Download anesthetic problems and emergencies

Anesthetic Problems and
Emergencies
A&A Chapter 12 pg. 319- 349
Why Do Problems Arise?
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Human error
Equipment error
Drug 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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Proper 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
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, 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?
Oxygen tank: check for empty tank, disconnected hose,
leaks
Flow meter: will gradually fall as the O2 tank empties
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Periodically check this!
*Which breathing system can go without new 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 some of the most common misassembled
parts happen 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
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Solution: Check signs of tube properly in the trachea
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If truly blocked  extubate or suction with RRC
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
Non-precise concentrations delivered
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Tipped over or over-filled
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Solution:
Vaporizer dial may be jammed
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Solution:
Equipment Failure
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POP-OFF VALVE PROBLEMS
The pop-off valve is inadvertently left closed
pressure builds  patient cannot exhale
=rupture of lungs and decreased venous return to
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Two reasons why pop off would be left closed?
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Solution:
*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 Agents
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Anesthetic protocol should be chosen based on
the patient’s needs
Anesthetist must be familiar with side effects
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Such as?
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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
TRAUMA PATIENTS
Physical Status Classification= P3, P4 or P5
Potential Problems:
 Respiratory
distress
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Pneumothorax:
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No negative pressure  lung tissue collapse
Pleural effusion:
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Fluid compressing lung expansion  lung tissue collapse
Pulmonary contusions/edema:
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No gas exchange
Patient Factors
TRAUMA PATIENTS
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Respiratory distress
Solution:
FLUID AND/OR AIR SHOULD BE REMOVED BEFORE
ANESTHESIA
Aseptic prep:
 Lateral chest wall
 7th-9th intercostal spaces
 Clip and scrub
Patient Factors
TRAUMA PATIENTS
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Respiratory distress
Solution:
What therapy might we provide for the patient while
they are stabilizing?
Patient Factors
TRAUMA PATIENTS
Potential Problems:
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Cardiac arrhythmias
 Pre-anesthetic ECG
 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…what diagnostic test??
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
Patient Factors-Group Discussion
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Geriatric
1. ASA Physical Status
Pediatric
Classification (pg. 25)
Brachycephalic
2. Patient description
Sighthounds
and example
Obese
3. Potential problems
Cesarean
4. Solutions
Neonates
Cardiovascular disease
Respiratory disease
Hepatic disease
Renal disease/Blocked Tom