9.1 DC Cardioversion in CCU Flashcards
a) List the advantages providing anaesthesia in the CCU.
Chairmans report piece
a) The advantages of providing anaesthesia in a coronary care unit for a maximum of three marks included:
Avoiding the transfer of an unstable patient to theatre
Cardiology department skills readily available
Specialist equipment and drugs are immediately accessible
Allows earlier treatment
Disadvantages of providing anaesthesia in the CCU. (30%)
Chairmans report piece
The most important disadvantage was anaesthetizing a patient in a remote and unfamiliar environment.
This statement needed to be expanded to
include the potential lack of monitoring (capnography), anaesthetic drugs, recovery and skilled assistance.
Few candidates mentioned the difficulty in
complying with the filling in of a WHO checklist.
b) Some of the factors that should have been considered before commencing anaesthesia included valid consent, recent investigations, starvation status and a potential need for intra- or inter-hospital transfer.
c) Required both anaesthetic and cardiological complications; the latter included arterial embolism, myocardial ischaemia, pulmonary
oedema, burns to the patient and electrical injury to staff.
Disadvantages of providing anaesthesia in the CCU. (30%)
Model answer
• Remote, unfamiliar environment.
• Possible lack of availability of monitoring,
especially capnography.
• Availability of anaesthetic drugs and equipment.
• Availability of skilled assistant.
• Feasibility of team briefing/WHO checklist/venous thromboembolism assessment.
• Availability of adequate recovery care and facilities.
• Adequacy of trainee competencies.
• Availability of named consultant supervision.
• Availability of timely anaesthetic support if problems encountered.
a) List the advantages providing anaesthesia in the CCU.
Don’t need to transfer unstable patient.
• Minimises delays to treatment.
• Close availability of cardiology specialist
equipment/drugs/staff.
b) What factors must be taken
into consideration when choosing
an anaesthetic technique for this
patient? (30%)
> > Period of starvation.
Reflux.
Anticipated difficult airway.
Any other investigation results.
Other medical history. May have limited history as patient has a GCS
of 13.
Likelihood of whether this is an isolated broad complex tachycardia or
the presenting feature of an ischaemic myocardial event.
Post-cardioversion plans, need for transfer elsewhere for further
management, e.g. cardiac catheter laboratory.
Consent.
c) What complications may
occur as a consequence of the
procedure? (40%)
Anaesthetic:
There are risks associated with all anaesthetics. However, the issues specific to this situation are as follows:
> > Aspiration secondary to full stomach.
> > Deterioration in cardiovascular stability.
> > Failure to gain important anaesthetic history information from patient due to reduced GCS and urgency of situation.
> > Risk of awareness.
Cardioversion:
» Arterial embolism causing stroke, cardiac ischaemia.
> > Asystole, pulseless ventricular tachycardia, ventricular fibrillation.
> > Burns.
> > Electrical injury to staff.
> > Pulmonary oedema.
