Anesthetic Emergencies

Question 1

What type of animal would be classified as an ASA I?

Answer 1

Normal, healthy patient (usually elective procedure)

Question 2

What type of animal would be classified as an ASA II?

Answer 2

A patient with mild, well-compensated systemic disease

Question 3

What type of animal would be classified as an ASA III?

Answer 3

A patient with severe, clinical systemic disease and/or multiple systemic diseases

Question 4

What type of animal would be classified as an ASA IV?

Answer 4

A patient with severe systemic, decompensating disease that is a constant threat to life

Question 5

What type of animal would be classified as an ASA V?

Answer 5

A moribund patient that is not expected to survive without the operation.

Question 6

T or F: if you put an E after a patient’s ASA classification, it stands for ‘elective’

Answer 6

False - it stands for emergency

Question 7

T or F: increased ASA status has been associated with higher risk of death in multiple studies in small animals, equines, and humans

Answer 7

T

Question 8

Which types of patients are more likely to succumb to anesthesia-related mortality?

Answer 8

Horses, sicker patients (higher ASA status)

Question 9

What two parts of anesthetizing a patient are the riskiest for the patient?

Answer 9

Induction and recovery

Question 10

T or F: you should wait to get the CPR status of your patient only once the patient has arrested

Answer 10

FALSE - should get when you’re having the owners sign an informed consent form

Question 11

What qualifies as pre-anesthetic blood work for an ASA I vs. any patient with an ASA > 1?

Answer 11

ASA 1: PCV, TS, Azostick, blood glucose

ASA >1: at least a CBC + chem

Question 12

What are some examples of standardized practices that should occur prior to anesthetizing a patient?

Answer 12

Requiring pre-anesthetic BW
Pre-surgical overnight fasting w/ free water access
Pain scores pre-/post-operatively
Standardize anesthetic equipment
Checklists for crash carts 
Signing off on tx sheets/drug calcs

Question 13

What are some examples of common anesthetic accidents or emergencies?

Answer 13

Drug miscalculations
Misadministration of drugs/IV catheter dislodgement
ET - intubation, tube obstruction/kinking, accidental extubation
Fluid misadministration/overdose
Anesthetic overdose
Cardiopulmonary arrest

Question 14

What is an example of a drug than can cause serious damage if extravasation occurs?

Answer 14

The barbiturate, thiopental - can cause severe tissue damage and potential sloughing if accidentally given SQ

Question 15

What are a few ways to confirm an ET tube is properly placed?

Answer 15

Direct visualization w/ laryngoscope
Using capnography to confirm CO2 presence
Thoracic auscultation

Question 16

What can occur if the ET tube has accidentally been placed in the esophagus?

Answer 16

Can result in desaturation, hypoxemia, and arrest if uncorrected

Question 17

What can be used in a very small or fluid intolerant patient in place of a drip set?

Answer 17

A roller Heska pump (fluid line goes through), Buretrol, or even a syringe pump

Question 18

Stage I of Anesthesia

Answer 18

Voluntary movement (awake)

Question 19

Stage II plane of Anesthesia

Answer 19

Involuntary movement (excitatory)

Question 20

Stage III of Anesthesia

Answer 20

Surgical anesthesia (may be further classified as light, medium, or deep)

Question 21

Stage IV of anesthesia

Answer 21

Impending cardiovascular collapse; hypotension with pupils central with no corneal reflex

Question 22

At what rate should chest compressions be occurring during CPR?

Answer 22

100-120 bpm

Question 23

What’s the best positioning and method for chest compressions for small patients?

Answer 23

Place in lateral recumbency with hands over where heart would be (4th-5th intercostal space-axilla)

Question 24

What’s the best positioning and method for chest compressions for larger patients (>20kg)?

Answer 24

Thoracic pump theory - pumping only occurs via changes in intrathoracic pressure
Place in lateral recumbency and put hands over widest part of chest

Question 25

What’s the best positioning and method for chest compressions for barrel-chested breeds, like English Bulldogs?

Answer 25

Place in dorsal recumbency and put hands over sternum (similar to humans)

Question 26

What constitutes basic life support, and when should it be started?

Answer 26

Chest compressions and ventilation; should start if no pulse and monitors are not reading