A/S - anesthetic emergencies
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- A/S anesthetic emergencies
- A/S anesthetic emergencies
- What is the tech role in an anesthetic emergency?
- Recognize signs of crisis and alert DVM, aticipate needed supplies, assist DVM
- Define geriatric
- has met 75% of life expectancy
- define pediatric
- 3 months of age or younger
- What are some patient factors that increase chance of anesthetic emergencies?
- geriatric, pediatric, brachycephalic, sighthounds, obese, c-section
- By how much should you reduce anesthesic doses in geriatric pt?
- 30-50%
- Will the recovery time be prolonged or shortened in a geriatric pt?
- prolonged
- Why should you avoid prolonged fasting in a pediatric pt?
- hypoglycemia could occur
- What anesthetic method is preferred in a pediatric pt?
- inhalation
- What is a major concern when anesthetizing a brachycephalic pt?
- airway obstruction
- What drug should not be given to sighthounds?
- Barbiturates
- What dose rate should you use in an obese pt?
- Dose according to ideal weight
- What dose rate should you use w/ a c-section? What drugs should be voided?
-
lowest effective dose
avoid ketamine/diazepam and barbiturates - What a condition caused by inadeuate tissue perfusion leading to cellular hypoxia, metabolic acidosis, and ultimaely death?
- Shock
- What are 4 types of shock?
- hypovolemic, vasculogenic, cardiogenic, obstructive
- What is hypovolemic shock? Causes?
- decrease in circulating blood volume due to loss of fluid - hemorrhage, v/d, diuresis, burns
- What is vasculogenic shock? Causes?
- vascular space is increased leading to decrease in blood pressure - sepsis, anaphalaxsis, drug overdose
- What is cardiogenic shock? Causes?
- failure of cardiac output - dysrhythmias, valvular insufficiency, congenital defects, heart muscle problems
- What is obstructive shock? Causes?
- restriction in blood flow - GDV, pneumothorax
- What are some signs of shock?
- tachycardia, hypotension, tachypnea, hypothermia, weakness, restlessness, depression, decr urine output, coma and pupil dilation, leads to cardiopulmonary arrest
- When tx shock, __ & __ medsare not absorbed since perfusion is poor Therefore it is a good idea to place an IV catheter before anesthesia.
- IM &/or SC
- What meds are given in a shock situation?
- rapid IV fluids, Dopamine/dobutamine (incr contraction of heart muscle), lidocaine/propranolol(arrythmias), glucocorticoids, antibiotics (sepsis), diuretics (oliguria/anuria)
- What are some things to check w/ the trach tube when the pt won't stay anesthetized?
- in traches? lg enough? cuff inflated? kinked? firmly attached to machine?
- What are some things to check w/ the vaporizer when the pt won't stay anesthetized?
- connected to O2? connected to delivery system? correctly set? filled?
- What are some things to check w/ the delivery system when the pt won't stay anesthetized?
- leaks? O2 flow adequate?
- What are some things to check w/ the O2 tank when the pt won't stay anesthetized?
- On? adequate supply in tank?
- What are some steps to take to avoid common errors that cause the pt to not remain anesthetized?
- proper checkout of machine, premeasure trach tube, check cuff, confirm correct placement of trach tube
- What are some signs that a pt is too deep?
- dilated pupils, no reflexes, bradycardia, delayed CRT, hypoventilation, no muscle tone
- What are some possible equipment errors that could cause a pt to be too deep?
- incorrect vaporizer setting or calibration, incorrect anesthetic in the machine
- What are some possible pt factors that could cause a pt to be too deep?
- hypothermia, shock, pre-ex dz, drug dosages or interactions
- What are some signs of resp depression?
- reduced resp rate (< 10 rpm), reduced tidal volume, +/- cyanosis
- What are some causes of resp depression?
- too deep, anesthetic drugs, surgical positioning (pressure on chest or diaphgragm), CNS/metabolic dz
- How do you tx resp depression?
- lighten plane, bag, correct surgical positioning, can use doxapram if above not effective
- ALL uncorrected cases of inadeuate ventilation can lead to ___-> ___->___->
- resp arrest -> cardiac arrest -> death
- What are some signs of abnormal breathing patterns?
