Emergency Anaesthesia Flashcards by Iseoluwa Ojo

Emergency→ Immediate operation usually within __________ of surgical consultation usually lifesaving, __________ simultaneously with surgical treatment.

Urgent→ Operation as soon as possible after __________ usually within __________ of surgical consultation.

one hour ; resuscitation

resuscitation ; 24 hours

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Emergency Theatre Provision:

A 24-hour emergency operating theatre is provided

Emergency cases will be operated on at __________.

Urgent cases will be operated on between the hours of ______-______ hours.

Emergency operations will take precedence over __________ cases

anytime

0830 - 2200

all other

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Preoperative challenges
Challenges of emergency anaesthesia

 Full stomach-emptying of gastric contents normally is delayed due to ____________________________

 This may be caused by trauma, pain, fear and opioids The _______________________________________ is used in the assessment residual gastric volume after trauma.

 The gastric volume >____mls/kg and a pH < than ______ correlate with more severe complications of aspiration

reduced gastric motility

time of ingestion of food to the time of trauma

20mls/kg ;2.5

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Possible causes of a full stomach

Emergency surgeries which may include ______,________,________,________

Anaesthesia causes will include _______ administration, __________ medications, __________ intubations which alters the _______ and reduce the _______________ tone
Others will include autonomic neuropathy Stress and pain
Encephalopathy
Obesity
Pregnancy
Abdominal malignancy causing raised intra abdominal pressure

TBI,Caesarian section, bowel obstruction, hiatal hernia

opioid; anticholinergic; nasogastric

gag reflex; lower esophageal

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Preoperative challenges

Full stomach:
It predisposes the patients to _________ & probable _________ of gastric contents resulting in a poor outcome

 This may occur due to the limited time available for patient preparation
The reduction in the time for patient assessment & evaluation increases the risk associated with anaesthesia for emergency procedures

regurgitation; aspiration

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Pre-operative challenges

Hypovolaemia→ __________ or __________ from __________ or __________ which results in __________ and __________, which may then lead to __________.

Coexisting medical disorders→ uncontrolled HTN, DM, asthma, CCF,
 __________ – and concomitant use of __________ medications

haemorrahge ; fluid loss

diarrhea ; vomiting

dehydration ; loss of electrolytes ; arrhythmias.

Pain; opioids

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Source of emergency Patients

Hemorrhagic
General surgery
Labour ward-ruptured uterus
Feto-maternal distress

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Source of emergency Patients

Femur/tibia

ectopic pregnancy

aneurysm

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SOURCE of emergency patients

Intensive Care
________ (____________________)

STBI(severe traumatic brain injury)

Burst abdomen

sudden acute deteriorating

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Anaesthetic Management

_____________ Assessment
_____________ Investigations
_____________
_____________
_____________
_____________ / _____________

Preoperative
Laboratory
Monitoring
Induction
Maintenance
Recovery / Shifting to ICU

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Preoperative assessment

Conventional Assessments of fitness for anesthesia and surgery (can or cannot?) be followed
_______ assessment and intervention to stabilise the patient

Cannot

Rapid

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Preoperative assessment

Primary survey
_________,_______,_______,_________

If not ________,_______, and __________ immediately you may not have a live patient on the operating table

Circulation
Airway
Breathing
Disability (Neurology)

assessed, diagnosed and treated

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Shock index =???

And the (lower or higher?) the value the poorer the prognosis

Heart rate <0.7
—————-
Systolic pressure

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Airway Assessment
Assessment of _________ and _________
Difficult Laryngoscopy with risk of failed intubation

Beware of
_________ and __________

patency and anatomy

C-Spine Injury

Full Stomach

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Airway Treat

Simple airway maneuvers- ________,___________

Simple airway adjuncts- ______,________ airways

________________ – Gum elastic bougie,McCoy laryngoscope blade,Videolaryngoscope,intubating LMA

A difficult airway may require a surgical access through a _____________.

