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20 Cards in this Set
- Front
- Back
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approach to telephone call |
1. on my way - expected arrival time 2. situation - info ---> situation ABC so far ---> Mx so far - preparation and management plan (call more help, prepare pt etc) 3. Person on phone - skill level, what they want from me |
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peripheral nerve block complications |
General 1. nerve damage AURORA (multicentre clinical registry) - permanent - 1: 15,000 - transient - 1:2,500 2. LA toxicity 3. infection 4. haemoatoma 5. allergy 6. failure of block Specific |
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basic algorithm for Mx of anaesthetic emergency |
COVER ABCD A Swift_Check C - circulation, capnograph, colour (saturation) O - oxygen (supply and analyser) V - ventilation, vaporiser E - ETT/ eliminate machine R - review monitor/ equipment A - airway B - breathing C - circulation D - Drugs A - awareness, air embolism, air in pleura, anaphylaxis Swift_Check - pt, surgeon, surrounds change order for spont breathing pt to: AB COVER CD A Swift_Check |
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Management of aspiration |
1. table tilt 30 degree head down 2. maintain cricoid pressure and suction oropharynx 3. ETT, suction ETT, then PPV 4. OGT 5. auscultate lungs - wheeze, decr A/E 6. ABG 7. bronchial aspirate 8. meds - no prophylactic antibiotics - consider corticosteroids if pH <2 9. No BAL NB - most recover in 2hr |
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Dealing with angry/ upset family/ breaking bad news |
Follow college guideline - RD10 SETUP 1. personnel - you + support - family + support - involve relevant department - legal, patient liaison 2. environment 3. timing - not disturbed PROCEDURE 1. open disclosure 2. supportive/ empathy / concern 3. apologies but not admit fault 4. questions 5. support services - SW, counselling 6. follow-up / contact 7. document ISSUES - specific to case - assess knowledge, warning shot, break news |
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Consent for GA |
1. Procedure 2. Common (1:10 - 100) a. pain b. sore throat c. PONV d. POCD e. visual change 3. Uncommon (1:1000 - 100,000) a. allergy b. awareness c. death d. CVA/ AMI e. teeth damage |
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Consent for neuroaxial |
Common 1. transient headache, backpain, deafness, shaking (1:10) 2. failure 1:10-20 3. dural puncture (1:100) Uncommon 1. infection 1:5,000 2. LA toxicity 1:10,000 3. nerve damage - temporary 1:10,000 - paraplegia 1:100,000 4. haematoma 1:150,000 |
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how do you orientate yourself to a new workplace |
1. environment - entry/ exit inc fire - evacuation plan - fire extinguisher - toilets 2. Equipment - arrest trolley/ defib/ button - Difficult initiation trolley - anaesthetic machine - morgan trolley + content 3. staff 4. protocol - nearest referral centre |
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Issues that need to be addressed after a major incidence |
follow college guideline RD 11 1. patient/ relative - breaking bad news 2. environment after major mishap 3. "second victim" - personnel involved 4. root cause analysis |
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Goals in NSx head injury |
1. avoid increase ICP- CBF (AB, C + D) AB --> SaO2 >96% --> decrease PaCO2 to normal range --> avoid acidosis --> avoid hypotension --> Drugs: ketamine, sux, N2O, VA (MAC >1) C --> venous drainage (HAT)- 30degree head up, avoid incr intrathoraic pressure (PEEP, cough strain), Tape not tie, Head position D - cerebral protection --> avoid hyperthermia, hypothermia (IHAST) --> Pharm: deep sedation--> Brain: mannitol/ hypertonic saline, dex, frusemide, N/S IVF (isoosmolar), avoid alb --> CSF: EVD 2. Maintain CPP - brain trauma foundation CPP 50-70mmHg(>70mmHg associ with pul Cx) 3. Avoid haemodynamic instability - avoid HTN - AMI, surgical blood loos - Avoid hypotension - cerebral vasodilation - incr ICP 4. Prevent secondary insult - avoid: hyperglycaemia, hyperthermia, seizure 5. early detection and management of complications |
