Mod 9C- CONDUCT OF EMERGENCY ANAESTHESIOLOGY

Question 1

What must be considered when thinking of choice of agents?

Answer 1

Risk of haemodynamic instability

Use of cardiac stable drugs

Trauma patients are at high risk of awareness due to hypotension

Question 2

Which agents are used for cardiac stability

Answer 2

Etomidate and ketamine

Volatile: SEVO, iso, des

Question 3

What forms part of intra-operative management in emergency patients

Answer 3

monitoring: central/arterial lines

Ongoing resus

Regular ABG

Blood transfusion: transfusion triggers, haemoconcentration, blood products

Question 4

What must one be careful for in the setting of emergency when dealing with emergence and extubation

Answer 4

Risk of aspiration still present at emergence.

Extubate only when protective reflexes have returned

Patient in left lateral/upright position

Question 5

What forms part of post-operative management for emergency surgeries

Answer 5

Ongoing resus: fluids, blood products, repeat investigations, analgesia

placement in ward, ICU, High care

Question 6

Who needs ICU placement

Answer 6

Prolonged shock, any cause
Massive sepsis
IHD
Extreme obesity
Overt gastric acid aspiration
Pulmonary disease
Requiring inotropes
Hypothermia (<34)
Intra-abdominal packs
Resp failure
Renal failure

Question 7

What are some specific emergency/trauma issues that might make anesthesiology difficult

Answer 7

Airway + C-spine problems

Full stomach

Decreased LOC + traumatic brain injury

Blunt chest + abdo trauma

Long bone and pelvic fractures

Hypothermia

Intoxication

Question 8

What forms part of assessment of the patient

Answer 8

team approach

ATLS guidelines