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Advanced Principles of Anesthesia - 931 > Crisis > Flashcards

Crisis Flashcards

1
Q

Bronchospasm s/s - (5)

A
  1. Increased peak airway pressures.
  2. Wheezing on lung exam.
  3. Increased expiratory time.
  4. Increased ETCO2 with upsloping ETCO2 waveform.
  5. Decreased tidal volumes if pressure control.
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2
Q

Bronchospasm differentials (6)

A
  1. Right mainstem
  2. Kinked ETT or mucus plug
  3. Anaphylaxis (tachycardia, hypotension, rash)
  4. Pneumothorax
  5. Aspiration
  6. Laryngospasm
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3
Q

Bronchospasm treatment

A
  1. Call for help
  2. 100% oxygen
  3. Change I:E
  4. Deepen anesthetic
  5. Rule out issues w/ETT (listen, suction)
  6. Give albuterol
  7. Epi 10 mcg
  8. Ketamine 0.2 - 1 mg/kg
  9. Hydrocort 100 mg
  10. Nebulized epinephrine
  11. R/O anaphylaxis
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4
Q

Laryngospasm s/s

A
  1. stridor
  2. respiratory distress
  3. intercostal recession
  4. rapid hypoxemia
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5
Q

Laryngospasm treatment

A
  1. Help
  2. 100% oxygen
  3. Stop stimulus
  4. Deepen anesthesia
  5. Open & Clear airway
  6. CPAP via bag
  7. Jaw Thrust or Larson’s
  8. Succinylcholine 0.1 mg/kg IV or 2 - 4 mg/kg IM
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6
Q

Laryngospasm differential diagnoses (6)

A
  1. circuit obstruction
  2. Supraglottic/laryngeal obstruction
  3. RLN damage
  4. residual NM blockade
  5. tension pneumothorax
  6. laryngeal edema
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7
Q

Aspiration s/s (5)

A
  1. direct visualization
  2. coughing/dyspnea
  3. laryngospasm/bronchospasm
  4. increased PIP
  5. hypoxemia
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8
Q

Aspiration on Induction treatment

A
  1. Suction
  2. Turn left lateral
  3. Avoid Cricoid
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9
Q

Aspiration on Induction Management

A
  1. 100% FiO2
  2. Empty stomach
  3. Cancel elective surgery
  4. Bronchodilators
  5. CXR
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10
Q

Anaphylaxis S/S

A
  1. hypoxemia
  2. dyspnea, wheezing, bronchospasm
  3. hypotension, tachycardia
  4. rash
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11
Q

Anaphylaxis Tx

A
  1. help + code cart
  2. stop trigger
  3. 100% O2
  4. Epi 10 - 100 mcg
  5. Fluid bolus
  6. symptom management: vaso, albuterol, benadryl (25-50 mg), methylpred (125 mg)

Labs: serum tryptase (mast cell degranulation) / plasma
histamine

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12
Q

Airway fire

A
  • Help
  • Stop all gas flows!
  • Remove ETT
  • Extinguish Fire
  • Suction
  • Re-intubate
  • Suction / PPV
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13
Q

Negative Pressure Pulmonary Edema s/s

A
  • Patient biting on tube
  • Hypoxia
  • Tachycardia
  • Inspiratory Crepitations
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14
Q

NPPV tx

A
  • 100% Oxygen
  • Raise HOB
  • Lasix 50mg IV
  • CPAP or PEEP 5-10cm H2O
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15
Q

MH s/s early

A
  • Increased ETCO2
  • Tachycardia
  • Tachypnea
  • Mixed Acidosis
  • Masseter Spasm
  • Cardiac Arrest d/t hyperkalemia
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16
Q

MH s/s late

A
  • Hyperthermia
  • Muscle Rigidity
  • Myoglobinuria
  • Arrhythmias
17
Q

MH tx

A
  • Help! MH Cart!
  • D/C Anesthetic gas!
  • 100% Oxygen
  • Increase Minute Ventilation
  • Dantrolene 2.5mg/kg (20mg in 60mL sterile water)
  • Ryanodex 2.5mg/kg (250mg in 5mL)
  • max 10 mg/kg, if not resolved prob not MH
  • MH Hotline: 1800-MH-HYPER
  • sodium bicarb 1-2 mEQ/kg
18
Q

MH tx later

A
  • Cool Patient; Stop at 38
  • ABG, K+, CK, myoglobin, coags, lactate
  • Acidosis—> Sodium Bicarb 1-2 mEq/kg
  • Hyperkalemia—> 25g dextrose + 10U RHI
  • Foley; Alkalinize urine
19
Q

MH differentials (6)

