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Anaesthesia > Emergency Anaesthesia > Flashcards

Emergency Anaesthesia Flashcards

1
Q

What is the definition of an emergency operation?

A

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

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2
Q

How soon should an urgent operation be performed?

A

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

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3
Q

Who should be consulted for logistical coordination in emergency cases?

A

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

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4
Q

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

A

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

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5
Q

When can urgent cases be operated on?

A

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

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6
Q

What takes precedence, emergency or non-emergency cases?

A

Emergency operations take precedence over all other cases.

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7
Q

What challenges does a full stomach present in emergency anaesthesia?

A

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

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8
Q

What causes delayed gastric emptying in emergency situations?

A

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

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9
Q

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

A

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

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10
Q

Name some emergency surgeries that may cause a full stomach.

A

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

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11
Q

How do anaesthetic drugs contribute to a full stomach?

A

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

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12
Q

What other conditions contribute to a full stomach?

A

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

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13
Q

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

A

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

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14
Q

Why is patient preparation time limited in emergency anaesthesia?

A

Emergency situations often leave limited time for thorough patient preparation.

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15
Q

What does hypovolaemia result from in emergency anaesthesia?

A

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

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16
Q

What coexisting medical disorders complicate emergency anaesthesia?

A

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

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17
Q

What is the source of emergency patients?

A

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

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18
Q

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

A

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

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19
Q

What are the stages of anaesthetic management?

A

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

20
Q

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

A

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

21
Q

What does the circulation assessment in emergency anaesthesia include?

A

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

22
Q

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

A

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

23
Q

How is airway patency assessed in emergency anaesthesia?

A

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

24
Q

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

A

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

25
Q

Name common anticipated problems in emergency breathing support.

A

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

26
Q

How should shock in a multiply injured patient be managed?

A

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

27
Q

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

A

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

28
Q

What are the essential steps in the neurological assessment?

A

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

29
Q

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

A

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

30
Q

What role does radiology play in emergency anaesthesia?

A

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

31
Q

What laboratory investigations are critical in emergency anaesthesia?

A

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

32
Q

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

A

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

33
Q

How should patients be positioned during emergency anaesthesia?

A

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

34
Q

What are the basic monitors used during emergency anaesthesia?

A

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

35
Q

What factors guide the choice of anaesthesia?

A

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

36
Q

What drugs are essential for preparation in emergency anaesthesia?

A

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

37
Q

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

A

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

38
Q

Outline the steps of Rapid Sequence Induction.

A

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

39
Q

How should anaesthesia be maintained in an emergency?

A

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

40
Q

What relaxants are recommended in emergency anaesthesia?

A

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

41
Q

What is the preferred volatile anaesthetic agent in emergency cases?

A

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

42
Q

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

A

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

43
Q

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

A

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

44
Q

What factors indicate the adequacy of fluid therapy?

A

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

45
Q

When should a patient be extubated after emergency anaesthesia?

A

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

Anaesthesia (16 decks)

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