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Anaesthetic emergencies Flashcards

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1
Q

What is this an chart of?

A

CPR Emergency Drugs + Doses

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2
Q

What is this a flow diagram of?

A

Post-Cardiac Arrest Care

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3
Q

What is this a flow diagram of?

A

CPR Algorithm

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4
Q

What is happening in this photo?

A

IPPV

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5
Q

What is this Capnograph showing?

A
  • A patient that is tachypnoeic
  • Resulting in low ETCO2
  • Re-breathing of expired CO2
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6
Q

What is this obese patient unable to achieve, based on this Capnograph?

A
  • Adequate Tidal Volume
  • Due to inadequate Alevolar plateau
  • Due to rapid RR + low TV
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7
Q

(Those that live to discharge)

Statistically, what is the overall survival rate for veterinary patients, following CPR?

A

Approx 10%

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8
Q

True or False.

You can get DNR orders for patients.

A

True

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9
Q

A patient that is otherwise healthy + arrests under GA, has a better chance of surviving to discharge following CPR.

What is this statistic?

A

47%

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10
Q

List 3 common causes of Cardiac Arrest

A
  1. Cardiovascular disease
  2. Anaesthetic overdose
  3. Other systemic diseases
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11
Q

List 6 signs of Cardiac Arrest

A
  1. No heartbeat ausculated, palpated or seen on ECG or Ultrasound
  2. No palpable Arterial pulse
  3. Widely, dilated Pupils - with no PLR
  4. Respiration absent - except for Cheyne-Stokes
  5. Grey or cyanotic MM’s
  6. Prolonged CRT

PLR = Pupil Light Response

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12
Q

List the 7 steps to address Cardiac Arrest/CPR

A
  1. Shout for help
  2. Place into Right lateral recumbency
  3. Check airway for patency + intubate at 100% O2
  4. Begin CPR compressions
    * Heal of hand over 5th intercostal space
    * Compress chest by 1/3-1/2 width of chest
    * Small dogs + cats = use thumb + fingers
    * Large dogs, over 20kg = use thoracic pump (R-lateral recumbency + compress widest point of ribs)
    * Aim for 100 compressions p/min
    * 60 - 120 times p/min
    * 2 min cycles
    * 5 compressions : 1 ventilation (If w/partner)
    * 15 compressions : 3 ventilations (if single)
  5. Check for a pulse, after each 2 min cycle
  6. Continue until spontaenous return of pulse + breathing occurs
  7. 15-20 mins gives a good outcome, if can manage
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13
Q

What 3 alternative + complimentary options can you provide to assist during CPR, under the direction of a VS?

A
  1. Admin Adrenaline, as per VS instructions
  2. Use Defibrillator
  3. Cardiac massage, per VS
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14
Q

List 7 potential causes of Human error, that can lead to Anaesthetic Emergencies

A
  1. Fatigue
  2. Failure to follow SOP (Inadequate history taking + pre-op assessment)
  3. Personal (Pre-occupied, in a rush)
  4. Inattentiveness
  5. Lack of familiarity (W/circuit or drugs)
  6. Incorrect calculation
  7. Incorrect admin of drugs
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15
Q

List the 6 pieces of Equipment that can fail during anaesthesia, causing fatal anaesthetic emergencies

A
  1. Vapouriser issues
  2. Malfunction of anaesthetic machine
  3. Defective APL valve
  4. ET problems
  5. Empty O2 cylinder
  6. Exhausted CO2 absorber
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16
Q

True or False.

ACP can’t be used in Hypovolaemic patients.

A

True

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17
Q

What can high volumes of volatile agents cause an anesthetic emergency?

A
  • Cardio Respiratory Depression > eventually leading to death
  • Due to its Cardiorespiratory depressant affects
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18
Q

Can out-of-date + poorly stored drugs lead to anaesthetic emergencies?

A

Yes

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19
Q

True or False.

ACP + Butorphanol will reduce the amount of induction + maintenance agents required.

A

True!

