gasnotes - anaesthetic emergencies

Question 1

What is anaphylaxis?

Answer 1

An IgE-mediated hypersensitivity reaction characterised by massive histamine release from mast cells

Anaphylaxis can lead to life-threatening distributive shock and airway oedema.

Question 2

What are the main symptoms of anaphylaxis?

Answer 2

Life-threatening distributive shock, airway oedema, gastrointestinal upset, rash

Symptoms may vary between patients.

Question 3

What are the common causes of anaphylaxis in anaesthesia?

Answer 3

Muscle relaxants, sugammadex, antibiotics

These agents are significant culprits in anaphylactic reactions during anaesthesia.

Question 4

Why is constant vigilance required in anaesthetised patients?

Answer 4

Sleeping patients can’t tell you that they feel sick

This necessitates monitoring for signs of anaphylaxis.

Question 5

List some signs to monitor for anaphylaxis in patients.

Answer 5

• Unexplained hypotension and tachycardia
• Rising ventilator pressures
• A rash (rarely witnessed)
• Bronchospasm

These signs can indicate an anaphylactic reaction.

Question 6

What is the first step in managing anaphylaxis according to the key points?

Answer 6

Call for help early

Early intervention is crucial in managing anaphylaxis.

Question 7

What should be done after calling for help in anaphylaxis management?

Answer 7

Cease infusion of the offending agent

Stopping the trigger is essential to prevent further reaction.

Question 8

What medication should be administered intramuscularly in anaphylaxis?

Answer 8

Adrenaline 💉

Adrenaline is the primary treatment for anaphylaxis.

Question 9

What fluid management step should be taken in anaphylaxis?

Answer 9

Rapidly infuse IV fluids

IV fluids help to manage hypotension and shock.

Question 10

What should be initiated if the patient arrests during anaphylaxis?

Answer 10

Start CPR

CPR is critical in cases of cardiac arrest.

Question 11

Fill in the blank: The main culprits of anaphylaxis in anaesthesia include muscle relaxants, sugammadex, and _______.

Answer 11

[antibiotics]

Question 12

ANZCOR guidelines for anaphylaxis

Answer 12

Question 13

What are the signs that a patient is losing blood, in rough order of reliability?

Answer 13

• You can see lots of blood
• Drains
• Surgical field
• The floor
• Tachycardia
• Tachypnoea
• Narrow pulse pressure
• Hypotension
• Oliguria

These signs help in assessing blood loss during surgery.

Question 14

Where can blood hide from the surgical team during an operation?

Answer 14

• Pelvis
• Long bones
• Mesothelial cavities
• Retroperitoneal space

Blood may not always be visible and can accumulate in various body spaces.

Question 15

What are the general aims of haemorrhage management?

Answer 15

• Stop the bleeding
• Replace the missing volume
• Maintain normal blood composition
• Clotting factors
• Biochemistry
• Acid-base balance

These aims guide the approach to managing haemorrhage effectively.

Question 16

What is the first step you should take when managing a patient with haemorrhage in an OSCE?

Answer 16

Call for assistance

Seeking help is critical in managing severe haemorrhage.

Question 17

Why is it important to ensure a patient can breathe before transfusing?

Answer 17

There’s no use in transfusing a patient who cannot breathe

Prioritizing airway management is crucial before any transfusion.

Question 18

What type of IV cannula should be inserted for a patient with haemorrhage?

Answer 18

Wide-bore IV cannula

A wide-bore cannula facilitates rapid fluid resuscitation.

Question 19

What type of fluid should be used to temporise the situation in a haemorrhage?

Answer 19

Crystalloid

Crystalloid solutions are typically used for volume expansion in emergency settings.

Question 20

What protocol should be activated in cases of massive haemorrhage?

Answer 20

Massive transfusion protocol

This protocol ensures rapid access to blood products during severe bleeding.

Question 21

What type of blood should be transfused first in an emergency?

Answer 21

O-negative blood

O-negative blood is universal and can be safely transfused in emergencies.

Question 22

What additional blood products might be considered in haemorrhage management?

Answer 22

• Platelets
• Fresh frozen plasma

These products help restore coagulation factors and improve patient outcomes.

Question 23

What is laryngospasm?

Answer 23

A life-threatening contraction of the laryngeal muscles that causes complete (or near-complete) airway obstruction.

Laryngospasm can be triggered by various stimuli, including irritation of the larynx.

Question 24

What triggers laryngospasm?

Answer 24

Stimulation of the larynx without sufficient ablation of the airway reflexes.

Common triggers include actions like wiggling the LMA.

Question 25

Who is more likely to experience laryngospasm, children or adults?

Answer 25

Children. ## Footnote Children are more prone to laryngospasm, especially when infected with a respiratory virus.

Question 26

What should never be attempted during laryngospasm?

Answer 26

Inserting an endotracheal tube through closed vocal cords. ## Footnote The vocal cords are fragile, and attempting to insert a tube can cause injury.

Question 27

What is the first recommended action to take when laryngospasm occurs?

Answer 27

Deepen the anaesthetic. ## Footnote Deepening the anaesthetic can help relax the laryngeal muscles.

Question 28

What should be administered to the patient during laryngospasm?

Answer 28

100% oxygen. ## Footnote Ventilating with 100% oxygen is crucial to ensure adequate oxygenation.

Question 29

What should be adjusted to help with laryngospasm?

Answer 29

Turn up the pressure. ## Footnote Increasing the pressure can assist in overcoming the obstruction.

Question 30

What medication should be considered during laryngospasm?

Answer 30

Paralyse the patient. ## Footnote Paralysis may be necessary to manage the airway safely.

Question 31

What is malignant hyperthermia (MH)?

Answer 31

An inherited disorder of sarcoplasmic calcium release. ## Footnote MH leads to uncontrolled calcium release, causing a hyper-metabolic state.

Question 32

What triggers malignant hyperthermia?

Answer 32

Volatile anaesthetic agents and suxamethonium. ## Footnote These agents cause uncontrolled calcium release.

Question 33

What is the mortality rate of untreated malignant hyperthermia?

Answer 33

100% mortality. ## Footnote Prompt treatment is crucial to prevent fatal outcomes.

Question 34

How common is malignant hyperthermia for junior doctors?

Answer 34

It is a once-in-a-career event. ## Footnote Junior doctors are not expected to know how to manage this crisis.

Question 35

What should you do when taking an anaesthetic history regarding malignant hyperthermia?

Answer 35

Make a point of asking about it. ## Footnote This helps identify patients at risk.

Question 36

What is the first step in managing a malignant hyperthermia crisis?

Answer 36

Cease administering the offending agent. ## Footnote Stopping the trigger is critical for management.

Question 37

What is the number one priority in treating malignant hyperthermia?

Answer 37

Administering dantrolene. ## Footnote Dantrolene is the only effective drug for MH.

Question 38

What should be done after administering dantrolene in a malignant hyperthermia crisis?

Answer 38

Active cooling with ice and chilled IV fluids. ## Footnote Cooling the patient is essential to manage hyperthermia.