Emergency Anaesthesia

Question 1

What is the definition of an emergency operation?

Answer 1

Emergency operation: Immediate surgery, usually within one hour of surgical consultation, often lifesaving with simultaneous resuscitation.

Question 2

How soon should an urgent operation be performed?

Answer 2

Urgent operations should be performed as soon as possible after resuscitation, typically within 24 hours of consultation.

Question 3

Who should be consulted for logistical coordination in emergency cases?

Answer 3

Emergency cases requiring coordination should be discussed with the Theatre Manager and Anaesthetic team.

Question 4

What is the provision for a 24-hour emergency operating theatre?

Answer 4

A 24-hour emergency operating theatre is always available for emergency cases.

Question 5

When can urgent cases be operated on?

Answer 5

Urgent cases can be operated on between 0830 and 2200 hours.

Question 6

What takes precedence, emergency or non-emergency cases?

Answer 6

Emergency operations take precedence over all other cases.

Question 7

What challenges does a full stomach present in emergency anaesthesia?

Answer 7

A full stomach increases the risk of regurgitation and aspiration during anaesthesia.

Question 8

What causes delayed gastric emptying in emergency situations?

Answer 8

Delayed gastric emptying is caused by trauma, pain, fear, opioids, and stress.

Question 9

What is the significance of gastric volume >20mls/kg and pH < 2.5?

Answer 9

A gastric volume >20mls/kg and pH < 2.5 correlate with severe aspiration complications.

Question 10

Name some emergency surgeries that may cause a full stomach.

Answer 10

Surgeries include TBI, Caesarean section, bowel obstruction, hiatal hernia.

Question 11

How do anaesthetic drugs contribute to a full stomach?

Answer 11

Anaesthetic drugs such as opioids and anticholinergics can contribute to a full stomach.

Question 12

What other conditions contribute to a full stomach?

Answer 12

Other causes include autonomic neuropathy, obesity, pregnancy, stress, and abdominal malignancy.

Question 13

What is the consequence of regurgitation and aspiration in emergency anaesthesia?

Answer 13

Regurgitation and aspiration can result in a poor outcome, such as severe respiratory complications.

Question 14

Why is patient preparation time limited in emergency anaesthesia?

Answer 14

Emergency situations often leave limited time for thorough patient preparation.

Question 15

What does hypovolaemia result from in emergency anaesthesia?

Answer 15

Hypovolaemia results from haemorrhage, diarrhoea, or vomiting, leading to dehydration and arrhythmias.

Question 16

What coexisting medical disorders complicate emergency anaesthesia?

Answer 16

Disorders include uncontrolled hypertension, diabetes, asthma, and congestive heart failure.

Question 17

What is the source of emergency patients?

Answer 17

Sources include the emergency department, general surgery, and labour ward.

Question 18

Name conditions from the Intensive Care Unit that require emergency anaesthesia.

Answer 18

ICU conditions include severe traumatic brain injury and other acute surgical emergencies.

Question 19

What are the stages of anaesthetic management?

Answer 19

Stages: Preoperative assessment, laboratory investigations, monitoring, induction, maintenance, recovery/ICU transfer.

Question 20

What are the components of a primary survey in emergency anaesthesia?

Answer 20

Primary survey includes airway, breathing, circulation, and neurological assessment.

Question 21

What does the circulation assessment in emergency anaesthesia include?

Answer 21

Circulation assessment: Pulse rate, extremity temperature, consciousness level, blood pressure.

Question 22

What is the shock index, and why is it important?

Answer 22

Shock index: Heart rate divided by systolic pressure; a higher ratio indicates a poorer prognosis.

Question 23

How is airway patency assessed in emergency anaesthesia?

Answer 23

Airway patency is assessed for obstruction, anatomy, and difficulty in laryngoscopy.

Question 24

What is the first treatment step if the airway is obstructed?

Answer 24

Airway obstruction treatments: Jaw thrust, chin lift, endotracheal intubation.

Question 25

Name common anticipated problems in emergency breathing support.

Answer 25

Anticipated problems: Tension pneumothorax, hemothorax, open pneumothorax, flail chest, cardiac tamponade.

Question 26

How should shock in a multiply injured patient be managed?

Answer 26

Management of shock: Stop bleeding, provide fluid therapy, consider surgery or interventional radiology.

Question 27

What is the main goal of managing shock in emergency anaesthesia?

Answer 27

The goal is to maintain blood pressure, correct hypoperfusion, and avoid further complications.

Question 28

What are the essential steps in the neurological assessment?

Answer 28

Neurological assessment includes a quick Glasgow Coma Scale score to prevent secondary damage.

Question 29

What is the Glasgow Coma Scale (GCS) used for?

Answer 29

GCS evaluates eye opening, verbal response, and motor response to classify head injuries.

Question 30

What role does radiology play in emergency anaesthesia?

Answer 30

Radiology, like X-rays and CT scans, is critical for diagnosing injuries but avoid shifting unstable patients.

Question 31

What laboratory investigations are critical in emergency anaesthesia?

Answer 31

Key investigations include haemoglobin, blood sugar, lactate, blood grouping, and coagulation profile.

Question 32

What should be checked when shifting a patient from the resuscitation suite?

Answer 32

Check airway, ventilation, fluids, monitoring, and any potential equipment issues when moving a patient.

Question 33

How should patients be positioned during emergency anaesthesia?

Answer 33

Ensure lines and tubes remain accessible and that fractured limbs are stabilised during positioning.

Question 34

What are the basic monitors used during emergency anaesthesia?

Answer 34

Monitors include pulse oximetry, ECG, temperature, and blood pressure; invasive options if needed.

Question 35

What factors guide the choice of anaesthesia?

Answer 35

Anaesthesia choice is guided by the type of injury, surgical technique, and anaesthetist’s preference.

Question 36

What drugs are essential for preparation in emergency anaesthesia?

Answer 36

Essential drugs: Anaesthetic and resuscitative agents, vasopressors, large bore IV access, and monitoring.

Question 37

What is Rapid Sequence Induction (RSI), and why is it important?

Answer 37

RSI minimises aspiration risk during airway control, especially in non-fasting patients.

Question 38

Outline the steps of Rapid Sequence Induction.

Answer 38

RSI steps: Pre-oxygenation, induction agent, cricoid pressure, muscle relaxant, intubation.

Question 39

How should anaesthesia be maintained in an emergency?

Answer 39

Anaesthesia maintenance involves low doses of volatile agents and incremental narcotics.

Question 40

What relaxants are recommended in emergency anaesthesia?

Answer 40

Preferred relaxants: Rocuronium, vecuronium, atracurium; pancuronium for elective ventilation.

Question 41

What is the preferred volatile anaesthetic agent in emergency cases?

Answer 41

Isoflurane is preferred for its safety profile and minimal myocardial depression effects.

Question 42

How should fluid therapy be managed in the early phase of emergency anaesthesia?

Answer 42

Early fluid therapy maintains systolic pressure >80 mm Hg, limiting haemorrhage and hypoperfusion.

Question 43

How should fluid therapy be adjusted in the late phase of emergency anaesthesia?

Answer 43

Late fluid therapy focuses on correcting oxygen debt with crystalloids, RBCs, plasma, and platelets.

Question 44

What factors indicate the adequacy of fluid therapy?

Answer 44

Fluid therapy adequacy: Monitored through BP, heart rate, urine output, CVP, and other parameters.

Question 45

When should a patient be extubated after emergency anaesthesia?

Answer 45

Extubation should only occur once physiological parameters stabilise; when in doubt, continue ventilation.