- increased effort/abdominal breathing, decr movement of chest or reservoir bag, cyanosis, unusual sounds (rales, crackles, muffled)
- What are some causes of unusual breathing patterns?
- too deep, misplaced trach tube, obstruction w/i resp system (aspirated material, mucus), obstruction w/i equipment, dz of resp system
- How do you tx abnormal breathing patterns?
- *Check popoff and bag first*, lighten plane, ventilate and watch (if resistance, probably an obstruction, disconnect & aspirate trach tube
- At what bpm is considered bradycardia in dogs? cats?
- <60 bpm in dogs, <100 bpm in cats
- What are some possible causes of bradycardia?
- too deep, increased vagal tone, hypothermia, metabolic problems, late stages of hypoxia
- What are some tx for bradycardia?
- lighten plane, support ventilation, keep pt warm, admin of anticholinergic (atropine)
- What bpm are considered tachycardia in lg, med, and sm dogs? In cats?
-
>120 bpm in large dogs
>140 bpm in med dogs
>150 bpm in sm dogs
>200 bpm in cats - What are some causes of tachycardia?
- too light? hypotension, shock, inadequate ventilation, drug induced (ketamine,anticholinergics), hyperthermia
- How is tachycardia tx?
- adj plane, fluid support, support ventilation, check temp/maintain normothermia
- What are some signs of cardiac dysrhythmias?
- irreg pulse rate & pressure, pulse deficits, irreg heart sounds, prolonged CRT, weak pulse, apllor, cyanosis, abnormal ECG tracings
- What are some causes of cardiac dysrhythmias?
- too light ot deep, drugs sensitized heart to effects of epinephrine (halothane, barbiturates), anesthetic drugs, hypoxia, surgical manipulation
- What are some steps to take to prevent cardiac arythymias?
- pre-surg PE and labs, correct hydration & metabolic imbalances beforehand, knowledge of drug interactions & proper protocols, fluids for cardiac support, proper anesthetic depth monitoring
- Tx for cardiac arythymias?
- asses & adj plane, ventilation, fluid therapy
- What are some signs of cardiac arrest?
- resp arrest, no pulse, no heart sounds, dilated/fixed pupils, lack of bleeding at surg sites, blue/gray tissue color, ECG changes
- What are some causes of cardiac arrest?
- inadequate ventilation -> resp arrest, anesthetic overdose, hypothermia, metabolic problems, cardioascular disturbances
- Tx for cardiac arrest?
- CPR, epinephrine, after resuscitation dopamine/dobutamine, evaluate CNS status
- What are some causes of vomitting/aspiration/regurgitation?
- drugs, light anesthesia (stage 2), feeding before anesthesia, stress, excitement, surgical manipulation
- What are some signs of aspiration?
- cyanosis, bronchospasm (wheezing, can't breathe in), apnea, tachypnea, pneumonia or pulmonary edema
- How can you prevent vomiting/regurgitation/aspiration?
- fast 12 hours before anesthesia, avoid stress & excitement, acepromazine (antiemetic), rapid intubation
- Tx for vomitting?
- place in sternal recumbency, keep mouth open & tongue out, tilt table downward, afterward examine and cleanse pharynx
- Tx for aspiration?
- suction airway/lavage w/ sterile saline, administer O2, admin of aminophylline & steroids if bronchospasm occurs, broad spectrun ABs, steam or mist, coupage
- What is metabolic hyperthermia?
- hypermetabolic state induced by drugs that leads to uncontrolled incr in temp, metabolic crisis, and may lead to death
- What are some predisposingfactors for malignant hyperthermia?
- genetic, infection, drugs, environmental stress & excietment
- What are some early signs of malignant hyperthermia?
- hyperventilation, tachypnea, incr body temp, skin nd mm flushed, tachycardia nad dysrhythmias, BP first incr then dramatically decr, muscle rigidity
- What are some late signs of malignant hyperthermia?
- muscle rigidity, core body temp 108-110, hemolysis, acuteremal failure, hypoglycemia, cerebral edema, death
- Tx for malignant hyperthermia?
- remove triggering agent ifpossible, IV fluids, cool body, O2, diuretics, corticosteroids