Crisis

Question 1

30yo NKDA open appendicetomy

1 min BP drops to 60, diff to vent, Vt 100mL

Question 2

CRM principles

Answer 2

1. Call for help early
2. Anticipate and plan
3. Set priorities
4. Leadership
5. Teamwork
6. Comm
7. Info
8. Attn
9. Distribute
10. Mobilse

Question 3

RESUSC, TRAUMA, CRISIS – Damage control resuscitation in severe trauma

[21B14] Discuss the principles of damage control resuscitation in severe trauma.

Question 4

Anaphylaxis

Answer 4

150 microg - 7.5-20kg 5yo
300 microg - >20kg 6-12yp
500 microg - 12yo+

Community vs periop

graded approach to (2022)
volume resus
IV adrenaline

Severity grading
Mild 1- skin (46% none - NAP6)
2 - CVS comp
- 10-20mcg, 500mL
3 - severe hypotension/hypoxaemia
- sBP <60, SpO2 <90
- 50-100 microg, 1L
4 - Arrest 2L
- mostly PEA
- CPR start at sBP <50 in anaes pt

DDx

MCT
imm/ASAP, 1, 4, 24hrs

• Low output state –> worth continuing CPR

Skin testing
- provoke IgE reaction - wheal/flare
- wheal expansion = pos rxn

MR
Sux 1:2000
Roc 1:2500

1:20000 all grades anaphylaxis (CVN)

H2 extend H1 blockade

D Hill M&M

Question 5

ANAESTHETIC CRISIS / COMPLICATIONS– Anaphylaxis

[15B08] A 20 year old patient has been successfully resuscitated from suspected anaphylaxis.

Describe your immediate and longer term post crisis management. [18B02] xx (also 13A06, 05B07, 03B01)

Answer 5

ANZCA BP 2022
**IMMEDIATE mx post resus

**Post crisis mx

1. Steroids
   - 2nd mx post acute mx and pt stable
2. TRYPTASE
   - peak 15-120min post onset
   - t1/2 2hr
   - declines 3-6 hrs post onset
   - 24 hrs = reliable baseline
   - ASAP onset sx, 1, 4, 24
3. Monitor/environ
   - Grade 2-3 –> HDU/ICU
   - Grade 1/2 settled –> 6hr close mon
4. ## Referral