By David C. Borshoff
The Anaesthetic quandary guide is a realistic quick-reference guide giving step by step directions for the administration of the commonest anaesthetic crises encountered within the OR. • 20 situation administration protocols disguise all significant situations that require rapid healing intervention to avoid a catastrophic end result, together with cardiac arrest, acute haemorrhage, anaphylaxis, aspiration, LAT, acutely increased airway strain, tricky airway, CICV, malignant hyperthermia, neonatal resuscitation and paediatric lifestyles aid, acute bronchospasm, air embolism, ACM ischaemia, hyperkalaemia, laryngospasm, maternal cave in, post-partum haemorrhage and transfusion response • A hindrance prevention part incorporates a 15-point laptop fee, a drawback prevention list and a listing of 10 terminal occasions to aid diagnose swiftly deteriorating occasions • Colour-coding, bulleted and numbered lists and flowcharts increase reminiscence keep in mind in a demanding scenario • The tabbed format permits speedy and simple navigation and use in the middle of a main issue A needs to for each anaesthetist and anaesthetic assistant.
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Additional resources for Anaesthetic Crisis Manual
6 Maintain anaesthesia – use TIVA. 7 Insert arterial line and consider CVC – do not delay dantrolene. 8 Actively cool the patient. 9 Treat associated conditions: Hyperkalaemia 22 Acidosis Arrhythmias 10 Maintain urine output at >2ml/min. 11 Monitor with serial ABGs, electrolytes and temperature. 12 Admit to the ICU. MH box is located. . . . Laboratory Ext No. . . . ICU Ext No. . . . MALIGNANT HYPERTHERMIA (MH) Signs suggesting possible MH Early Elevated EtCO2 Masseter spasm Tachycardia Arrhythmias Developing Acidosis Temperature rise CVS instability arrest Hyperkalaemia Late Cola-coloured urine ""CK Coagulopathy #SpO2 If there is a malignant hyperthermia pre-prepared ‘box’ in the hospital, use it and follow the task card system.
2 Place the patient in a head down and lateral position. 3 Remove the airway and suction the pharynx. 4 Intubate and suction bronchial tree when airway secured. 5 Ventilate with 100% oxygen. 6 If aspiration is severe, proceed only with emergency surgery. 7 Empty the stomach before emergence. 8 Consider admission to ICU. ICU Ext No. . . . ASPIRATION How much assistance required depends on the severity and circumstances. g. turning the patient) may limit the amount of aspiration. Positioning the patient will depend on the type of surgery and practical limitations.
Amiodarone can be used for ventricular irritability but lignocaine and other class 1B antiarrhythmic agents should be avoided – for dosage see tab 1. Beta blockers can also have an adverse effect through myocardial depression and decreasing clearance of anaesthetic agent. Advanced life support should be continued for at least one hour because of the duration of binding to the myocardium. 5mg/kg bolus over 1 minute (100ml in adult). Commence infusion of 15ml/kg/hr (1000ml per hour in adults). At 5 minutes: Repeat the bolus dose and double the infusion rate if not responding.
Anaesthetic Crisis Manual by David C. Borshoff