Transcript ANESTHETIC PROBLEMS AND EMERGENCIES

Anesthetic Problems and
Emergencies
A&A pg. 319
Why Do Problems Arise?
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Human error
Equipment error
Adverse effects
Patient factors
Anesthetic problems will inevitably occur at
some point in your career.
No anesthetic experience is the same, so
beware of the false sense of security!
Human Error
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Failure to obtain an adequate history or
physical exam on the patient
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Ideally, every patient scheduled for anesthesia
should have a complete PE, and a thorough history
obtained with the owner present.
*Less than ideal circumstances are common:
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Owner drops patient off in a hurry
Patient brought in by neighbor or friend
Receptionist takes the history
HISTORY?
Human Error
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Lack of familiarity with the anesthetic
machine or drugs
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Thank goodness for LVTs!
Human Error
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Fatigue
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Distracted or rushed
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Scheduling of surgeries can help with this
Usually you have your surgical patient and…
Inattentiveness
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Having a low level of anxiety is good!
Human Error
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Incorrect administration of drugs
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Inaccurate weight
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Math errors – calculating OR drawing up
Use of wrong medication
Use of wrong concentration
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Enro, ketamine, dexmed, pred
Incorrect route of administration
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Units, scale is off
IV v. IM
Confusion between syringes
*ALWAYS LABEL SYRINGES
Equipment Failure
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CO2 ABSORBER EXHAUSTION
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How is CO2 removed from a rebreathing system?
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How is CO2 removed from a non-rebreathing system?
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Best way to keep an eye on exhaled CO2?
↑ CO2 = Tachypnea, tachycardia, brick red
mucous membranes, cardiac arrhythmias
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Equipment Failure
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NO OXYGEN FLOW
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Which two parts of the machine may be malfunctioning?
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Flow meter: will gradually fall as the O2 tank empties
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Periodically check this!
Oxygen tank: check for empty tank, disconnected hose,
leaks
*Which breathing system can go without O2
flow longer?
Equipment Failure
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ANESTHETIC MACHINE MISASSEMBLED
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The better you know this machine and the flow of
gas, the quicker you will be able to solve problems.
*Where do you think the most common misassembled
part happens on the machine?
Equipment Failure
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ENDOTRACHEAL TUBE PROBLEMS
 Blocked tube
Twisting or kinking of the tube (inappropriate
positioning)
 Accumulation of material such as blood, mucus,
excess lubricant
*What tubes do you need to pay special attention to?
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Blocked tube  decreased oxygen to patient
How would this scenario lead to cardiac arrhythmias?
Solution: Check signs of tube properly in the trachea
 If truly blocked  extubate or suction with RRC
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Equipment Failure
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ENDOTRACHEAL TUBE PROBLEMS
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Tube advanced too far into a bronchus
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How do you solve this?
Cuff or tube is damaged
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Solution?
Equipment Failure
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VAPORIZER PROBLEMS
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Wrong anesthetic in the vaporizer
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Tipped over or over-filled
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Solution:
Solution:
Vaporizer dial may be jammed
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Solution:
Equipment Failure
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POP-OFF VALVE PROBLEMS
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The pop-off valve is inadvertently left closed
Two reasons why pop off would be left closed?:
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Solution: open the pop-off valve and/or decrease
the oxygen flow rate.
*Can adjust the amount of gas in the reservoir bag by
adjusting the pop off valve
Anesthetic Agents
“Every injectable or inhalation agent has the potential
to harm a patient and, in some cases, cause
death”. (Page 323)
Review the description of the physiological effects of
pre-anesthetic and general anesthetic agents in
chapter 3.
 Anesthetic protocol should be chosen based on
the patient’s needs
 Anesthetist must be familiar with side effects
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Such as?
Why is balanced anesthesia safer?
Patient Factors
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Trauma
Age
Weight
Breed
Organ disease
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Urinary obstruction
Patient Factors
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TRAUMA PATIENTS
Physical Status Classification= P3, P4 or P5
Potential Problems:
 Respiratory
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distress
Pneumothorax/Pleural effusion:
 No negative pressure or fluid compressing lung
expansion
Pulmonary contusions/edema: fluid in lung parenchyma
 No gas exchange
FLUID SHOULD BE REMOVED BEFORE ANESTHESIA
*What therapy might we want to provide while patient is
stabilizing?
Patient Factors
TRAUMA PATIENTS
Potential Problems:
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Cardiac arrhythmias
 What drug should you have on hand and know
the dose for?
Shock, hemorrhage
 What fluids might you prep?
Fractures/organ rupture anemia
Unknown internal injuries
Patient Factors
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TRAUMA PATIENTS
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Solutions:
Stabilize patient- may be hours to days
decrease anesthetic risk!
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Obtain rads, ECG, blood work