Surgical Emergencies Flashcards
During the laser microlaryngoscopy there is an airway explosion and fire. The first thing to do is…
Remove the endotracheal tube in its entirety
ensuring the entire tub is removed, turn off the gasses and oxygen, pour water or saline into the airway reintubate and examine the airway. Next steps are decided upon examination.
During the laser microlaryngoscopy there is an airway explosion and fire. The first thing to do is…
Remove the endotracheal tube in its entirety
ensuring the entire tub is removed, turn off the gasses and oxygen, pour water or saline into the airway reintubate and examine the airway. Next steps are decided upon examination.
Action point
The moment when an individual recognizes that an employee may be on the path toward committing some type of violent act in the workplace and subsequently takes action to prevent it
-talk to person directly, supervisor, HR, security
Flash point
Moment when workplace violence occurs, & it’s too late for any type of prevention strategy & best avoided by implementing initiatives early, once an action point has been detected
Vasogenic shock
Resulting from anaphylaxis or sepsis
Moderate blood loss
750 mL to 1500 mL
15% to 30% of total blood volume
Crystalloids are the recommended fluid replacement 
Disseminated intravascular coagulation (DIC)
Inappropriate clotting, followed by hemorrhaging
Coagulation goes systemically instead of locally
Two causes of DIC
Systemic response
-Trauma
-Sepsis
-Obstetrics: amniotic fluid into mothers blood
Release of procoagulant into the bloodstream
-Boney tumor
DIC complications
-Severe bleeding
-stroke (clots cause most harm, in spine or kidney)
-Reduced blood flow to organs
-Overload of liver and kidneys
DIC treatment
-Correct the cause
-Treat with FFP and cryoprecipitate (replaces clotting factors)
-Heparin sometimes used in the beginning (draw PTTs, order for heparin once PTT is trending down)
-volume/blood replacement
Venous air embolism risk
-pressure in the right atrium is less than atmospheric pressure
-Neuro procedures where the patient is sitting
-hysteroscopy and TUR procedures
Arterial air embolism risk
-bypass
-Dialysis
Air embolism signs and symptoms
-Rapid onset pulmonary edema (fluid in air sacs in lungs)
-Drop in ET CO2
-Hypoxia
-Hypotension
-Arrhythmias
-Neurologic damage
Venous air embolism treatment
-first identify and occlude the sites of air entry
-Sloppy wet sponges, irrigation syringe
-Bone wax
-Discontinue nitrous oxide
-Place patient in left lateral position (Durant’s maneuver)*
-Aspirate RA (right atrium) catheter
Arterial air embolism treatment
-Deep Trendelenburg position
-Aspirate air from circuit
Cardiac arrest, medical reasons
-MI
-Arrhythmias
-Anaphylactic reaction
-Emboli
-Vagal stimulation
-Malignant hyperthermia
-Anesthesia overdose
-Hypoxia
-Laryngospasm
-Aspiration
-Hypothermia
-Electrolyte imbalance
Cardiac arrest surgical reasons
-hypovolemic shock related to blood loss (Nick something and bleeding out)
OMI (Oh my) for cardia emergencies
Oxygenation
Monitors
IV Fluids
Treatments for Vfib with inadequate heart rate/blood pressure
-CPR
-Defibrillator
-Epinephrine (for BP)
-Amiodarone (good for her myocardium, helps it contract)
Treatment for Vfib with adequate heart rate
-Epi (for blood pressure)
-Amiodarone (good for myocardium, helps it contract)
-dopamine
-ICU monitored bed
-Cardioversion, after meds and when controlled
Premature ventricular contraction (PVC)
Relatively common event where the heartbeat is initiated by the ventricles rather than by the Sino atrial (SA) node
Ventricular tachycardia
Tachycardia with beats initiated in the ventricles
Sawtooth rhythm
Ventricular fibrillation
Uncoordinated contractions of the ventricles
Quivering rhythm
Ventricular arrhythmias - Couplet
Pair of PVCs
Ventricular arrhythmias - Run
Several PVCs in a row
Think of it as unsustained Vtach
Supraventricular tachycardia (SVT)
Tachycardia caused by an electrical impulse originating above the ventricles
SVT treatment
-Vagal stim
-Adenosine: have to slam it in IV (short half-life, metabolizes fast) and causes long cardiac pause (asystole)
-sync cardioversion
Treating bradycardia
-Atropine (contraindicated for glaucoma patients, give epi instead)
-Dopamine drip
-Pacer
Pulseless electrical activity (PEA)
Dead patient
Causes are 6 Hs and 6 Ts
PEA causes (6 Hs)
-hypovolemia
-Hypoxia
-Hydrogen ions (acidosis)
-hyper/hypokalemia
-Hypoglycemia
-Hypothermia
PEA causes 6 Ts
-Toxins (drug overdose)
-Tamponade, cardiac
-Tension pneumothorax
-Thrombosis (MI/PE)
-Tachycardia
-Trauma
Treatment for PEA
CPR
Treat the underlying cause
PH normal value
7.35-7.45
pO2 normal value
80-100
pCO2 normal value
35-45
Respiratory acid
Leaves through lungs
HCO3 normal value
22-26
Metabolic base
Leaves through kidneys
Respiratory acidosis caused by
decrease ventilation
Treat with ventilation
Respiratory alkalosis cause by
hyperventilation
Treat with sedation or decreased ventilation
Metabolic acidosis caused by
Excess production of metabolic acids (lactic acid from ischemic tissue)
-cardiac arrest
-Sepsis
-Ketoacidosis
-Renal failure
Treat with bicarb (make my liver)
Metabolic alkalosis caused by
Acid loss
-Upper GI loss, vomiting
-diuretics (potassium loss= hydrogen ion loss)
-Over administration of alkali
Treat the cause
Compensated ABG
PH= within normal limits
CO2 and HCO3= not within normal limits
Partially compensated ABG
PH, CO2 and HCO3= not within normal limits
Uncompensated ABG
PH= not WNL
CO2 and HCO3= 1 not WNL and 1 WNL
The perioperative nurse would expect labs for the patient with the DIC to look like
Prolonged PT/PTT
Low fibrinogen and low platelets (using them up)
Diagnostic peritoneal lavage (DPL)
-For hemodynamically unstable or uncooperative (intoxicated) pts
-indicated for hypotension and LUQ pain to determine intraabdominal bleeding
-done with local, infra/supraumbilical incision
-blood maybe present, if not use NS/LR 10mL/kg to instill into abdomen
-fluid then sent to lab for evaluation
Focused assessment with sonography in trauma (FAST)
-reveals fluid in the chest or abdomen
-Portable, noninvasive scan
-Performed on chest, pelvis, and all for quadrant of the abdomen
-Ideal for pregnant trauma patients
-Cannot evaluate organs
Glasgow coma scale (GCS)
Used to assess level of brain injury
-3 indicators: eye-opening, verbal communication, noxious stimuli
-Best score: 15
-Worst score: 3
Hemorrhage class one
<15%
Less than 750 mL
Hemorrhage class two
Mild
15-30%
750 -1500 mL
Hemorrhage class three
Moderate
30-40%
1500 -2000 mL
Hemorrhage class four
Severe
>40%
Greater than 2000 mL
