Module 5: Office Anesthesia Emergencies

Question 1

A deficiency of oxygen in the body’s tissues and can be the end result of significant cardio respiratory complications

Answer 1

Hypoxia

Question 2

Hypoxia can ultimately result in

Answer 2

Cardiac dysrhythmias, cardiac arrest, neurologic or brain damage, ultimately death

Question 3

Complete or partial obstruction of the airway during anesthesia is most often due to posterior positioning of what?

Answer 3

Tongue in the oropharynx

Question 4

What are the signs of airway obstruction?

Answer 4

Choking, gagging, Supra stern also notch retraction, labored breathing, rapid pulse then decreased pulse, respiratory arrest, and cardiac arrest

Question 5

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

Answer 5

Early treatment of airway obstruction

Question 6

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

Answer 6

Treatment if the tongue continues to fall backward in the throat and occlude the airway

Question 7

The quickest, easiest surgical airway is what?

Answer 7

Cricothyrotomy

Question 8

A surgical airway below the level of the larynx into the trachea

Answer 8

Tracheostomy

Question 9

1. Cleanse the overlying skin
2. Locate the cricothyroid membrane by palpation
3. Utilize the emergency cricothyrotomy needle or a large gauge to enter the trachea beneath the vocal cords through the cricothyroid membrane
4. Attach the tube of the cricothyrotomy device to an oxygen source such as an anesthesia machine or Ambu bag and ventilate with 100% oxygen

Answer 9

How to perform a cricothyrotomy

Question 10

Foreign bodies include

Answer 10

Partial dentures, surgical packs, teeth

Question 11

Prevention of airway obstruction includes

Answer 11

Preoperative removal of foreign bodies, effective placement of packs, adequate suctioning, good visualization of the field

Question 12

1. Digital removal of the foreign body only if it can be well visualized
2. 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.
3. Direct laryngoscopy for visualization and retrieval of the foreign body with forceps and/or suction
4. If the foreign body cannot be removed and severe obstruction persists, a cricothyrotomy may become necessary

Answer 12

Treatment of a foreign body

Question 13

Why are chest compressions preferred over abdominal thrusts when there is a foreign body?

Answer 13

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

Question 14

A protective reflex of the vocal cords that attempts to prevent passage of foreign matter into the larynx, trachea, and lungs

Answer 14

Laryngospasm

Question 15

Crowing sounds and labored respiratory efforts are typical of?

Answer 15

Partial airway obstruction

Question 16

A complete laryngospasm is characterized by what?

Answer 16

Cessation of crowing sounds, Suprasternal retraction, and paradoxical chest movements

Question 17

What is the prevention of a laryngospasm?

Answer 17

Proper pack placement, changing packs when necessary, adequate suctioning, control of secretions, adequate anesthesia levels

Question 18

1. Administer 100% oxygen via nasal hood
2. Establish proper head position to maintain/establish airway
3. Pack off surgical site
4. Suction of oral cavity and oropharynx with tonsil suction tip
5. Positive pressure, 100% oxygen via bag/mask system
6. Administer Succinylcholine 10-20mg IV support ventilation manually until the effects and drug have dissipated and strong spontaneous respiration has resumed

Answer 18

Treatment of a laryngospasm

Question 19

Succinylcholine may precipitate in what?

Answer 19

Malignant hyperthermia

Question 20

In children what should be administers with succinylcholine to prevent bradycardia and life-threatening dysrhythmias?

Answer 20

Atropine

Question 21

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

Answer 21

Bronchospasm

Question 22

During a bronchospasm the patient has more difficulty with what?

Answer 22

Expiration than with inspiration

Question 23

1. 100% oxygen via bag/mask
2. Albuterol inhalation 4-8 puffs via inhaler every 20 minutes for up to 4 hours, then every 1-4 hours as needed
3. Ipratropium bromide 2 puffs stat; repeat every 4 hours
4. Epinephrine injection
5. Intubation/ventilation
6. Steroid injection such as Decadron 4-6mg IV or hydrocortisone 100 mg IV
7. Diphenhydramine 50 mg IV
8. Aminophylline is no longer considered a first-time drug
9. If not completely responded to steps 1-6, EMS should be activated

Answer 23

Treatment of a bronchospasm

Question 24

What are the two types of epinephrine injections to use for a bronchospasm?

Answer 24

1. 0.5 mL of 1:1000 solution IM or sublingual if anaphylaxis is suspected and/or hypotension present
2. IV epi: 3-5 mL of 1:10,000 solution slowly in small increments (severe bronchospasm only with hypotension present)

Question 25

Aspiration occurs when?

Answer 25

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

Question 26

Solid foods should not be eaten for how many hours before surgery?

Answer 26

6 hours

Question 27

Clear liquids can be consumed how many hours before surgery?

Answer 27

2 hours

Question 28

What is the normal gastric emptying time?

Answer 28

30-90 minutes

Question 29

1. Activate EMS, protect the integrity of the IV
2. 100% oxygen via bag/mask
3. Turn patient on right side with head down
4. Tonsil suction of the oral cavity/oropharynx
5. Removal of visible foreign bodies with a laryngoscope and Magill forceps
6. Intubation with suction via a suction catheter
7. Transport to an acute care facility

Answer 29

Treatment of emesis with aspiration

Question 30

Hyperventilation occurs when?

Answer 30

The patient is breathing at a rate faster than their normal breathing pattern or breathing more deeply than the body requires

Question 31

What is hyperventilation triggered by?

Answer 31

A change in the body’s balance of oxygen and carbon dioxide

Question 32

Hyperventilation may be caused by?

Answer 32

Anxiety, apprehension, fear, pain, overdosing on certain medications

Question 33

1. Terminate treatment and remove foreign bodies from mouth and remove surgical instruments from view
2. Maintain the airway
3. Verbally try to calm the patient
4. Monitor vital signs
5. Do NOT give oxygen
6. Have a patient breathe into a bag to recapture exhaled carbon dioxide

Answer 33

Treatment of early hyperventilation

Question 34

1. If a non-sedated patient fails to respond, administer IV midazolam, diazepam, propofol, etc.
2. Continue to monitor vital signs
3. Discontinue rebreathing bag as breathing returns to normal
4. Activate EMS if condition deteriorates

Answer 34

Treatment of advanced hyperventilation

Question 35

What drug reverses narcotics?

Answer 35

Naloxone (Narcan)

Question 36

What drug reverses benzodiazepines?

Answer 36

Flumazenil (Romazicon)

Question 37

What is an anesthetic drug that cannot be reversed?

Answer 37

Propofol