When to call for help

Core principle: early escalation is good practice

• If you are worried, call for help early—don’t wait for things to become a crisis.
• Calling for help is not failure; it is safe anaesthetic practice and expected for new starters.
• Use the “time-critical” mindset: if deterioration could happen in minutes, escalate now.
• If you are stuck (uncertain plan, unfamiliar equipment, unexpected findings), escalate before proceeding.
• If you need a second pair of hands (airway, lines, drugs, positioning), call early so help arrives before you are overwhelmed.

Who to call (typical UK theatre/critical care escalation)

• Your supervising consultant anaesthetist (first choice for clinical decisions and high-stakes situations).
• On-call anaesthetic registrar/consultant (if your supervisor not immediately available).
• ODP/anaesthetic assistant (immediately for airway help, equipment, drugs, calling additional support).
• Theatre coordinator/charge nurse (extra staff, equipment, delays, escalation pathways).
• ICU outreach/critical care team (deteriorating ward patient, peri-arrest, high oxygen/vasopressor needs).
• Call 2222 (or local emergency number) for peri-arrest/arrest; state location clearly.

Airway: call early

• Any difficulty with oxygenation (SpO2 falling, poor chest movement, cyanosis) despite basic manoeuvres—call immediately.
• Difficult mask ventilation, difficult supraglottic airway (SGA) placement, or difficult intubation—call early, before repeated attempts.
• Failed intubation or “can’t intubate, can’t oxygenate (CICO)”—call for immediate senior help and activate emergency airway plan.
• Unexpected airway findings (swelling, bleeding, tumour, limited mouth opening) or aspiration risk—escalate before inducing anaesthesia if possible.
• If you are considering front-of-neck access (FONA) or you cannot confidently state the next step—call now.

Breathing/ventilation: when to escalate

• Persistent hypoxia (low oxygen saturations) or rising CO2 despite adjustments—call for help.
• High airway pressures, suspected bronchospasm, or sudden difficulty ventilating—call early and ask for extra hands.
• Suspected pneumothorax, pulmonary oedema, or severe aspiration—call senior help and prepare for ICU support.
• Any situation where you are unsure whether the problem is patient vs equipment—call while you troubleshoot.

Circulation: hypotension, arrhythmia, bleeding

• Severe or persistent hypotension (especially with signs of poor perfusion) despite initial fluid/vasopressor steps—call senior help.
• Bradycardia with hypotension, new tachyarrhythmia, chest pain, or ECG changes—escalate early.
• Major haemorrhage or rapidly increasing blood loss—activate the major haemorrhage protocol and call consultant help.
• Any need for vasopressor infusion, multiple boluses, or escalating doses—call early and consider ICU input.
• Suspected anaphylaxis (sudden hypotension, bronchospasm, rash/angioedema)—call for help and treat immediately.

Neurology and sedation: safety triggers

• Unexpected low consciousness, seizures, or focal neurology—call for help and treat as time-critical.
• Over-sedation (airway obstruction, hypoventilation) during regional/MAC/sedation lists—call for help early.
• Local anaesthetic systemic toxicity (LAST): tinnitus, metallic taste, agitation, seizures, arrhythmias—call for help, stop local anaesthetic, start lipid rescue per guideline.

Regional anaesthesia: when to stop and escalate

• If you are unsure about anatomy, needle position, or safe dose—pause and call a senior.
• High/total spinal (rapid hypotension, bradycardia, difficulty breathing, arm weakness, reduced consciousness)—call immediately and treat as an emergency.
• Unexpected severe pain, paraesthesia, or injection resistance—stop and seek advice.
• Anticoagulation/antiplatelet uncertainty (timing, renal function, neuraxial safety)—do not proceed; call for senior guidance.

Perioperative emergencies: always escalate

• Cardiac arrest/peri-arrest—call 2222 immediately; start ALS; get senior anaesthetist and resus team.
• Malignant hyperthermia suspicion (rising CO2, tachycardia, rigidity, hyperthermia)—call for help, stop triggering agents, give dantrolene, call MH hotline if available.
• Sepsis with haemodynamic instability—call senior help; early antibiotics/fluids/vasopressors; consider ICU.
• Obstetric emergencies (e.g., high spinal, major haemorrhage, eclampsia)—call consultant anaesthetist and obstetric emergency team.

Non-technical triggers: when uncertainty is the reason to call

• You do not feel safe to proceed (lack of supervision, unfamiliar procedure, unfamiliar patient complexity).
• Consent/capacity concerns, DNACPR/ceilings of care uncertainty, or disagreement within the team—escalate to senior decision-maker.
• Equipment problems you cannot rapidly fix (ventilator, anaesthetic machine, suction, oxygen supply)—call for help and use backup plans.
• Communication issues: if you cannot get the right people to the right place quickly, escalate via theatre coordinator and emergency call systems.

How to call effectively (structured, fast)

• Say: who you are, where you are, what is happening, and what you need (e.g., “Need consultant in Theatre 3 now for difficult airway”).
• Use a simple structure: Situation–Background–Assessment–Request (SBAR).
• State the immediate risk (e.g., “SpO2 82% and falling despite ventilation”).
• Ask for specific help: extra airway-skilled person, ultrasound, blood products, ICU review, additional staff.
• While help is coming: keep oxygenation and circulation as priorities; assign tasks (call 2222, get airway trolley, draw up drugs).