Jaw Thrust, chin lift

oral, nasal

Endotracheal Intubation

cricothyroidotomy

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Breathing with ventilatory support

Respiratory rate – Bradypnoea, tachypnoea

Respiratory rates <___ or >____ are seen in life threatening conditions

Oxygen saturation – very useful if signs of _________ are present

<5 or >35

hypoxia

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Anticipated problems needing intervention

List 5

Treatment – ___________ insertion , ———— of the wound, ____________ and ___________

Tension pneumothorax
Massive Hemothorax
Open Pneumothorax
Flail Chest
Cardiac Tamponade

Intercostal drain; Sealing; Intubation & ventilation

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Important 5 places to access after primary survey
In posttraumatic patients

_________ injuries
_______ bones
____________ for pneumohaemthorax
____________
_________ and __________

External; Long

Chest – x ray

Abdomen

Pelvis and Retro peritoneum

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Shock in a multiply injured patient is “__________ shock” unless proven otherwise

hemorrhagic

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Management of shock

___________ – ______ intervention / interventional __________

_________ bore canulae – (peripheral or central?) – send for ________ and _______ - lab

2 litres of _____________________ ???

Exsanguinating hemorrhage O -ve blood

Stop Bleeding; Surgical; Radiology

2 large; peripheral; grouping and cross matching

warm crystalloids

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Neurological
Quick GCS scored over 15

Prevent secondary Neurological damage
May result from
_________,_________,___________

Hypoxia Hypotension Hypercapnia

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_________ _______tension probably is not to be advocated for head injured patients

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Permissive Hypo

TRAUMA

Glascow Coma Scale (GCS)

•Head injury mild (_______),
moderate (_______), severe (_____)

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13-15

9-12

3-8

Radiology
______
_________
________
_________- ______ view CT

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X rays –
Chest
Pelvis
C Spine – lateral

Do Not Shift ___________________ patient to Radiology Room

Hemodynamically unstable

CT (reduces or lengthens?) time to diagnosis

Reduces

Shifting of Patients from Resuscitation Suite “ Only down the corridor” Airway Ventilation _______ and ______ __________ Check – __________,_________,____________ Only half way through corridor– Beware of _________ injuries

Fluids and drugs Monitoring Battery of ventilators, Oxygen cylinders, Syringe pumps undiagnosed

Positioning Beware – ______,_______,________ All are inserted as they are important – so keep them accessible Take care of __________ limbs Every shifting in a _________ patient can cause further ______ in blood pressure

lines- tubes- bags fractured; hypovolemic fall

Monitoring Basic Monitors •______,_______,________,_________ •_____________________ Don’t waste time in getting an arterial line- can be placed after surgeons have started hemorrhage control CVP – PCWP ??

Pulse Oximetry, ECG, Temperature, NIBP Invasive Arterial blood pressure-

Choice of anaesthesia  guided by the ________ of the injury and ________ surgical technique the preferences of the ________ ________ or ________ anaesthesia However, due to urgency, ________ is always preferable to ________

nature ; location anaesthetist General ; regional anaesthesia GA ; RA

Preparation for anaesthesia ____________ drugs, ____________ drugs , vasopressors _______,________ IV access (large bore cannula ____/___G) Anaesthetic ____________ Tiltable _________ Informed _________ _______________

Anaesthetic drugs Resuscitative drugs atropine, adrenaline 16/18G machine check trolley ; assistant Acid prophylaxis

RSI Gold standard for prevention of _______________________ It is a method for achieving rapid _______________ whilst minimising the risk of __________ and __________ of ___________ It is important in patients who has not ________

aspiration of gastric content control of the airway regurgitation ; aspiration ; gastric contents. fasted

RSI The goal is to ________ without having to use __________________ ventilation _______ table Full _________ with _______ ready _________ assistant IV access

intubate ; bag-valve-mask Tilting ; monitoring ; suction Trained assistant

Rapid sequence induction steps _______________________ FOR ____ MINUTES Calculated sleep dose of induction agent ______,______,________,________ __________ or __________ maneuvers applied on the cricoid cartilage which forms a _______ ring and could directly __________ the __________ Suxamethonium ____ mg/kg __________ and __________ is carried out immediately the patient is relaxed Check __________ before releasing ________ pressure. Secure the tube.