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20
Q

List 12 potential patient factors that can lead to an anaesthetic emergency

A
  1. Obesity
  2. Brachycephalic breeds
  3. Respiratory disease
  4. CVS disease
  5. Neonatal patients
  6. Geriatric patients
  7. Pregnancy
  8. Casarean sections
  9. Sighthounds w/low body fat
  10. Renal disease
  11. Hepatic disease
  12. Shock
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21
Q

If in doubt…?

A

Shout!

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22
Q

Where should emergency drug dosage sheets for crash boxes?

A
  1. Theatre
  2. Recovery rooms
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23
Q

List the 9 drugs that should be kept in the Crash kit

A
  1. Atropine
  2. Adrenaline
  3. Lignocaine
  4. Diazepam
  5. Naloxone (Narcan)
  6. Dopamine (Dobutamine)
  7. Doxapram (Dopram)
  8. Atipamezole
  9. Sodium bicarbonate
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24
Q

When should Atropine be used in Anaesthetic Emergencies?

A
  • Bradycardia
  • As it reduces Vagal tone (PNS)
  • An Anticholinergic
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25
When should **Adrenaline** be used in Anaesthetic Emergencies?
1. Bradycardia 2. Cardiac arrest * Inc the **HR + force of contractions**
26
When should **Lignocaine** be used in Anaesthetic Emergencies?
Arrythmias
27
When should **Diazepam** be used in Anaesthetic Emergencies?
Seizures
28
When should **Naloxone** be used in Anaesthetic Emergencies?
Opioid overdose
29
When should **Dopamine** be used in Anaesthetic Emergencies?
Increase force of Myocardial contractions
30
When should **Doxapram** be used in Anaesthetic Emergencies?
Analeptic drug (Resp + CNS stimulant)
31
When should **Atipamezole** be used in Anaesthetic Emergencies?
Reverse or **partially** reverse Medetomidine
32
When should **Sodium bicarbonate** be used in Anaesthetic Emergencies?
Metabolic Acidosis (D+ + Renal failure)
33
What rate should you provide **Atropine** via **IV** or **down the ET tube**, during Anaesthetic Emergencies?
1. **IV** = 0.0**4** mg/kg 2. **Down ET tube** = 0.0**8** mg/kg
34
What rate should you provide **Adrenaline** via **IV** or **down the ET tube**, during Anaesthetic Emergencies?
1. **IV** = 0.**1** mg/kg (high dose) 2. Down **ET tube** = 0.**2** mg/kg
35
What rate should you provide **Lignocaine** via **IV** or **down the ET tube**, during Anaesthetic Emergencies?
1. **IV** = **2** mg/kg 2. Down **ET tube** = **4** mg/kg
36
What rate should you provide **Diazepam** via **IV**, during Anaesthetic Emergencies?
**IV** = 0.**2** - 0.**5** mg/kg
37
What rate should you provide **Naloxone** via **IV**, during Anaesthetic Emergencies?
**IV** = 0.0**1** - 0.0**2** mg/kg
38
How should you **administer Dopamine** during Anaesthetic Emergencies?
Infusion
39
What rate should you provide **Doxapram** via **IV**, during Anaesthetic Emergencies?
**IV** = **5** - **10** mg/kg
40
List **4** pieces of **Crash Kit** equipment, that can be used in an Emergency
1. **Ambu bag** 2. Defribilator 3. **Urinary catheter** 4. IV catheter
41
What is this?
* **Ambu** bag * A ***self-inflating*** resus bag
42
What is this? & When can this be used?
1. Defibrilator 2. Cardiac Arrest
43
What 2 pieces of equipment can you attach an **Ambu** bag to?
1. Mask 2. ET tube
44
When do you use an Ambu bag?
1. Respiratory Arrest 2. To provide to **IPPV**
45
**Why** is a **Defibrilator** useful for patients in Cardiac Arrest?
1. **Stimulates heart beats + Myocardial contractions** 2. By providing an **electrical charge** to the **cardiac muscle** 3. **Simulating** contractions
46
