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Junior Anaesthesia > Emergency Anaesthesia > Flashcards

Emergency Anaesthesia Flashcards

1
Q

Emergency→ Immediate operation usually within __________ of surgical consultation usually lifesaving, __________ simultaneously with surgical treatment.

Urgent→ Operation as soon as possible after __________ usually within __________ of surgical consultation.

A

one hour ; resuscitation

resuscitation ; 24 hours

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2
Q

Emergency Theatre Provision:

A 24-hour emergency operating theatre is provided

Emergency cases will be operated on at __________.

Urgent cases will be operated on between the hours of ______-______ hours.

Emergency operations will take precedence over __________ cases

A

anytime

0830 - 2200

all other

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3
Q

Preoperative challenges
Challenges of emergency anaesthesia

 Full stomach-emptying of gastric contents normally is delayed due to ____________________________

 This may be caused by trauma, pain, fear and opioids The _______________________________________ is used in the assessment residual gastric volume after trauma.

 The gastric volume >____mls/kg and a pH < than ______ correlate with more severe complications of aspiration

A

reduced gastric motility

time of ingestion of food to the time of trauma

20mls/kg ;2.5

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4
Q

Possible causes of a full stomach

Emergency surgeries which may include ______,________,________,________

Anaesthesia causes will include _______ administration, __________ medications, __________ intubations which alters the _______ and reduce the _______________ tone
Others will include autonomic neuropathy Stress and pain
Encephalopathy
Obesity
Pregnancy
Abdominal malignancy causing raised intra abdominal pressure

A

TBI,Caesarian section, bowel obstruction, hiatal hernia

opioid; anticholinergic; nasogastric

gag reflex; lower esophageal

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5
Q

Preoperative challenges

Full stomach:
It predisposes the patients to _________ & probable _________ of gastric contents resulting in a poor outcome

 This may occur due to the limited time available for patient preparation
The reduction in the time for patient assessment & evaluation increases the risk associated with anaesthesia for emergency procedures

A

regurgitation; aspiration

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6
Q

Pre-operative challenges

Hypovolaemia→ __________ or __________ from __________ or __________ which results in __________ and __________, which may then lead to __________.

Coexisting medical disorders→ uncontrolled HTN, DM, asthma, CCF,
 __________ – and concomitant use of __________ medications

A

haemorrahge ; fluid loss

diarrhea ; vomiting

dehydration ; loss of electrolytes ; arrhythmias.

Pain; opioids

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7
Q

Source of emergency Patients

A

Hemorrhagic
General surgery
Labour ward-ruptured uterus
Feto-maternal distress

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8
Q

Source of emergency Patients

A

Femur/tibia

ectopic pregnancy

aneurysm

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9
Q

SOURCE of emergency patients

Intensive Care
________ (____________________)

A

STBI(severe traumatic brain injury)

Burst abdomen

sudden acute deteriorating

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10
Q

Anaesthetic Management

_____________ Assessment
_____________ Investigations
_____________
_____________
_____________
_____________ / _____________

A

Preoperative
Laboratory
Monitoring
Induction
Maintenance
Recovery / Shifting to ICU

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11
Q

Preoperative assessment

Conventional Assessments of fitness for anesthesia and surgery (can or cannot?) be followed
_______ assessment and intervention to stabilise the patient

A

Cannot

Rapid

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12
Q

Preoperative assessment

Primary survey
_________,_______,_______,_________

If not ________,_______, and __________ immediately you may not have a live patient on the operating table

A

Circulation
Airway
Breathing
Disability (Neurology)

assessed, diagnosed and treated

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13
Q

Shock index =???

And the (lower or higher?) the value the poorer the prognosis

A

Heart rate <0.7
—————-
Systolic pressure

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14
Q

Airway Assessment
Assessment of _________ and _________
Difficult Laryngoscopy with risk of failed intubation

Beware of
_________ and __________

A

patency and anatomy

C-Spine Injury

Full Stomach

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15
Q

Airway Treat

Simple airway maneuvers- ________,___________

Simple airway adjuncts- ______,________ airways

________________ – Gum elastic bougie,McCoy laryngoscope blade,Videolaryngoscope,intubating LMA

A difficult airway may require a surgical access through a _____________.

