Anaesthetics Emergencies

Question 1

ALS drugs in shockable rhythms

Answer 1

Adrenaline 1 mg after 2nd shock, then every 2nd loop

Amiodarone 300 mg after 3 shocks

Question 2

ALS drugs in non shockable rhythm

Answer 2

Adrenaline 1 mg immediately, then every 2nd loop

Question 3

4 Hs and 4 Ts

Answer 3

Hypoxia
Hypovolaemia
Hyper/hypokalaemia/metabolic disorders
Hypothermia/hyperthermia

Tension pneumothorax
Tamponade
Toxins
Thrombosis (pulmonary/coronary)

Question 4

Difficult airway risk factors

Answer 4

Known difficult airway
Airway deterioration (trauma, oedema or bleeding)
Restricted airway access Obesity / OSA
Aspiration risk

Question 5

IV adrenaline doses for MODERATE anaphylaxis (hypotension, bronchospasm)

Answer 5

Draw up 1 mg in 10ml
Adrenaline 1:10,000 = 100mcg/ml

Adult - 5-20mcg (0.05-0.2ml)
Child - 1-5mcg/kg (0.01 - 0.05ml/kg)

Question 6

IV adrenaline doses for SEVERE anaphylaxis

Answer 6

Draw up 1 mg in 10ml
Adrenaline 1:10,000 = 100mcg/ml

Adult - 100-200mcg = 1 - 2ml
Child 5-10mcg/kg = 0.05 - 0.1 ml/kg

Question 7

IM adrenaline doses in anaphylaxis

Answer 7

1:1000 (1mg/ml) into lateral thigh

Adult = 0.5ml (500mcg) <12 years = 0.3ml (300mcg) <6 years = 0.15ml (150mcg)

Question 8

When is peak serum tryptase level reached

Answer 8

15-120 min after onset of reaction

Biological half life is approx 2 hours

Question 9

How to prepare adrenaline infusion

Answer 9

Adult 0.05 to 4 mcg/kg/min
Child 0.1 to 5 mcg/kg/min

3mg/50ml = 60mcg/ml with 1ml/hr = 1mcg/min

70kg Adult 3.5-28ml/hr

Question 10

Optimising Bag/Mask

Answer 10

Dentures in
Optimise position
2 hands + assistant
OPA/NPA
\+/- muscle relaxant

Question 11

Optimising LMA insertion

Answer 11

Change type
Change size
Cuff inflation/deflation
Place with laryngoscope
\+/- muscle relaxation

Question 12

Optimising ETT insertion

Answer 12

Dentures out
Best: person, position, blade (i.e. video laryngoscope)
BURP
Bougie - only 1 blind attempt

Question 13

Immediate reversal dose of sugammadex (post roc/vec)

Answer 13

1.2g or 6 x 200mg vials (Child: 16mg/kg)

Question 14

Naloxone dose for reversal of opioids

Answer 14

400mcg bolus

Child: 10mcg/kg

Question 15

Manual procedures to treat laryngospasm

Answer 15

Remove LMA and clear airway
Consider OP/NP airway
Jaw thrust and CPAP 30cmH2O (do not give +ve pressure breath)
Apply bilateral painful inward pressure to Larson’s point (behind lobule of ear)

Paeds: Consider gentle chest compressions

Question 16

Pharmacological relaxation for laryngospasm (when SpO2 stable & >92%(

Answer 16

Propofol 20% of induction dose

Suxamethonium IV 35mg (Paeds: 0.5mg/kg)

Question 17

If laryngospasm and SpO2 dropping or <92%

Answer 17

Proceed to intubation
Adult: Suxamethonium 100mg
Paeds: Suxamethonium IV 2mg/kg, IM 4mg/kg

Question 18

Steps to manage bronchospasm

Answer 18

Miminse surgical stimulation
Manually ventilate
Deepen anaesthesia
Emergency drug therapy 
Optimise ventilator
Other drug adjuncts + infusions
Art line and ABGs

Question 19

Other causes of high airway pressures other than primary bronchospasm

Answer 19

Anaphylaxis
Laryngospasm on LMA
Tube position
Chest wall rigidity
Pneumothorax
LV failure

Question 20

Emergency drug therapy for bronchospasm

Answer 20

Inhaled salbutamol 12 puffs via circuit
Inhaled ipratropium bromide 6 puffs
IV salbutamol 250mcg slow bolus
IV adrenaline 0.1-0.5ml of 1:10,000

Question 21

Management of aspiration

Answer 21

Position - head down, left lateral
Remove LMA/OP and suction pharynx
Suxamethonoim IV 100mg 
Intubate and suction through ETT with largest suction catheter
Ventilate with 100% O2

Question 21

Management of aspiration

Answer 21

Position - head down, left lateral
Remove LMA/OP and suction pharynx
Suxamethonoim IV 100mg 
Intubate and suction through ETT with largest suction catheter
Ventilate with 100% O2

Question 22

Aspiration, if SpO2 dropping or <90%

Answer 22

Do not delay oxygenation

Bag mask ventilation with 100% O2 or manual breaths via ETT with 100% O2