Intraoperative Emergencies

Question 1

DX VAE

Answer 1

hypotension, hypotension, decreased ETCO2
high level of suspicion - crani, uterine, bladder perf
precordial doppler - roaring
esophageal steth - windmill
TEE - air

Question 2

TX VAE

Answer 2

100% FiO2
bone wax
saline on surgical field
aspirate CVL
gentle compression IJV
left lateral decubitus
supportive including increased CVP

Question 3

TX pHTN

Answer 3

• normothermia
• correct acidosis, hypoxia, hypercarbia
• decreased oxygen consumption > paralyze
• decreased catecholamines > sedate
  UNSUCCESSFUL
• pulmonary vasodilators - nitric, PGE1, nitrates
  UNSUCESSFUL
• ECMO

Question 4

Laryngospasm

Answer 4

call for help
FiO2 100%
place oral airway
larsons maneuver
PPV with facemask
deepen aneshtesia
sux if cant break

Question 5

Complications of jet vent

Answer 5

subcutaneous emphysema
barotrauma
air trapping
pneumomediastinum
aspiration of resected debris
gastric distension

Question 6

treat MH

Answer 6

2.5 mg/kg dantrolene till ETCO2 decrease or temp stops rising
1 mg/kg dantrolene gtt
stop sux and volaties
hyperventilate
cool
UOP with IVF, lasix, mannitol
treate hyppK
treat acidos
treat rhabdo
prepare for dysrhtymias - lidocaine
MONITOR FO 72 hours

Question 7

Intraoperative Cooling

Answer 7

cool IVF
cool OR
forced air to ambient temp setting
pack ice at neck, axilla, groin
cool lavage bladder, abdomen etc
cold peritoneal dialysis
CPB

Question 8

low UOP at MH

Answer 8

IVF
mannitol
lasix

Question 9

code dose epi adults

Answer 9

1 mg q5 mins

Question 10

code dose amiodarone adults

Answer 10

300 mg first round + 150 mg second round

Question 11

code dose lidocaine adults

Answer 11

1-1.5 mg/kg first roung + 0.5-0.75 mg/kg

Question 12

code dose epi peds

Answer 12

0.01-0.03 mg/kg IV
0.1 mg/kg ETT

Question 13

code dose amiodarone peds

Answer 13

5 mg/kg

Question 14

code dose lidocaine peds

Answer 14

1 mg/kg

Question 15

code defib peds

Answer 15

2 J/kg first defib + 4 J/kg second defib + >4 J/kg (no higher than adult or 10 J/kg)

Question 16

SVT peds adenosine dose

Answer 16

0.1 mg/kg first dose + 0.2 mg/kg second dose

Question 17

sync cardio peds SVT

Answer 17

0.5-1 J/kg first + up to 2 Jkg second

Question 18

DDX for hypoxemia

Answer 18

MACHINE:
- O2 supply fail
- machine failure
- circuit disconnect
- low FiO2
- nitrous

ETT:
- extubated
- kinked
- clogged
- main stemmed
- broken pilot balloon

LUNGS:
- atelectasis
- pulmonary edema
- PE
- bronchspasm
- laryngospasm
- PTX, hemothorax

HEART:
- decreased CO
- MI
- sepsis
- anemia
- increased demand

TOXINS:
- CO
- MetHb
- cyanide/nitroprusside

SURGERY:
- abdomina insufflation
- compression of airway/vessels
- VAE
- AFE
- bone cement syndrome

Question 19

DDX high airway pressures

Answer 19

VENT:
inappropriate vent settings
kink in circuit
scavenger closed

ETT:
Clogged
Kinked
mainstem
FB

Lungs:
Bronchospasm
anaphylaxis
pulmonary edema
tPTX
decreased CW compliance

CARDIAC:
cardiac tamponade

ANESTHESIA:
light anesthetic depth
muscle tone

SURGERY:
abdominal insufflation
abdominal compartment syndrome
steep reverse Tberg
thoracic insufflation