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Blood conservation strategy |
PREOP 1. address - malnutrition, Fe, B12, folate 2. EPO 3. autologous donation 4. cease: anticoaguation, anti platelet, NSAID, aspirin, herbal (fish oil) 5. delay elective surgery INTRAOP A. surgical 1. technique 2. tourniquet 3. glue/ putty B. anaesthetic 1. regional 2. normovolaemic haemodilution 3. normal T, O2, BSL, CO2 4. induced hypotension 5. reduce PEEP c. general 1. TXA 2. cell salvage POSTOP 1. monitor for blood loss 2. restrictive transfusion thresholds 3. normal - Temp, coagulation 4. GI prophylaxis 5. incr FiO2, decr O2 consumption 6. avoid and treat infections 7. EPO |
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Plan for AFOI |
CIMPLE Max dose LA 8ml/kg (8.3 by british thoracic society) 70kg = 560mg (my formula used 370mg of lignocaine, safe down to a weight of 50kg) 1. Glycopyrolate 200mg IV (antisiagalouge) - 3mcg/kg 2. nebulise 4ml 2% lignocaine, only 25% absorbed = 20mg 3. co-phenylcaine (5% lig + pheny 0.5%) 3 spray to either nostril = 0.6ml = 30mg 4. Remifentanyl TCI 5. Lignocaine spray 10% 4 puff to back of throat = 40mg 6. Lignocaine gel 2% - 2ml to reinforced ETT dilate + NPA = 40mg now used 130mg lignocaine 7. O2 - cut HM + NP one sided 8. bronchoscope, stand in front, patient sitting 9. 6 syringe 2% lignocaine 2ml + air. spray as i go. 2 spray above VC, 2 spray at cords, 2 spray below cords. total used 370mg can use up to 9ml more 2% lignocaine |
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causes of ischaemia |
OH CRAP Oxygen Hb Contractility Rate/ Rhythm After load Preload |
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anaesthetic tissue for those on chemotherapy agents |
1. cancer - 4 M's 2. Drug effect on patient (pulmonary, cardiac, hepatic, nephro) 3. anaesthetic issues - difficult IVC, friable tissue 4. drug interactions |
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anaesthetic issue for cancer patients |
1. 4 M's 2. VTE 3. nutrition 4. electrolytes 5. immunosuppression 6. IV access |
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Issues with long case |
CNS: BIS CVS: fluid balance - IDC, maintenance RESP: airway oedema GI: PONV Haem : DVT proph ENDO: BSL MONITORING - Temp - PAC - eye, nerve Dx, pad - art line OTHER: pain Mx |
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Management of anaesthesia |
"pre, intra, postop" INTRA OP - after ensuring appropriately prepared theatre with skilled assistant - approach anaesthetic with consideration to: BED PIM B: blood products E: equipment: cell saver, rapid infuser, difficult airway trolley, warmer (air/fluid) D: Drugs - pressor, inotrope, dilator P: Pain - ?regional I: IV access: ?CVC M: monitoring: artline, BIS/temp, TOE/CVP, cardiac output, PA cath - induction - maintenance - extubation |
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Mx of crisis/ trauma |
1. emergency situation 2. multi-team approach 3. Concurrent assessment and management 4. follow guideline - EMST/ ALS/ Anaphylaxis/ COVER ABC 5. Team leader - A and B 6. delegate other tasks inc: a. Circulation - IVC/ blood/ fluids/ ABG b. recruit/ telephone - call for help, haematologist, radiologist, surgeon, theatre, ICU, transfer c. Preparation - drugs/ fluids/ procedures d. Defibrillator e. record keeper/ timer |
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Assessment of a patient |
1. in my assessment, in addition to normal anaesthetic preoperative workup, the issues i want to focus on are.... 2. approach Hx, Ex, Ix 3. Consultation 4. Premediation 5. Prepare theatre |
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Planning postop care consider |
1. nursing dependency 2. pain mx + PONV 3. O2/ fluids 4. physio 5. complications related to procedure 6. spefici obs e.g. neuro,flap |
