” and outright rejection of checklists are growing. Problems reported often concern human factors: poor design, inadequate introduction and training, duplication with other safety checks, poor int...

Despite improving patient safety in some perioperative settings, some checklists are not living up to their potential and complaints of "checklist fatigue" and outright rejection of checklists are growing. Problems reported often concern human factors: poor design, inadequate introduction and training, duplication with other safety checks, poor int...

Advances in aerospace technology offer the promise of significantly safer and more reliable operations, but human operators will continue to play a critical role in the success of most aerospace activities. Regulatory bodies such as the US Federal Aviation Administration (FAA) and educational groups advocate changes in training in the mechanisms of...

Background: Postoperative infection after craniotomy carries an increased risk of morbidity and mortality. Identification and correction of the risk factors should be prioritized. The association of intraoperative hyperglycemia with postoperative infections in patients undergoing craniotomy is inadequately studied. Methods: A total of 224 patien...

Purpose of review: Intraoperative neurophysiologic monitoring (IONM) has been rapidly adopted as a standard monitoring technique for a growing number of surgical procedures. This article offers a basic review of IONM and discusses some of its latest applications and anesthetic techniques that optimize monitoring conditions. Recent findings: IONM...

Does your heart rate increase when you are paged to the emergency department or ICU for emergency airway management? Would you know how to handle the unexpected arrival of a patient with a gunshot wound to the neck and worsening airway compromise? This guide to critical airway emergencies will prepare you to safely manage these high-pressure situat...

Purpose of review: Electronic medical devices are an integral part of patient care. As new devices are introduced, the number of alarms to which a healthcare professional may be exposed may be as high as 1000 alarms per shift. The US Food and Drug Administration has reported over 500 alarm-related patient deaths in five years. The Joint Commission...

Background: Debate regarding the merits of screening pilots for sleep apnea has been stimulated by recently issued guidance from the Federal Aviation Administration. It has long been appreciated that sleep apnea results in poor quality sleep, and that poor quality sleep is associated with daytime fatigue and decrements in performance. However, the...

Some types of emergencies are difficult to place into a single category. This chapter discusses the management of problems such as burn injury, emergencies in the MRI scanner, drug and fluid extravasation, and accidental intra-arterial injections. The pathophysiology of each problem is discussed, followed by checklists for diagnosis and treatment.

This resource contains relevant step-by-step information on how to detect, manage, and treat complications and emergencies during the perioperative period. Concisely written, highlighted sections on immediate management and risk factors reinforce essential points for easy memorization, while consistent organization and checklists provide ease of le...

The perioperative setting is a complex environment in which critical events happen without warning and can quickly become life threatening. Clinical decision-making is the process by which a physician uses prior knowledge, reason, and the clinical scenario to formulate a diagnosis or treatment plan. Although this is usually an intuitive process, bi...

Purpose of review: Anemia is common in neurosurgical patients, and is associated with secondary brain injury. Although recent studies in critically ill patients have shifted practice toward more restrictive red blood cell (RBC) transfusion strategies, the evidence for restrictive versus liberal transfusion strategies in neurosurgical patients has...

A 38-yr-old man developed the acute onset of expressive aphasia and right hemiparesis during the performance of an advanced aerobatic flight maneuver. Magnetic resonance imaging (MRI) demonstrated patchy infarction in the territory of the left middle cerebral artery. Magnetic resonance, angiography (MRA) revealed a dissection of the left internal c...

Patient care in the operating room is a dynamic interaction that requires cooperation among team members and reliance upon sophisticated technology. Most human factors research in medicine has been focused on analyzing errors and implementing system-wide changes to prevent them from recurring. We describe a set of techniques that has been used succ...

Purpose of review: Anesthesiologists work in a complex environment that is intolerant of errors. Cognitive errors, or errors in thought processes, are mistakes that a clinician makes despite 'knowing better'. Several new studies provide a better understanding of how to manage risk while making better decisions. Recent findings: Heuristics, or me...

Background and Goals: Intraoperative MRI (IMRI) provides substantial benefits for the treatment of intracranial disease.1 Magnet safety underlies all aspects of patient care, but the unique workflow, limited access, and difficult communication make patient care extremely challenging. The MR OR is dark and noisy with multiple distractions, unfamilia...

