Quick Reference Handbook (QRH) | The Association of Anaesthetists
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Quick Reference Handbook (QRH)

Introduction to the Quick Reference Handbook (QRH)

The Quick Reference Handbook (QRH) is a collection of guidelines for unexpected or uncommon anaesthesia-related emergencies. It aims to ensure the response to a crisis is as organised and all-encompassing as possible, at a time when the cognitive load can impair performance.

The QRH helps clinicians focus on delivering care, using the skills and knowledge they already have. All clinicians should become familiar with the QRH and be practised in its use, so it's automatically reached for in a crisis.

Keeping your QRH up to date

From time to time individual QRH guidelines will be updated. It's important you replace these in your copy to ensure your QRH is up to date. You can check which edition you have by looking at the Contents page.

If the Contents page says August 2019 this is the latest version. To update from the January 2019 to the August 2019 edition you'll need to replace the following pages:

  • 0-1 Cover page (updated web address)
  • 0-2 Contents (updated to August 2019 edition; contains updated guideline version numbers)
  • 3-12 Cardiac ischaemia (removal of incorrect reference to "1%" GTN solution)

If you are familiar with the QRH you can download the 'as is' PDF version, or, if you wish to modify the QRH you can download the editable Word version.

Past updates to the QRH

Previous version: January 2019 update

To update from the May 2018 to the January 2019 edition you’ll need to replace the following pages:

  • 0-1 Cover page (updated logo)
  • 0-2 Contents (updated to January 2019 edition; contains updated guideline version numbers)
  • 3-1 Anaphylaxis v.3 (further important updates in the light of NAP6)
  • 3-4 Bronchospasm v.2 (critical correction to drug dose units)

Previous version: May 2018 update

To update from the January 2018 to the May 2018 edition you’ll need to replace the following pages:

  • 0-1 Cover page (contains new wording)
  • 0-2 Contents (updated to May 2018 edition; contains updated guideline version numbers)
  • 3-1 Anaphylaxis v.2 (updated to reflect conclusions of NAP6)
  • 3.-2 Major blood loss v.2 (corrected re: tranexamic acid administration)

Previous version: January 2018 launch

If the Content page says January 2018 this was the launch edition. All guidelines were ‘v.1

What the QRH is not

The QRH is not a substitute for learning and practicing clinical skills. Nor is it a substitute for being familiar with more detailed guidelines and algorithms, such as those for managing cardiac arrest or difficult airway.

It's essential that clinicians learn about these and practice their implementation elsewhere. For example, it's expected that in using the QRH guideline for managing cardiac arrest, clinicians will already have underlying knowledge of conditions causing cardiac arrest and will be competent in providing advanced life support.


The QRH is also not intended to be used as a rule book every single time one of the guideline situations is encountered. For instance, most ordinary occasions of hypotension will have a simple cause and will respond to obvious remedies. The hypotension guideline becomes useful if the situation is out of the ordinary or becomes unremitting. Conversely, for the more immediate and uncommon problems, such as cardiac arrest in theatre, the guideline should be used from the outset to help avoid missing out useful steps in resolving the situation.

The guidelines in the QRH are not intended to be standards of medical care. The ultimate judgement about a particular clinical procedure or treatment plan must be made by the clinician in light of the clinical data presented and the diagnostic and treatment options available.

Using the guidelines

For more information on the guidelines and how to use them in a crisis read Finding your way around the QRH. If you intend to introduce the QRH in your unit, you should read and follow the implementation guide. We also recommend joining the Emergency Manuals Implementation Collaborative for online community-based support in implementation.

You can download the 'as is' PDF version of the QRH, or if you wish to modify it, you can download the editable Word version.

If you have any feedback or comments about the QRH, please contact secretariat@anaesthetists.org

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