A
  • Thyroid Storm
  • Pheochromocytoma
  • Neuroleptic Malignant Syndrome
  • Serotonin Syndrome
  • Hypoventilation or insufflation
  • Over heating
20
Q

Aspiration differentials

A
  • Breathing circuit obstruction
  • Bronchospasm
  • Foreign body aspiration
  • Acute pulm edema / ARDS
21
Q

Anaphylaxis differentials

A
  • Breathing circuit obstruction
  • Airway foreign body
  • Tension Pneumo
  • Type IV Allergy: localized cutaneous reaction, t-cell mediated, non-life
    threatening
  • Hemorrhage
  • PE
  • Overdose
  • MI
  • Aspiration
22
Q

Refractory hypotension s/s

A
  • Warm = vasodilation (sepsis, anesthesia OD)
  • Cold = Hypovolemia
  • Tachycardia & HoTN
23
Q

Refractory hypotension treatment (primary)

A
  • Help / Check Pulse
  • Inspect for Blood Loss
  • Fluid Bolus & Another IV
  • Vasopressor
  • Epinephrine 10mcg or Vaso 1-4 units
  • Turn down gas
  • Trendelenburg
  • 100% Oxygen
24
Q

Refractory hypotension treatment (secondary)

A
  • Hydrocortisone 100mg (adrenal insufficiency)
  • Labs: ABG, Hgb, Lytes, Ca+, Lactate, T/S
  • TEE, Foley
25
Q

Refractory hypotension differentials

A
  • Sepsis
  • Shock
  • Pneumo
  • Anaphylaxis
  • Pneumoperitoneum
  • Hemorrhage
  • Vasodilators
  • Vagal Stimulation
  • Hypovolemia
  • Embolism
  • Myocardial Ischemia
  • LA Toxicity
26
Q

Hemorrhage s/s

A
  • Massive Blood Loss
  • HoTN
  • Tachycardia
  • Cool Extremities
27
Q

Hemorrhage treatment

A
  • Help / 100% Oxygen
  • IV Fluid Bolus & Another IV
  • Trendelenburg
  • Vasopressor Boluses
  • Call for rapid infuser
  • Page surgical help
  • T/S + T/C
  • Keep Warm
  • A-line
  • ABG, Coags
  • Foley
  • Monitor for hypocalcemia
28
Q

Differentials for hemorrhage dash

A
  • Dehydration
  • Sepsis
  • Anaphylaxis
  • Heart Failure
29
Q

Transfusion triggers

A
  • PRBC: Hgb <7
  • PLT: <50k
  • FFP (10-15cc/kg): INR/PTT 1.5X norm
  • CRYO (10u): Fibrinogen <80-100 mg/dL
30
Q

MI treatment

A
  • Help / 100% Oxygen
  • STEMI team/ Cards consult - EKG to confirm
  • Labs: Troponin, ABG, CBC - Treat HoTN/HTN
  • Beta Blocker if appropriate (esmolol 0.5mg/kg or metoprolol 1-2mg increments)
  • Aspirin 160-325mg
  • Fentanyl/morphine
  • Nitro Infusion
  • TEE??
  • Transfer for PCI
31
Q

Residual paralysis

A
  • Low tidal volumes
  • Hypoxemia
  • Poor hand grip/ head lift
  • Unable to open eyes
  • Poor cough
32
Q

Residual paralysis tx (6)

A
  • Help / 100% oxygen
  • Bag patient if needed
  • Jaw thrust, NPA
  • Apply PNS to check TOF & Administer reversal agent
  • Maintain normothermia/normocarbia & lytes
  • Neuro Exam: pupils/gag
33
Q

Residual paralysis differentials

A
  • Stroke
  • LEMS/ Myasthenia gravis
  • Laryngeal nerve Palsy
  • Myxoedema coma
  • Hypoglycemia
34
Q

Thyrotoxic crisis s/s

A
  • Fever >41 C
  • Sweating
  • Tachycardia >140bpm, Atrial Fib/ Ventricular
    arrthymias
  • Hyper then HoTn
  • N/V
  • CHF
  • Mixed metabolic/ Respiratory Acidosis
35
Q

Thyrotoxic crisis tx

A
  • Help/ 100% Oxygen
  • Rehydrate w/ IV NS
  • Treat fever w/ tepid sponges
  • Non-selective BB: Esmolol 0.5mg/kg; 50-100mcg/kg/min
  • Labs: T3, T4, TSH
  • Hydrocortisone 200mg IV

Further Management

  • Propylthiouracil 1g via NG tube
  • Sodium Iodide 500mg IV or Potassium Iodide 5 drops via NG
36
Q

Thyrotoxic crisis differentials

A
  • MH
  • Pheochromocytoma
  • Infection/ Sepsis

Advanced Principles of Anesthesia - 931 (3 decks)

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