A

Jaw Thrust, chin lift

oral, nasal

Endotracheal Intubation

cricothyroidotomy

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16
Q

Breathing with ventilatory support

Respiratory rate – Bradypnoea, tachypnoea

Respiratory rates <___ or >____ are seen in life threatening conditions

Oxygen saturation – very useful if signs of _________ are present

A

<5 or >35

hypoxia

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17
Q

Anticipated problems needing intervention

List 5

Treatment – ___________ insertion , ———— of the wound, ____________ and ___________

A

Tension pneumothorax
Massive Hemothorax
Open Pneumothorax
Flail Chest
Cardiac Tamponade

Intercostal drain; Sealing; Intubation & ventilation

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18
Q

Important 5 places to access after primary survey
In posttraumatic patients

_________ injuries
_______ bones
____________ for pneumohaemthorax
____________
_________ and __________
— — — — — —

A

External; Long

Chest – x ray

Abdomen

Pelvis and Retro peritoneum

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19
Q

Shock in a multiply injured patient is “__________ shock” unless proven otherwise

A

hemorrhagic

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20
Q

Management of shock

___________ – ______ intervention / interventional __________

_________ bore canulae – (peripheral or central?) – send for ________ and _______ - lab

2 litres of _____________________ ???

Exsanguinating hemorrhage O -ve blood

A

Stop Bleeding; Surgical; Radiology

2 large; peripheral; grouping and cross matching

warm crystalloids

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21
Q

Neurological
Quick GCS scored over 15

Prevent secondary Neurological damage
May result from
_________,_________,___________

A

Hypoxia Hypotension Hypercapnia

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22
Q

_________ _______tension probably is not to be advocated for head injured patients

A

Permissive Hypo

23
Q

TRAUMA

Glascow Coma Scale (GCS)

•Head injury mild (_______),
moderate (_______), severe (_____)

A

13-15

9-12

3-8

24
Q

Radiology
______
_________
________
_________- ______ view CT
—
— — — —

A

X rays –
Chest
Pelvis
C Spine – lateral

25
Q

Do Not Shift ___________________ patient to Radiology Room

A

Hemodynamically unstable

26
Q

CT (reduces or lengthens?) time to diagnosis

A

Reduces

27
Q

Shifting of Patients from Resuscitation Suite

“ Only down the corridor”
— Airway
— Ventilation
—_______ and ______
__________
— Check – __________,_________,____________
— Only half way through corridor– Beware of _________ injuries

A

Fluids and drugs
—

Monitoring

Battery of ventilators, Oxygen cylinders,
Syringe pumps

undiagnosed

28
Q

Positioning

Beware – ______,_______,________

All are inserted as they are important – so keep them accessible
Take care of __________ limbs

Every shifting in a _________ patient can cause further ______ in blood pressure

A

lines- tubes- bags

fractured; hypovolemic

fall

29
Q

Monitoring

Basic Monitors

•______,_______,________,_________
•_____________________

Don’t waste time in getting an arterial line-
can be placed after surgeons have started hemorrhage control
CVP – PCWP ??

A

Pulse Oximetry, ECG, Temperature, NIBP

Invasive Arterial blood pressure-

30
Q

Choice of anaesthesia
 guided by the ________ of the injury and ________
surgical technique
the preferences of the ________
________ or ________ anaesthesia
However, due to urgency, ________ is always preferable to ________

A

nature ; location

anaesthetist

General ; regional anaesthesia

GA ; RA

31
Q

Preparation for anaesthesia

____________ drugs,
____________ drugs , vasopressors
_______,________
IV access (large bore cannula ____/___G) Anaesthetic ____________
Tiltable _________
Informed _________
_______________

A

Anaesthetic drugs
Resuscitative drugs
atropine, adrenaline
16/18G
machine check
trolley ; assistant
Acid prophylaxis

32
Q

RSI
Gold standard for prevention of _______________________

It is a method for achieving rapid _______________ whilst minimising the risk of __________ and __________ of ___________

It is important in patients who has not ________

A

aspiration of gastric content

control of the airway

regurgitation ; aspiration ; gastric contents.

fasted

33
Q

RSI

The goal is to ________ without having to use __________________ ventilation

_______ table
Full _________ with _______ ready
_________ assistant
IV access

A

intubate ; bag-valve-mask

Tilting ; monitoring ; suction

Trained assistant

34
Q

Rapid sequence induction steps

_______________________ FOR ____ MINUTES

Calculated sleep dose of induction agent ______,______,________,________

__________ or __________ maneuvers applied on the cricoid cartilage which forms a _______ ring and could directly __________ the __________

Suxamethonium ____ mg/kg

__________ and __________ is carried out immediately the patient is relaxed

Check __________ before releasing ________ pressure. Secure the tube.