True or False. Defilbrilators may be used in certain **Arrhythmias**, but an **ECG** must be used.
True
47
What does an **IV catheter** provide during an anaesthetic emergency?
Access to provide: 1. Drugs 2. **Fluids** 3. Blood
48
What does an **Urinary catheter** provide during an anaesthetic emergency?
* Used to **administer** drugs v**ia ET tubes** * Such as ***Adrenaline*** + ***Atropine***
49
List **4** potential Anaesthetic problems
1. Patient is **too light** 2. Patient is **too deep** 3. Respiratory arrest 4. Cardiac Arrest
50
Name **6** reasons to why the patient may become **too light**, under anaesthetic
1. **Vapouriser** is ***off*** or ***empty*** 2. **ET tube** is ***too small***, ***un-inflated cuff***, ***blocked*** or ***misplaced*** 3. Breath holding 4. **Shallow** respiration 5. **Inadequate flow rates** 6. Circuit/machine **malfunction**
51
Name **2** reasons to why the patient may become **too deep**, under anaesthetic
1. **Vapouriser** set **too high** (*most common*) 2. **Presence** of **pre-existing problem** (*Shock, anaemia*)
52
What steps should you take, if the patient has gone **too deep** under anaesethetic?
1. **Shout** for help 2. **Turn down** the **vapouriser** 3. Initiate **IPPV** 4. Provide **supportive treatment** (***IV fluids**, warmth, **antagonists**, emergency drugs; Naloxone, Dopram, **Antisedan***)
53
List **4 signs** of recovery, from a patient that has gone **too deep** under anaesthesia
1. **Inc**reased **HR** 2. **Stronger** **pulse** 3. **Improved MM** colour 4. Improved **CRT** time
54
What 2 main **reflexes** should you monitor for patients with **Induction Apnoea**?
1. **Eye** position 2. **Palpebral** reflex
55
True or False. Induction apnoea will require **IPPV** for a short period.
True
56
# 5 .. What should you do if a patient goes into **Induction Apnoea**?
1. Assess **eye position + palpebral reflex** 2. Intiate **IPPV** 3. **Assess depth** of ana, again 4. **Reduce vapouriser %** or just give **100% O2** only 5. Proceed w/**caution**
57
True or False. True Respiratory Arrest can be fatal.
True
58
Name **4** potential causes of **Respiratory Arrest** occur?
1. **Anaesthetic overdose** 2. **Lack** of **O2** (Cylinder failure or circuit error) 3. **Pre-existing** respiratory **disease or injury** 4. **Side effects** of **pre-meds** or **induction agents**
59
# 3 - 8.. List the signs of Respiratory Arrest
1. **Dyspnoea** ***before*** **Arrest** 2. **Cyanosis** 3. **Abnormal**: * HR * RR * CRT * Pulse * **Pupil dilation**
60
What are the **5 steps** you should take when a patient goes into **Respiratory Arrest**
1. Inform VS 2. **Intubate** (if not already) 3. **Turn off vapouriser** 4. Commence **IPPV** 5. **Check heart** - to ***ensure no cardiac arrest***
61
# 9 steps... **How** do you provide **IPPV**?
1. **Close** or ***partially close*** **APL valve** 2. **Fill** reservoir **bag** w/**O2** 3. **Gently squeeze** bag, **until** patient's **chest rises**, **slightly** 4. **Open** APL **valve** 5. **Repeat Q6 secs** **until** **signs** of **recovery** occur 6. **Continue IPPV** until vital signs **improve** 7. **Cease** for **30 secs** 8. **Watch** for **spontaneous breathing** 9. If **not** - **continue** bagging
62
What is happening here?
A Cat may be in Respiratory Arrest and a Ambu bag is being used to provide O2 + support
63
What type of compression is being provided here?
**Cardiac** pump compression technique
64
What type of compression is being provided here?
**Thoracic** pump compression technique
65
What is this?
Crash cart!
66
What is this showing?
**Posterior paddle assembly** of the defibrilator
67

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