Module 5: Office Anesthesia Emergencies Flashcards
A deficiency of oxygen in the body’s tissues and can be the end result of significant cardio respiratory complications
Hypoxia
Hypoxia can ultimately result in
Cardiac dysrhythmias, cardiac arrest, neurologic or brain damage, ultimately death
Complete or partial obstruction of the airway during anesthesia is most often due to posterior positioning of what?
Tongue in the oropharynx
What are the signs of airway obstruction?
Choking, gagging, Supra stern also notch retraction, labored breathing, rapid pulse then decreased pulse, respiratory arrest, and cardiac arrest
A. 100% oxygen via nasal mask
B. Place the patient in a Trendelenburg position and pack off the surgical site
C. Digital traction of the tongue with gauze, tongue forceps, a hemostat or tongue suture
D. Suction the oropharynx
Early treatment of airway obstruction
A. A nasopharyngeal airway can be utilized in a conscious or semiconscious patient
B. In an unconscious patient an oropharyngeal airway can be used
C. Consider using an LMA, igel, or other supraglottic airway
D. Endotracheal intubation
Treatment if the tongue continues to fall backward in the throat and occlude the airway
The quickest, easiest surgical airway is what?
Cricothyrotomy
A surgical airway below the level of the larynx into the trachea
Tracheostomy
- Cleanse the overlying skin
- Locate the cricothyroid membrane by palpation
- Utilize the emergency cricothyrotomy needle or a large gauge to enter the trachea beneath the vocal cords through the cricothyroid membrane
- Attach the tube of the cricothyrotomy device to an oxygen source such as an anesthesia machine or Ambu bag and ventilate with 100% oxygen
How to perform a cricothyrotomy
Foreign bodies include
Partial dentures, surgical packs, teeth
Prevention of airway obstruction includes
Preoperative removal of foreign bodies, effective placement of packs, adequate suctioning, good visualization of the field
- Digital removal of the foreign body only if it can be well visualized
- Chest compressions if no airflow during ventilation with the patient in the supine position. The Heimlich maneuver can be used if the patient is upright.
- Direct laryngoscopy for visualization and retrieval of the foreign body with forceps and/or suction
- If the foreign body cannot be removed and severe obstruction persists, a cricothyrotomy may become necessary
Treatment of a foreign body
Why are chest compressions preferred over abdominal thrusts when there is a foreign body?
More pressure is developed inside the chest for expelling the foreign body and there is a less chance that the sharp pointed tip at the lower end of the sternum will puncture an internal organ
A protective reflex of the vocal cords that attempts to prevent passage of foreign matter into the larynx, trachea, and lungs
Laryngospasm
Crowing sounds and labored respiratory efforts are typical of?
Partial airway obstruction
A complete laryngospasm is characterized by what?
Cessation of crowing sounds, Suprasternal retraction, and paradoxical chest movements
What is the prevention of a laryngospasm?
Proper pack placement, changing packs when necessary, adequate suctioning, control of secretions, adequate anesthesia levels
- Administer 100% oxygen via nasal hood
- Establish proper head position to maintain/establish airway
- Pack off surgical site
- Suction of oral cavity and oropharynx with tonsil suction tip
- Positive pressure, 100% oxygen via bag/mask system
- Administer Succinylcholine 10-20mg IV support ventilation manually until the effects and drug have dissipated and strong spontaneous respiration has resumed
Treatment of a laryngospasm
Succinylcholine may precipitate in what?
Malignant hyperthermia
In children what should be administers with succinylcholine to prevent bradycardia and life-threatening dysrhythmias?
Atropine
A generalized contraction of the smooth muscles of the small bronchi and bronchioles in the lungs, resulting in a restriction of the flow of air to and from the lungs
Bronchospasm
During a bronchospasm the patient has more difficulty with what?
Expiration than with inspiration
- 100% oxygen via bag/mask
- Albuterol inhalation 4-8 puffs via inhaler every 20 minutes for up to 4 hours, then every 1-4 hours as needed
- Ipratropium bromide 2 puffs stat; repeat every 4 hours
- Epinephrine injection
- Intubation/ventilation
- Steroid injection such as Decadron 4-6mg IV or hydrocortisone 100 mg IV
- Diphenhydramine 50 mg IV
- Aminophylline is no longer considered a first-time drug
- If not completely responded to steps 1-6, EMS should be activated
Treatment of a bronchospasm
What are the two types of epinephrine injections to use for a bronchospasm?
- 0.5 mL of 1:1000 solution IM or sublingual if anaphylaxis is suspected and/or hypotension present
- IV epi: 3-5 mL of 1:10,000 solution slowly in small increments (severe bronchospasm only with hypotension present)
Aspiration occurs when?
Contents of the stomach enter the lungs secondary to emesis or when a foreign body or fluid inadvertently enters the lungs from the oral pharyngeal cavity through the larynx
Solid foods should not be eaten for how many hours before surgery?
6 hours
Clear liquids can be consumed how many hours before surgery?
2 hours
What is the normal gastric emptying time?
30-90 minutes
- Activate EMS, protect the integrity of the IV
- 100% oxygen via bag/mask
- Turn patient on right side with head down
- Tonsil suction of the oral cavity/oropharynx
- Removal of visible foreign bodies with a laryngoscope and Magill forceps
- Intubation with suction via a suction catheter
- Transport to an acute care facility
Treatment of emesis with aspiration
Hyperventilation occurs when?
The patient is breathing at a rate faster than their normal breathing pattern or breathing more deeply than the body requires
What is hyperventilation triggered by?
A change in the body’s balance of oxygen and carbon dioxide
Hyperventilation may be caused by?
Anxiety, apprehension, fear, pain, overdosing on certain medications
- Terminate treatment and remove foreign bodies from mouth and remove surgical instruments from view
- Maintain the airway
- Verbally try to calm the patient
- Monitor vital signs
- Do NOT give oxygen
- Have a patient breathe into a bag to recapture exhaled carbon dioxide
Treatment of early hyperventilation
- If a non-sedated patient fails to respond, administer IV midazolam, diazepam, propofol, etc.
- Continue to monitor vital signs
- Discontinue rebreathing bag as breathing returns to normal
- Activate EMS if condition deteriorates
Treatment of advanced hyperventilation
What drug reverses narcotics?
Naloxone (Narcan)
What drug reverses benzodiazepines?
Flumazenil (Romazicon)
What is an anesthetic drug that cannot be reversed?
Propofol
