gasnotes - anaesthetic emergencies Flashcards
What is anaphylaxis?
An IgE-mediated hypersensitivity reaction characterised by massive histamine release from mast cells
Anaphylaxis can lead to life-threatening distributive shock and airway oedema.
What are the main symptoms of anaphylaxis?
Life-threatening distributive shock, airway oedema, gastrointestinal upset, rash
Symptoms may vary between patients.
What are the common causes of anaphylaxis in anaesthesia?
Muscle relaxants, sugammadex, antibiotics
These agents are significant culprits in anaphylactic reactions during anaesthesia.
Why is constant vigilance required in anaesthetised patients?
Sleeping patients can’t tell you that they feel sick
This necessitates monitoring for signs of anaphylaxis.
List some signs to monitor for anaphylaxis in patients.
- Unexplained hypotension and tachycardia
- Rising ventilator pressures
- A rash (rarely witnessed)
- Bronchospasm
These signs can indicate an anaphylactic reaction.
What is the first step in managing anaphylaxis according to the key points?
Call for help early
Early intervention is crucial in managing anaphylaxis.
What should be done after calling for help in anaphylaxis management?
Cease infusion of the offending agent
Stopping the trigger is essential to prevent further reaction.
What medication should be administered intramuscularly in anaphylaxis?
Adrenaline 💉
Adrenaline is the primary treatment for anaphylaxis.
What fluid management step should be taken in anaphylaxis?
Rapidly infuse IV fluids
IV fluids help to manage hypotension and shock.
What should be initiated if the patient arrests during anaphylaxis?
Start CPR
CPR is critical in cases of cardiac arrest.
Fill in the blank: The main culprits of anaphylaxis in anaesthesia include muscle relaxants, sugammadex, and _______.
[antibiotics]
ANZCOR guidelines for anaphylaxis
What are the signs that a patient is losing blood, in rough order of reliability?
- You can see lots of blood
- Drains
- Surgical field
- The floor
- Tachycardia
- Tachypnoea
- Narrow pulse pressure
- Hypotension
- Oliguria
These signs help in assessing blood loss during surgery.
Where can blood hide from the surgical team during an operation?
- Pelvis
- Long bones
- Mesothelial cavities
- Retroperitoneal space
Blood may not always be visible and can accumulate in various body spaces.
What are the general aims of haemorrhage management?
- Stop the bleeding
- Replace the missing volume
- Maintain normal blood composition
- Clotting factors
- Biochemistry
- Acid-base balance
These aims guide the approach to managing haemorrhage effectively.
What is the first step you should take when managing a patient with haemorrhage in an OSCE?
Call for assistance
Seeking help is critical in managing severe haemorrhage.
Why is it important to ensure a patient can breathe before transfusing?
There’s no use in transfusing a patient who cannot breathe
Prioritizing airway management is crucial before any transfusion.
What type of IV cannula should be inserted for a patient with haemorrhage?
Wide-bore IV cannula
A wide-bore cannula facilitates rapid fluid resuscitation.
What type of fluid should be used to temporise the situation in a haemorrhage?
Crystalloid
Crystalloid solutions are typically used for volume expansion in emergency settings.
What protocol should be activated in cases of massive haemorrhage?
Massive transfusion protocol
This protocol ensures rapid access to blood products during severe bleeding.
What type of blood should be transfused first in an emergency?
O-negative blood
O-negative blood is universal and can be safely transfused in emergencies.
What additional blood products might be considered in haemorrhage management?
- Platelets
- Fresh frozen plasma
These products help restore coagulation factors and improve patient outcomes.
What is laryngospasm?
A life-threatening contraction of the laryngeal muscles that causes complete (or near-complete) airway obstruction.
Laryngospasm can be triggered by various stimuli, including irritation of the larynx.
What triggers laryngospasm?
Stimulation of the larynx without sufficient ablation of the airway reflexes.
Common triggers include actions like wiggling the LMA.
Who is more likely to experience laryngospasm, children or adults?
Children.
Children are more prone to laryngospasm, especially when infected with a respiratory virus.
What should never be attempted during laryngospasm?
Inserting an endotracheal tube through closed vocal cords.
The vocal cords are fragile, and attempting to insert a tube can cause injury.
What is the first recommended action to take when laryngospasm occurs?
Deepen the anaesthetic.
Deepening the anaesthetic can help relax the laryngeal muscles.
What should be administered to the patient during laryngospasm?
100% oxygen.
Ventilating with 100% oxygen is crucial to ensure adequate oxygenation.
What should be adjusted to help with laryngospasm?
Turn up the pressure.
Increasing the pressure can assist in overcoming the obstruction.
What medication should be considered during laryngospasm?
Paralyse the patient.
Paralysis may be necessary to manage the airway safely.
What is malignant hyperthermia (MH)?
An inherited disorder of sarcoplasmic calcium release.
MH leads to uncontrolled calcium release, causing a hyper-metabolic state.
What triggers malignant hyperthermia?
Volatile anaesthetic agents and suxamethonium.
These agents cause uncontrolled calcium release.
What is the mortality rate of untreated malignant hyperthermia?
100% mortality.
Prompt treatment is crucial to prevent fatal outcomes.
How common is malignant hyperthermia for junior doctors?
It is a once-in-a-career event.
Junior doctors are not expected to know how to manage this crisis.
What should you do when taking an anaesthetic history regarding malignant hyperthermia?
Make a point of asking about it.
This helps identify patients at risk.
What is the first step in managing a malignant hyperthermia crisis?
Cease administering the offending agent.
Stopping the trigger is critical for management.
What is the number one priority in treating malignant hyperthermia?
Administering dantrolene.
Dantrolene is the only effective drug for MH.
What should be done after administering dantrolene in a malignant hyperthermia crisis?
Active cooling with ice and chilled IV fluids.
Cooling the patient is essential to manage hyperthermia.
