Crisis Flashcards
(36 cards)
1
Q
Bronchospasm s/s - (5)
A
- Increased peak airway pressures.
- Wheezing on lung exam.
- Increased expiratory time.
- Increased ETCO2 with upsloping ETCO2 waveform.
- Decreased tidal volumes if pressure control.
2
Q
Bronchospasm differentials (6)
A
- Right mainstem
- Kinked ETT or mucus plug
- Anaphylaxis (tachycardia, hypotension, rash)
- Pneumothorax
- Aspiration
- Laryngospasm
3
Q
Bronchospasm treatment
A
- Call for help
- 100% oxygen
- Change I:E
- Deepen anesthetic
- Rule out issues w/ETT (listen, suction)
- Give albuterol
- Epi 10 mcg
- Ketamine 0.2 - 1 mg/kg
- Hydrocort 100 mg
- Nebulized epinephrine
- R/O anaphylaxis
4
Q
Laryngospasm s/s
A
- stridor
- respiratory distress
- intercostal recession
- rapid hypoxemia
5
Q
Laryngospasm treatment
A
- Help
- 100% oxygen
- Stop stimulus
- Deepen anesthesia
- Open & Clear airway
- CPAP via bag
- Jaw Thrust or Larson’s
- Succinylcholine 0.1 mg/kg IV or 2 - 4 mg/kg IM
6
Q
Laryngospasm differential diagnoses (6)
A
- circuit obstruction
- Supraglottic/laryngeal obstruction
- RLN damage
- residual NM blockade
- tension pneumothorax
- laryngeal edema
7
Q
Aspiration s/s (5)
A
- direct visualization
- coughing/dyspnea
- laryngospasm/bronchospasm
- increased PIP
- hypoxemia
8
Q
Aspiration on Induction treatment
A
- Suction
- Turn left lateral
- Avoid Cricoid
9
Q
Aspiration on Induction Management
A
- 100% FiO2
- Empty stomach
- Cancel elective surgery
- Bronchodilators
- CXR
10
Q
Anaphylaxis S/S
A
- hypoxemia
- dyspnea, wheezing, bronchospasm
- hypotension, tachycardia
- rash
11
Q
Anaphylaxis Tx
A
- help + code cart
- stop trigger
- 100% O2
- Epi 10 - 100 mcg
- Fluid bolus
- symptom management: vaso, albuterol, benadryl (25-50 mg), methylpred (125 mg)
Labs: serum tryptase (mast cell degranulation) / plasma
histamine
12
Q
Airway fire
A
- Help
- Stop all gas flows!
- Remove ETT
- Extinguish Fire
- Suction
- Re-intubate
- Suction / PPV
13
Q
Negative Pressure Pulmonary Edema s/s
A
- Patient biting on tube
- Hypoxia
- Tachycardia
- Inspiratory Crepitations
14
Q
NPPV tx
A
- 100% Oxygen
- Raise HOB
- Lasix 50mg IV
- CPAP or PEEP 5-10cm H2O
15
Q
MH s/s early
A
- Increased ETCO2
- Tachycardia
- Tachypnea
- Mixed Acidosis
- Masseter Spasm
- Cardiac Arrest d/t hyperkalemia
16
Q
MH s/s late
A
- Hyperthermia
- Muscle Rigidity
- Myoglobinuria
- Arrhythmias
17
Q
MH tx
A
- Help! MH Cart!
- D/C Anesthetic gas!
