Emergency Situation

Question 1

Priorities

Answer 1

. Airway
. Restore respiratory status
. Cardiovascular status
maintained or restored
. Hemostasis provided

Question 2

Order of Treatment

Answer 2

. Chest injuries
. Shock
. Wound protection/closure
. Fractures
. Vital sign monitoring
. Provision of reassurance and comfort for the patient

Question 3

Warning signs of impending
cardiac arrest

Answer 3

– Chest pain
– Unstable BP
– Tachycardia
– Cardiac Dysrhythmias
– Respiratory Changes
– Hypovolemia
– Laryngospasm

Question 4

Roles during cardiac arrest surgical setting; well defined by facility policy

Answer 4

. STSR role is to protect the
sterile field
. May be required to assist
. Anesthesiologist will manage
the code
. Circulator will provide support

Question 5

Malignant Hyperthermia

Answer 5

. Life-threatening
. Develops during or after anesthesia
– Rapid increase in body temperature
– Unexplained tachycardia
– Unstable blood pressure
– Muscle rigidity
– Tachypnea
– Cyanosis
. Usually triggered by an anesthetic agent (Halothane) and
muscle relaxant (Succinylcholine)
. Predisposition cannot be absolutely determined
. Family history of muscle disorders may indicate
predisposition
. May be diagnosed with a muscle biopsy taken under a local anesthetic

Question 6

Malignant
Hyperthermia Treatment

Answer 6

. Stop administration of triggering anesthetic
. Deepen anesthesia
– Opioids, Barbiturates, Propofol
. Follow hospital protocol
. Packing the patient in ice
. Circulating ice water through nasogastric
tube
. Irrigation of the open cavity with chilled
irrigation
. Dantrolene, steroids, and diuretics
. Adjust ventilation to compensate for
increased CO2
. Administer 100% oxygen

Question 7

Disseminated Intravascular Coagulation

Answer 7

. Blood begins to coagulate within the body
. Generalized activation of clotting mechanism which leads
to consumption of the coagulation factors.
. Treatment is by transfusion of fresh frozen plasma

Question 8

Seizures

Answer 8

. Disturbance in CNS function – Abnormal electrical activity
within the brain
. Types of seizures:
– Gran mal
– Petit mal
– Psychomotor
– Focal
. Treatment of seizures:
– Protect the patient from injury
– Maintain airway
– Anti convulsive drugs

Question 9

Anaphylactic Reactions

Answer 9

. Allergic reaction to a substance or protein
. Common causes:
– Local anesthetics
– Codeine
– Antibiotics
– Animal derived drugs:
. Insulin
. Contrast media
– Latex

Question 10

Anaphylactic Shock

Answer 10

. Signs:
– Itching
– Swelling
– Difficulty breathing
– Hypotension
– Tachycardia
– Diminished urine
output
– Death

. Treatment:
– Maintain airway
– Provide oxygen
– Treat for shock
– Epinephrine
– Steroids
– IV fluids and plasma
– Levophed