PRE-OXYGENATION ; 3 MINUTES STP, propofol ,etomidate, ketamine Cricoid pressure ; Sellicks maneuvers signet ring ; compress ; eosophagus 1; Laryngoscopy and intubation position ; cricoid pressure

Choice of Induction agent For Adequately resuscitated Receive standard anesthetic care : ______,______,_________

STP,Propofol,Etomidate

Choice of Induction agent Fro Inadequately resuscitated, unstable but conscious A ________________ dose of induction agent Choice : ______,_________

reduced titrated Ketamine Etomidate

Choice of Induction agent In extremis eg if patient is unconscious and apneic Induction agents ___________________ Can use ____________________

should not be used – inappropriate muscle relaxants

Controlled or Spontaneous ? No Place for spontaneous ventilation in a hemodynamically unstable - critically ill patient and Severe shock – where there is ↓______________________ increased need for __________________ And perhaps associated _________________

blood supply to diaphragm minute ventilation Respiratory failure

Maintenance of Anesthesia Till hemodynamic stability is attained – Incremental dose of _______ and (low or high?) concentration of ________ agents As the circulatory state improves dose of narcotics, volatile agents or propofol can be _____eased

narcotics; low; volatile agents Increased

Relaxants __________,___________– least effect on heart (not available) ____________ (??allergy) If elective ventilation is planned – ___________ is best due to _______ and __________ effect in shocked patient

Rocuronium, vecuronium Atracurium Pancuronium vagolytic; sympathomimetic

Volatile Anesthetic of choice ________ – _________ – __________

Isoflurane – sevoflurane – desflurane

Volatile Anesthetic of choice Isoflurane Impressive safety profile _____tension – due to ______________ and not _______________

Hypo vasodilatation myocardial depression

Fluid therapy - Early Phase Till ________________ Fluids to maintain systolic pressure of >____ mm Hg To reduce _____ formation and ______________ and to prevent ____________ vasoactive support for most shock refractory to fluid therapy _____________ infusion remain the mainstay of

control of hemorrhage; 80 clot; dislodgement of clots hypoperfusion Catecholamine

Fluid Therapy- late Phase To maximise the __________ to correct the _________________ Fluid (crystalloids or colloids) to increase ____________ RBCs to improve ___________ Plasma and platelets to correct __________ _____________ to be continued in the _____ –until _______________

perfusion ; oxygen debt volume ; oxygen carriage coagulation; Resuscitation ICU ; lactate clearance

Fluid Therapy Adequacy of fluid therapy is accessed by monitoring the __________,______,______,_______ _____________ Variation _____________ Variation

Blood Pressure, Heart rate, urine output CVP Systolic Pressure ; Pulse Pressure

In patients with intestinal obstruction the passage of __________ is very important

nasogastric tube

Anaesthesia for intestinal obstruction •_____________________________ (concern) balanced salt solutions ( _________,_________ ) Kcl →K correction, • • • darrows solution Bicarbonate GAR NG Tube

fluid & electrolyte balance Lactated Ringers, 0.9% saline

 Anaesthesia for Penetrating eye injury ______________ RSI (↑ intraocular press)→ _________ and _______ Alternative : __________, _________

Suxamethonium vitreous loss & blindness rocuronium Delay surgery

Anaesthesia for antepartum haemorrhage Placenta praevia or accreta GA orRA Adequate ____________ availability of _________________ ______ for caesarean ↓blood loss & need for blood transfusion

IV access cross-matched blood RA

Blood loss Physiologically, haemodynamic compensatory mechanisms maintain vital organ perfusion till about ______% TBV loss, beyond which there is risk of critical ______________ . Inadequate resuscitation at this stage leads to __________

30 hypoperfusion

Avoid Hypothermia Core body temperature <_____°C Causes Coagulopathy Acidosis Decreased cardiac output Arrhythmias

To Extubate or Not _______________ till the physiological parameters return ____________________– worse outcomes ———————- is strongly recommended

Elective ventilation Premature extubation Awake extubation

Transfer to the ICU Usually transferred by bringing the ICU _______ – reduces the number of transfers ________ from ICU brought along with the trolley/cot _______________ with ______ Circuit Take care of _________ tubing and ___________ Handing over to the _________ - vital

trolley; Monitors Oxygen cylinder; Bains invasive; Urobags intensivist

Emergency Anaesthesia Flashcards

(53 cards)