A

PRE-OXYGENATION ; 3 MINUTES

STP, propofol ,etomidate, ketamine

Cricoid pressure ; Sellicks maneuvers

signet ring ; compress ; eosophagus

1; Laryngoscopy and intubation

position ; cricoid pressure

35
Q

Choice of Induction agent

For Adequately resuscitated

Receive standard anesthetic care : ______,______,_________

A

STP,Propofol,Etomidate

36
Q

Choice of Induction agent

Fro Inadequately resuscitated, unstable but conscious

A ________________ dose of induction agent
Choice : ______,_________

A

reduced titrated

Ketamine Etomidate

37
Q

Choice of Induction agent

In extremis eg if patient is unconscious and apneic

Induction agents ___________________

Can use ____________________

A

should not be used – inappropriate

muscle relaxants

38
Q

Controlled or Spontaneous ?
No Place for spontaneous ventilation in a hemodynamically unstable - critically ill patient and

Severe shock – where there is

↓______________________
increased need for __________________
And perhaps associated _________________

A

blood supply to diaphragm

minute ventilation

Respiratory failure

39
Q

Maintenance of Anesthesia
Till hemodynamic stability is attained – Incremental dose of _______ and (low or high?) concentration of ________ agents

As the circulatory state improves dose of narcotics, volatile agents or propofol can be _____eased

A

narcotics; low; volatile agents

Increased

40
Q

Relaxants

__________,___________– least effect on heart (not available)

____________ (??allergy)

If elective ventilation is planned – ___________ is best due to _______ and __________ effect in shocked patient

A

Rocuronium, vecuronium

Atracurium

Pancuronium

vagolytic; sympathomimetic

41
Q

Volatile Anesthetic of choice
________ – _________ – __________

A

Isoflurane – sevoflurane – desflurane

42
Q

Volatile Anesthetic of choice

Isoflurane
Impressive safety profile
_____tension – due to ______________ and not _______________

A

Hypo

vasodilatation

myocardial depression

43
Q

Fluid therapy - Early Phase

Till ________________
Fluids to maintain systolic pressure of >____ mm Hg
To reduce _____ formation and ______________ and to prevent ____________ vasoactive support for most shock refractory to fluid therapy
_____________ infusion remain the mainstay of

A

control of hemorrhage; 80

clot; dislodgement of clots

hypoperfusion

Catecholamine

44
Q

Fluid Therapy- late Phase

To maximise the __________ to correct the _________________

Fluid (crystalloids or colloids) to increase ____________

RBCs to improve ___________

Plasma and platelets to correct __________

_____________ to be continued in the _____ –until _______________

A

perfusion ; oxygen debt

volume ; oxygen carriage

coagulation; Resuscitation

ICU ; lactate clearance

45
Q

—
—
—
—
—
—
—Fluid Therapy

Adequacy of fluid therapy is accessed by monitoring the
__________,______,______,_______

_____________ Variation
_____________ Variation

A

Blood Pressure, Heart rate, urine output CVP

Systolic Pressure ; Pulse Pressure

46
Q

In patients with intestinal obstruction the passage of __________ is very important

A

nasogastric tube

47
Q

Anaesthesia for intestinal obstruction

•_____________________________ (concern)
balanced salt solutions ( _________,_________ )

Kcl →K correction,
• • •
darrows solution Bicarbonate GAR
NG Tube

A

fluid & electrolyte balance

Lactated Ringers, 0.9% saline

48
Q

 Anaesthesia for Penetrating eye injury

______________ RSI (↑ intraocular press)→ _________ and _______
—
Alternative — : __________, _________

A

Suxamethonium

vitreous loss & blindness

rocuronium

Delay surgery

49
Q

Anaesthesia for antepartum haemorrhage

Placenta praevia or accreta
GA orRA
Adequate ____________
availability of _________________
______ for caesarean
↓blood loss & need for blood transfusion

A

IV access

cross-matched blood

RA

50
Q

Blood loss
Physiologically, haemodynamic compensatory mechanisms maintain vital organ perfusion till about ______% TBV loss, beyond which there is risk of critical ______________ .

Inadequate resuscitation at this stage leads to __________

A

30

hypoperfusion

51
Q

Avoid Hypothermia
Core body temperature <_____°C

Causes
Coagulopathy
Acidosis
Decreased cardiac output
Arrhythmias

A

35

52
Q

To Extubate or Not

_______________ till the physiological parameters return

____________________– worse outcomes

———————- is strongly recommended

A

Elective ventilation

Premature extubation

Awake extubation

53
Q

Transfer to the ICU

Usually transferred by bringing the ICU _______ – reduces the number of transfers

________ from ICU brought along with the trolley/cot

_______________ with ______ Circuit

Take care of _________ tubing and ___________
Handing over to the _________ - vital

A

trolley; Monitors

Oxygen cylinder; Bains

invasive; Urobags

intensivist

Junior Anaesthesia (16 decks)

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