Emergencies Flashcards
Is any anaesthetic procedure without risk?
No
What can reduce the likelihood of anaesthetic emergencies occurring?
Adequate pre-anaesthetic assessment, appropriate use of anaesthetic drugs and careful monitoring
What can cause anaesthetic emergencies?
Human error - fatigue, failure, personnel, inattentiveness, lack of familiarity
Equipment failure - vaporiser, misassemble, pop-off, valve, ET problems, empty O2 tank, CO2 absorber exhausted
Give examples of anaesthetic agents
ACP
Halothane
Xylazine
Give examples of patient variation factors
Respiratory disease Sighthounds CVS disease Neonatal patients Brachycephalic Renal Trauma Obesity Caesarean sections Geriatric Hepatic
What are the principles of emergency care
Alert VS Stay calm Prioritise Be aware of emergency kit location keep emergency drug dosage sheets in crash box DON'T PANIC
Give examples of crash kit drugs
Atropine Adrenaline Lignocaine Diazepam Narcan Dopamine Doxapram Atipamezole Sodium Bicarbonate
state common problems occurred during anaesthetic
patient too light
Patient too deep
respiratory arrest
Cardiac arrest
What could cause a patient to be too light?
Vaporiser problems ET tube problems Breath holding Shallow respiration Inadequate O2 flow Anaesthetic machine
What could cause a patient to be too deep?
vaporiser set too high
Presence of pre-exisiting problems
What are the signs of a patient being too deep?
Slow shallow respiration Pale/cyanotic mms CRT >2s Bradycardia with weak pulse Absence of reflexes
What do you do when the patient is too deep?
Turn down vaporiser
Initiate bagging - IPPV
Supportive Tx - IV fluids, heat, drugs
What are signs of recovery?
Increased HR
Improved mm colour
Stronger pulse
Improved CRT
Describe bagging a patient
IPPV
Requires intubation and O2 supply
Close/part close APL valve
Fill reservoir bag with O2
Gently squeeze bag until patient chest rises slightly
Repeat every 6secs until signs of recovery noted
why does respiratory arrest occur?
- Anaesthetic overdose
- Pre-existing respiratory disease
- Lack of O2
- Side effects of pre-meds
How do you assess for induction apnoea?
Look at eye position and palpebral reflex
Describe the signs of respiratory arrest
dyspnoea, cyanosis and abnormal HR, CRT, pulse and pupil dilation
Give signs of cardiac arrest
no heartbeat can be ausculated, palpated or seen on ECG/ultrasound
No palpable arterial pulse
MMs grey or cyanotic, CRT prolonged
Pupils widely dilated with no PLR
Repiration absent except for Cheyne-stokes respiration
What can cause cardiac arrest?
Underlying disease, overdose
What do you do when a patient is undergoing cardiac arrest?
Notify VS/get help
Once cardiac arrest is established you must begin compressions ASAP
Deliver compressions at 100-120bpm in 2min cycle
Intubate patient, if not already
IPPV at 10bpm
If on own do 30:2, compressions:breaths
Check for pulse after 2min cycle
What treatment is given for cardiac arrest?
Compressions until spontaneous return of pulse and breathing occurs
Drugs
Keep patient warm
How should cardiac compressions be given?
Animal lying on right side Heal of hand at 5th intercostal space Compress cheat by 1/3 - 1/2 width of chest Small dogs/cats - use thumb and fingers Rate: 100 compressions per min
What equipment can be used in emergencies?
Defibrillator - used in cardiac arrest to stimulate heart and myocardial contractions
Self-inflating resuscitator bag - used in respiratory arrest to provide IPPV, may use mask or attach to ET tube
Urinary catheter - used to admin drugs via ET tubes
IV catheter - emergency access for drugs, fluids etc.
What are the emergency golden rules?
Stay calm, alert VS ASAP Turn off vaporiser Make sure you know how to deliver IPPV Be familiar with cardiac compressions Have a well stocked crash box to hand