Electronic medical records (EMR) may increase the safety and efficiency of healthcare. Anesthesia care is a significant component of the perioperative period, yet little is known about the adoption of anesthesia information management systems (AIMS) by US anesthesiologists, particularly in non-academic settings. Herein, we report the results of a s...

This resource contains relevant step-by-step information on how to detect, manage, and treat complications and emergencies during the perioperative period. Concisely written, highlighted sections reinforce essential points for easy memorization while consistent organization and checklists provide ease of learning and clarity. Anesthesia providers w...

When a passenger becomes sick while flying on board a commercial airline flight, the cabin crew commonly solicit the assistance of a volunteer physician. Although in-flight medical emergencies take place every day, little is known about the epidemiology of these events. A new study by Sand and colleagues sheds light on the incidence of specific ill...

As the chapter titles of this book imply, use of an AIMS within an anesthesia service affects far more than the intraoperative anesthesia record, although that is the use most visible to clinicians. When implemented well, an AIMS has the potential to positively affect almost every process—clinical and business—related to anesthesia delivery. The op...

Dr. Jones, an anesthesiologist, boards a plane to visit her ailing father who is scheduled to have a colectomy after recently being diagnosed with colon cancer. She is worried about his cardiac status and long-standing history of diabetes. Having been in practice for 20 years, she is also concerned about a number of aspects of his care. Will he rec...

Wireless technology is an integral part of everyday life. Most people commonly think of cellular telephones when they speak of wireless communications, but many other wireless technologies are quickly becoming equally as popular, available, and affordable. The result of this increase in both visibility and popularity is that “wireless” is rapidly b...

The existing and emerging information technology standards that are of relevance to AIMS are discussed in this chapter. The focus is on the use of standards in the AIMS, both in terms of the persistent storage of data and the import of data from and export to other systems. Although the emphasis is on standards that have direct relevance for the st...

The preoperative period is the time during which critical patient data are gathered, processed, and disseminated. This information is used to plan for and schedule personnel, equipment, and a myriad of subtasks to ensure a smooth day in the OR. The level and the thoroughness of planning determine the efficient utilization of personnel and facilitie...

Although the advantages and shortcomings of an AIMS have been debated, in the age of advanced computers, it seems arcane to manually transcribe to a paper form numbers that are displayed on a patient monitor. Potential human errors associated with manual systems include failing to record data due to distraction or forgetfulness, misreading data, an...

Simulation-based education in healthcare owes its origins mainly to the discipline of anesthesia. The practice of anesthesia has often been likened to the dynamic environment of aviation, where the stakes are high and safety is of paramount importance. In recent decades, a number of innovative and forward-thinking individuals have developed the dis...

The safe, efficient, and coordinated passage of a patient through the surgical and anesthesia experience begins long before the patient arrives at the hospital on the day of surgery. The process actually begins at the time a patient's health concern is recognized and a medical professional concurs that surgery is needed. From that moment forward, h...

The editors of this book assume that its readers either have recently made the decision to purchase an AIMS or are contemplating a purchase soon. The material presented in this book is intended to be a resource for facilities as they attempt to revise current workflow and behavior to become more facile in their electronic documentation. However, it...

An OR management system (ORMS) comprises a suite of integrated software modules within an application that contains the functional and technical capability to schedule cases (and reschedule them as necessary), organize and bill the materials and supplies used, plan the clinical staff required, and document clinical data at the point of care in all...

It is a simplification to view simulators as the solution that will address shortcom-ings in education. Simulation is not the end point; it is only a tool that must be one part of a well-considered and well-executed curriculum. This chapter will discuss some of the forces that are shaping how simulation is currently being used and will speculate on...

The primary motivation, or return on investment (ROI), for purchasing an EMR for most office-based physician practices focuses predominately on the ability to enhance and automate charge capture. In the paper world, a patient would be seen by a physician, who would create notes on paper records. The physician would then typically complete a “superb...

The first description of an automated intraoperative anesthesia recording machine was noted as early as 1934. 1 The device recorded tidal volume, FiO 2, and blood pressure. Since then, many attempts have been made to replace the paper record. One group even used video recording machines to record all of the information presented visually to an anes...