- 100% Oxygen
- Increase Minute Ventilation
- Dantrolene 2.5mg/kg (20mg in 60mL sterile water)
- Ryanodex 2.5mg/kg (250mg in 5mL)
- max 10 mg/kg, if not resolved prob not MH
- MH Hotline: 1800-MH-HYPER
- sodium bicarb 1-2 mEQ/kg
18
Q
MH tx later
A
- Cool Patient; Stop at 38
- ABG, K+, CK, myoglobin, coags, lactate
- Acidosis—> Sodium Bicarb 1-2 mEq/kg
- Hyperkalemia—> 25g dextrose + 10U RHI
- Foley; Alkalinize urine
19
Q
MH differentials (6)
A
- Thyroid Storm
- Pheochromocytoma
- Neuroleptic Malignant Syndrome
- Serotonin Syndrome
- Hypoventilation or insufflation
- Over heating
20
Q
Aspiration differentials
A
- Breathing circuit obstruction
- Bronchospasm
- Foreign body aspiration
- Acute pulm edema / ARDS
21
Q
Anaphylaxis differentials
A
- Breathing circuit obstruction
- Airway foreign body
- Tension Pneumo
- Type IV Allergy: localized cutaneous reaction, t-cell mediated, non-life
threatening - Hemorrhage
- PE
- Overdose
- MI
- Aspiration
22
Q
Refractory hypotension s/s
A
- Warm = vasodilation (sepsis, anesthesia OD)
- Cold = Hypovolemia
- Tachycardia & HoTN
23
Q
Refractory hypotension treatment (primary)
A
- Help / Check Pulse
- Inspect for Blood Loss
- Fluid Bolus & Another IV
- Vasopressor
- Epinephrine 10mcg or Vaso 1-4 units
- Turn down gas
- Trendelenburg
- 100% Oxygen
24
Q
Refractory hypotension treatment (secondary)
A
- Hydrocortisone 100mg (adrenal insufficiency)
- Labs: ABG, Hgb, Lytes, Ca+, Lactate, T/S
- TEE, Foley
25
Refractory hypotension differentials
- Sepsis
- Shock
- Pneumo
- Anaphylaxis
- Pneumoperitoneum
- Hemorrhage
- Vasodilators
- Vagal Stimulation
- Hypovolemia
- Embolism
- Myocardial Ischemia
- LA Toxicity
26
Hemorrhage s/s
- Massive Blood Loss
- HoTN
- Tachycardia
- Cool Extremities
27
Hemorrhage treatment
- Help / 100% Oxygen
- IV Fluid Bolus & Another IV
- Trendelenburg
- Vasopressor Boluses
- Call for rapid infuser
- Page surgical help
- T/S + T/C
- Keep Warm
- A-line
- ABG, Coags
- Foley
- Monitor for hypocalcemia
28
Differentials for hemorrhage *dash*
- Dehydration
- Sepsis
- Anaphylaxis
- Heart Failure
29
Transfusion triggers
- PRBC: Hgb <7
- PLT: <50k
- FFP (10-15cc/kg): INR/PTT 1.5X norm
- CRYO (10u): Fibrinogen <80-100 mg/dL
30
MI treatment
- Help / 100% Oxygen
- STEMI team/ Cards consult - EKG to confirm
- Labs: Troponin, ABG, CBC - Treat HoTN/HTN
- Beta Blocker if appropriate (esmolol 0.5mg/kg or metoprolol 1-2mg increments)
- Aspirin 160-325mg
- Fentanyl/morphine
- Nitro Infusion
- TEE??
- Transfer for PCI
31
Residual paralysis
- Low tidal volumes
- Hypoxemia
- Poor hand grip/ head lift
- Unable to open eyes
- Poor cough
32
Residual paralysis tx (6)
- Help / 100% oxygen
- Bag patient if needed
- Jaw thrust, NPA
- Apply PNS to check TOF & Administer reversal agent
- Maintain normothermia/normocarbia & lytes
- Neuro Exam: pupils/gag
33
Residual paralysis differentials
- Stroke
- LEMS/ Myasthenia gravis
- Laryngeal nerve Palsy
- Myxoedema coma
- Hypoglycemia
34
Thyrotoxic crisis s/s
- Fever >41 C
- Sweating
- Tachycardia >140bpm, Atrial Fib/ Ventricular
arrthymias
- Hyper then HoTn
- N/V
- CHF
- Mixed metabolic/ Respiratory Acidosis
35
Thyrotoxic crisis tx
- Help/ 100% Oxygen
- Rehydrate w/ IV NS
- Treat fever w/ tepid sponges
- Non-selective BB: Esmolol 0.5mg/kg; 50-100mcg/kg/min
- Labs: T3, T4, TSH
- Hydrocortisone 200mg IV
Further Management
- Propylthiouracil 1g via NG tube
- Sodium Iodide 500mg IV or Potassium Iodide 5 drops via NG
36
Thyrotoxic crisis differentials
- MH
- Pheochromocytoma
- Infection/ Sepsis
