7. Emergency Anesthesia Flashcards Preview

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Flashcards in 7. Emergency Anesthesia Deck (20):
1

Hemoabdomen - what do you worry about

hypovolemia, ventilatory compromise, loss of oxygen carrying capacity, poor periph perfusion, met and lactic acidosis, mismatch in oxygen supply and demand

2

correct hypovolemia

- isotonic crystalloids, 1/4 to 1/3 of shock dose (90ml/kg) and give as bolus.
- consider hypertonic or colloid
- monitor

3

correct anemia

- whole blood (helps O2 carrying capacity and coag factors)

4

clinical signs of loss of O2 arrying capacity

tachycardia, tachypnea, hypotension, collapse, lethargic
- some same PCV <20%, or serial PCV with significant decrease
- lactate inc.

5

indication patient needs transfusion

loosing blood at high rate

6

preanesthetic hemoabdomen

pre-oxygenate, minimal CV effects (opiods, benzos), analgesia, may be ventilation

7

common hemoabdomen arrthymia
when do you treat it?

ventricular tachycardia / VPCs
- treat if super high rate or hypotensive, treat with lidocaine (can do CRI)

8

hemoabdomen induction and maintenance

propofol -> splenic engorgement
ketamine doesn't
alfaxolone

9

permissive hypotension

keep MP low until you control the source of bleeding, thus reducing amount of fluid dilution
- goal is to maintain SAP <90mmHg with MAP 50-55mmHg

10

Thoracic trauma what do you do

multiple xrays! thorax and abdomen

11

preanesthetic considerations in thoracic trauma

- hold chest up above abdomen
- monitor if using full mu (resp depression)

12

induction in thoracic trauma

rapid induction and rapid intubation
be careful with PPV, can cause pulmonary edema (ards) can tolerate a higher co2 in these animals

13

PEEP

positive end expiratory pressure
- opens up collapsed alveoli
- keeps some positive pressure in alveoli after breath
- can use peep valve or put scavenge tube into a bucket of water (ghetto peep)
- can cause drop in BP or cause more hypoxemia by only expanding open alveoli

14

GDV What do you worry about?

1. inc P on portal vein and CVC (dec. venous return, dec. CO, GI system congestion)
2. dec. tissue perfusion causes ischemia of stomach (free radical damage, lactic acidosis, arrhythmia)
3. Compromised coronary blood supply (-> arrythmias, difficult ventilation)

15

GDV Checklist

1. Two large bore catheters (in forelimbs) for fluid resuscitation for 1/4-1/3 shock dose
2. BW (PCV/TS, electrolytes, lactate, A/B status)
3. ECG (spleen torsed or dec. coronary BF -> VTach/VPCs)
4. R lateral radiograph to confirm
5. Analgesia! (full mu)
6. Trocarize(use US) or pass stomach tube (needs to be sedate)

16

GDVInduction

- use ECG
- rapid, inflate cuff (prone to regurg!!)

17

post op gdv

- suction pharynx before extubating
- continue fluids
- recheck lactate, and electrolytes

18

C section

- maintain BP (directly correlated to placental BF)
- ensure oxygenation
- minimize drug effects on fetus

19

C section steps

1. place IV
2. pre clip, line block if tolerated
3. pre place monitoring
4. preoxygenate 3-5 minutes
5. have surgeons ready
6. rapid intubate
7. full mu after delivery

20

MAC of pregnant animals is ____, another reason to _______

reduced
go FAST