Anesthetic Accidents and Complications

Question 1

esophageal intubation

Answer 1

• lungs sound ok
• capnograph reads 0
• pulse ox ?
• patient gets light plane anesthesia

Question 2

endobronchial entubation

Answer 2

• lungs sounds = unilateral
• capnograph = low
• pulse ox = ? ok
• plane anesthesia = ? ok
• only oxygenating one lobe!
  
  • hyperventilating the one lung, CO2 is washed out faster
• premeasure tube!
• pleural effusion/pneumothorax have similar presentation: distinguish by backing the tube up

Question 3

regurgitation

Answer 3

• esophageal stricture because the regurgitation sits in the esophagus
  
  • the E-tube prevents aspiration
• can try flushing the esophagus with some water to increase pH

Question 4

aspiration pneumonia

Answer 4

• increased lung sounds
• normal capnograph
• pulse ox = low ?
• regurgitation destroys surfactant - can’t expand, can’t breathe
• deep plane of anesthesia
• treat using PEEP (positive end expiratory pressure) +/- bronchodilators

Question 5

closed pop off valve

Answer 5

• sudden drop in BP
• capnograph reading is 0
• increase in pressure over heart from lungs leads to cardiac arrest due to lack of bloodflow back to heart (VC compression)
• no plane of anesthesia because patient is dead…

Question 6

different types of shock

Answer 6

• cardiogenic
  
  • high preload and low BP
• hypovolemic
  
  • low preload and low BP + vasoconstriction
• vasodilatory
  
  • low preload and low BP + vasodilation

Question 7

possible causes of cardiogenic shock

Answer 7

heart disease

closing pop off valve

pregnancy

ventilator

Question 8

possible causes of hypovolemic shock

Answer 8

hemorrhage

dehydration

fluid shift (3rd space)

Question 9

possible causes of vasodilatory shock

Answer 9

anaphylactic shock

septic shock

snake bite

heat stroke

Question 10

vasodilatory shock

Answer 10

drop in preload (CVP)

drop in afterload (BP)

Question 11

treat hypotension w/

Answer 11

fluid therapy (colloids, hypertonic, crystalloids)

blood products

inotropes

vasopressors (dopamine, NE, ephedrine, AVP)

fix underlying cause!

Question 12

if the patient has hypoxia:

Answer 12

check ET tube for endobronchial intubation

check CO2 for esophageal intubation

check pulse ox for VQ mismatch

Question 13

if the patient is hypotensive:

Answer 13

hypovolemia-fluid therapy, inotrope, fix underlying cause

cardiogenic-inotrope, fix underlying cause

vasodilatory-fluid therapy, inotrope, fix underlying cause