Quick reference handbook Flashcards
Describe the key basic plan
OABCDE
1. Oxygenation
- Check fresh flows
- Check FiO2 set to 100% and turn flow to 15L
-Visually inspect the entire breathing system patient to ventilator
- Confirm reservoir bag is moving
- Airway
- Check position of airway device (listen for noise)
-Check capnography is compatible with a patient airway
- Confirm airway device is patient= pass suction catheter
- Consider isolating the equipment i.e. connect to self inflating bag and measure pressures - Breathing
- Look at: chest symmetry, breath sounds, sats, VT exp and ET CO2
- Feel the airway pressure using the APL
- Consider NMB to help with ventilation - Circulation
- check rate, rhythm, CRT - Check the depth of anaesthesia + NMB
- Consider surgical pathology
- Call for help
What is the key basic plan for cardiac arrest
- Confirm cardiac arrest + call for help + allocate roles: defib/ chest compressions
- Oxygenation
- Turn Fio2 to 100, flow to 15L
- Turn off all anaesthetic agents
-Manually inspect all circuits
- Ensure reservoir bag/ billows operational - Airway
- Check airway patency
- Consider passing suction catheter
- Manually check airway pressure with self inflating bag
4.Breathing
- Check ETCO2, RR, TV exp
- Clinically asses the chest wall/ auscultate the lungs
- Ensure appropriate settings chosen on ventilator/ manually ventilate patient
- Feel for airway pressures using APL - Circulation
- Establish adequate IV access/ IO access
- Follow ALS algorithm - Systemically evaluate potential cause
- If ROSC resume anaesthesia
List the common causes of cardiac arrest as per the ALS manual
4 Hs + 4Ts
Hypoxia
Hypothermia
Hypo/hyperkalaemia
Hypovolaemia
Toxins
Tamponade
Tension pneumothorax
Thrombus
List the peri-operative causes of cardiac arrest
Vegal tone
Drug error
Local anaesthetic toxicity
Acidosis
Embolism- gas/fat/amniotic
Massive blood loss
List the potential causes of intra-operative hypoxia
Airway issues
- Kinking / displacement of the endotracheal tube
- main bronchus intubation
- forign body within the ETT
- Laryngospasm
Breathing
- Bronchospasm
- Pneumothorax
- aspiraton
- pulmonary oedema
Circulation–> Those that cause shock CHOD
Cardiogenic- MI, tamponade
Hypovolaemia- massive blood loss
Obstructive- circulatory embolism
Distributive- sepsis, anaphylaxis, malignant hyperthermia crisis
List potential causes of increased airway pressures
Airway
- Forign body
- Airway kinking
- main bronchus intubation
- Laryngospasm + stridor
Breathing
- Pneumothoax
- Pulmonary oedema
- Bronchospasm
- Anaphylaxis
Circulation
- Circulator embolism
Exposure
- Surgical pneumoperitoneum
- Inadequate neuromuscular blockade
List the surgical causes of hypotension
- Decreased venous return (vena cava compression/ pneumoperitoneum)
- Blood loss
- Vegal reaction
- Embolism- (gas/fat/thrombus/cement)
List other potential causes of intraoperative hypotension
Breathing
- High intrathoracic pressures i.e. pneumothorax/ large tidal volumes
Circulation: CHOD
Cardiogenic- MI, valvular issues, tamponade
Hypovolaemia- blood loss, inadequate fluid resusitation,
Obstructive- circulatory embolism
Distributive- anaphylaxis, sepsis
Other causes:
- Local anaesthetic toxicity
- Endocrine cause i.e steroid dependency
With hypertension - what key issues should be excluded during the breathing assesment
Hypoxia and hypercapnia
List some of the potential causes of intra-operative hypertension
Pain:
- Inadequate analgesia
NMB:
- Inadequate paralysis
Medication:
- omission of usual anti-hypertensive
Surgical issues:
- Prolonged torniquet time
- Painful stimulus
Medical issues
- Bladder distension
- Renal failure
- Raised ICP (cushing’s triad)
- Seizures
- Thyrotoxicosis
- Phaeochromocytoma
Fluid issues:
- Over-administration of fluids
- Fluid overload
- TURP syndrome
List some of the potential causes of intraoperative bradycardia
Drugs:
- Remifenyl
- Digoxin
- Beta blockers
- Calcium channel blockers
Medical issues
- Hyperkalaemia
- Hypothermia
- Raised intra-cranial pressure
Ventilation issues
- Raised intrathoracic pressures
Surgical issues
- Vegal response secondary to surgical stimuli
- pneumoperitoneum
- surgical stimulus with inadequate depth
List some of the causes of intraoperative tachycardias
Surgical/ anaesthetic
- Stimulation with inadequate depth of anaesthesia
- central line/ wire displacement
- local anaesthetic toxicity
Medical
- primary medical arrhythmia
- myocardial infarction
- Electrolyte disturbance
- sepsis
- circulator embolus- gas/fat/amniotic
- Anaphylaxis
- Malignant hyperthermia crisis
List the causes of peri-operative hyperthermia
COMMON
* Excessive insulation, high ambient temperature, external warming
devices, especially infants and children (most common)
* Surgical devices, e.g. HIFU, diathermy, radiotherapy
* Prolonged epidural anaesthesia
* Sepsis (→ 3-14) e.g. during manipulation of a urological device
* Blood transfusion
* Allergic reaction / anaphylaxis (→ 3-1)
Drug induced:
* Neuroleptic malignant syndrome (e.g. haloperidol and other
antipsychotics)
* Malignant hyperthermia crisis (late sign) (→ 3-8)
* Serotonin syndrome (cocaine, amphetamine, phencyclidine, MDMA)
* Anticholinergic syndrome (tricyclic antidepressants, antipsychotics,
antihistamines)
* Sympathomimetic syndrome (cocaine, MDMA, amphetamines)
Toxic:
* Radiologic contrast neurotoxicity
* Alcohol withdrawal
Endocrine:
* Thyrotoxicosis
* Phaeochromocytoma
Neurologic:
* Meningitis
* Intracranial blood
* Hypoxic encephalopathy
* Traumatic brain injury
List the initial diagnosis of hyperthermia you should suspect in peri-operative hyperthermia
- Excessive heating (most common)
- Inadequate dissipation of metabolic heat
- Excessive heat production
- Actively maintained fever
- Actively maintained fever (typically cold peripheries, vasoconstricted) OR
- Non-febrile hyperthermia (typically warm peripheries, vasodilated)
- Suspect malignant hyperthermia crisis or neuroleptic malignant syndrome?
What are the complications of hyperthermia
- Hyperkalaemia, hypoglycaemia, acidosis
- Hypotension , malignant hypertension
- Altered conscious level, convulsions
- Coagulopathy and disseminated intravascular coagulation
