Transcript ANESTHETIC PROBLEMS AND EMERGENCIES

Response to Anesthetic Problems
and Emergencies
We are going to talk about your response to:
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Depth of anesthesia issues
Cardiac arrest
Recovery period problems
ANIMALS THAT WILL NOT STAY ANESTHETIZED
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Double-check equipment
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Vaporizer
Oxygen
ET tube
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Too small in diameter?
Double-check the patient
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Respirations
 Rapid and shallow can lead to not enough
anesthetic gas exchange
 Check capnograph
ANIMALS THAT ARE TOO DEEPLY ANESTHETIZED
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Respirations
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Rate:
Character:
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Mucous membranes:
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Capillary refill time:
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Heart rate:
ANIMALS THAT ARE TOO DEEPLY ANESTHETIZED
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Pulse quality:
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ECG:
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Temperature:
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Reflexes:
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Muscle tone:
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Pupils:
TREATING EXCESSIVE ANESTHETIC DEPTH
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Lower vaporizer setting
Notify veterinarian
Manually ventilate the patient
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1. Close the pop-off valve
2. Fill the reservoir bag with pure oxygen
3. Gently squeeze the bag until the patient’s chest rises
slightly (not above 20 cm H2O)
4. Repeat until animal shows signs of recovery
Reversals, doxapram, fluids, warmth
CARDIAC ARREST
A sudden cessation of effective ventilation and circulation.
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Signs it’s coming:
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Cyanosis
Respiratory arrest
CRT > 2 sec
Weak arterial pulse
Very low BP readings
Abnormal ECG tracing
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VPCs
V-fibrillation
Asystole
CARDIAC ARREST
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Signs it’s here:
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No heart beat auscultated
No palpable pulse
MM gray
No PLR; no corneal reflex
Respirations- only agonal
Initiate CPCR: a team effort!
ASK FOR HELP
CARDIAC ARREST – ABCDE???
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There is a critical window to restore oxygen
delivery to the brain
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How long do you have?
Ideally, 5 people would participate in the
resuscitative efforts
Performs chest compressions
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Bags the animal
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Assess the pulse during compressions and ECG
when compressions are temporarily suspended
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Draws up and administers drugs on the
veterinarian’s orders
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Maintains a record of procedure
Can be done with less!
1.
CARDIAC ARREST – CBADE
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Circulation restoration is most important
Start compressions!
Positioning
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Slightly different based on size
CARDIAC ARREST - CBADE
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Circulation
RATE: 1-2 times per second
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~80 times per minute for a large dog
~120 times for small dogs or cats
Chest should be compressed ~1/3 the diameter
of the chest wall
Compressions and bagging should be
administered simultaneously.
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If you are alone, 10 compressions per 2 breaths.
**Circulation should take priority over
breathing, if working alone**
CARDIAC ARREST - CBADE
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Can switch to internal massage
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What procedure would be performed?
Invasive, but can get higher return of
cardiac output
Defibrillation may be started
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Electric shock (J/kg)
No alcohol if defibrillating!
CARDIAC ARREST - CBADE
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Continue compressions until you have
return of spontaneous circulation
Palpate pulse, continue ECG, auscultate
continuously
Continue bagging after beat is back
CARDIAC ARREST - CBADE
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Airway and Breathing
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Intubate
Ventilate every 10 seconds
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CARDIAC ARREST - ABCDE
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Drugs:
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Epinephrine
Dopamine/dobutamine- increase force and rate of CO
Atropine
Lidocaine
Routes:
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IV- drugs, fluids
IT – drugs
IC – last resort
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Which ventricle?
CARDIAC ARREST - ABCDE
ECG
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Periodically check for spontaneous
contractions by discontinuing external
compression
Done by either palpating for a pulse or
looking for QRS complexes on the ECG.
CARDIAC ARREST - ABCDE
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After Care:
Common for patient to repeat arrest
within 24 hours
Neurological tests needed
Must be monitored extremely close
Reading Assignment
Other reasons for the clinical signs of being too
deeply anesthetized:
Page 336-377
(Start at Pale MM, stop at Cardiac Arrest)
Problems That May Arise in the Recovery Period
Pages 341-343
I would suggest reviewing the chapter key points
and Procedures 12-1 through 12-11 as well.