The focus of this chapter is medical device interfaces in the context of anesthesia service delivery, including a discussion of some of the business, clinical, and technical issues and constraints that have applied in the past and are likely to continue to impose themselves in the future. Device data interfaces designed and used exclusively for sin...

The latter part of the twentieth century brought the world firmly into the information age. Whereas improved mechanization and industrial technologic development previously drove the economy, now information and related technologies are preeminent. Information technology companies such as Microsoft and Google are now market leaders, joining the ran...

The changing face of healthcare, along with changing expectations from residents with respect to the quality of education that they receive, has challenged residency programs, to rethink the model that they use and develop new strategies with consideration of the new environment. Furthermore, the volume of information in the medical field is growin...

Managed care is placing severe financial and organizational pressures on healthcare institutions, while at the same time capitation and competition are limiting resources. In response, institutions are beginning to re-engineer themselves from revenue to cost centers. Research indicates that of the three major clinical service components that compri...

Management of medications in the OR is a topic of special interest that has surfaced in recent years. Historically, pharmacists seldom had much interaction with anesthesiologists and frequently “relinquished” control of most medications used by anesthesiologists. Controlled substances, defined as Schedule II–V by the US Drug Enforcement Agency (DEA...

Data collection and analysis is the cornerstone and first step toward process improvement. Through integration of multisource data and delivery of processed data to multiple users in a real-time, near real-time, or periodic fashion, an AIMS has several distinct advantages over traditional paper-based record-keeping systems. For example, data collec...

Electronic generation, transmission, and storage of health data have transformed patient care by making it easy to acquire, search, manipulate, and distribute large amounts of information. An electronic workflow facilitates direct patient care and can be used for purposes such as quality assurance and submission of health insurance claims. Informat...

Selecting an AIMS is a complex process that requires careful consideration not only by the anesthesiology department, whose work flow will be dramatically affected by the choice, but also by the IT department of the hospital. In addition, input from stakeholders who use other hospital information systems (e.g., Medical Records, Pharmacy, Lab, Nursi...

The development of AIMS and the more comprehensive EMR has focused primarily on the myriad of technologic challenges. As these challenges are met and electronic systems become the accepted method for record keeping, medicolegal proceedings will inevitably rely upon electronic data to determine liability when patient injury occurs. This chapter will...

The first AIMS installation at The Mount Sinai Medical Center (MSMC) occurred in January 1991 in a cardiothoracic and liver transplantation suite of six ORs. Currently, the Department of Anesthesiology at MSMC provides anesthesia care in approximately 50 ORs, 16 labor and delivery rooms, and 10 non-OR procedural areas. This growth occurred in vario...

No off-the-shelf solution exists for electronic anesthesia record keeping and perioperative information management. Every AIMS is installed in a unique environ ment of equipment and hardware, software and network parameters, interconnected databases, and clinical workflow. Every vendor's AIMS, regardless of how highly developed and mature it is at...

Although many health-care providers are familiar with an electronic health record (EHR) and use it routinely, anesthesiologists have a unique understanding of how information is used throughout the perioperative period. Anesthesiologists are responsible for knowing all aspects of the patient’s medical history, and therefore review all areas of the...

Anesthesia Information Management Systems (AIMS) have been in existence for several decades, but their use in clinical practice has been very limited until recently. When initially developed, AIMS were primarily focused on replacing paper records with an electronic form. In parallel, the healthcare industry has recognized that electronic medical re...

Introduction: Pulse oximeters are reliable, objective, and noninvasive monitors that have broad application in aerospace medicine. New technology enables pulse oximeters to perform well in adverse environments and measure additional parameters. Small, battery-powered devices can be used to monitor oxyhemoglobin saturation while in flight. Theory...

One purpose of preanesthesia evaluation clinics (PECs) is to decrease the incidence of day-of-surgery delays and cancellations by ensuring that patients are medically ready for surgery. In several single-center studies, PECs have been shown to have a positive impact. However, limited information is available regarding their overall use and perceive...

Effective communication is essential to patient safety. Although radio pagers have been the cornerstone of medical communication, new devices such as cellular telephones, personal digital assistants (PDAs), and laptop or tablet computers can help anesthesiologists to get information quickly and reliably. Anesthesiologists can use these devices to s...