Emergencies in Anaesthesia by Keith Allman, Andrew McIndoe, Iain Wilson

By Keith Allman, Andrew McIndoe, Iain Wilson

The second one variation of this crucial guide presents a pragmatic, available consultant to all emergency events encountered in the course of, and instantly following, anaesthesia. It covers the main specialties together with cardiovascular medication, breathing medication, obstetrics, and paediatrics, and every part starts with a transparent desk directory presentation, prognosis, exclusions, fast motion, and stick to up motion. those subsections are then elevated upon in bullet layout. extra sections disguise functional tactics comparable to find out how to insert a chest drain and the way to manage inhaled medicinal drugs lower than anaesthesia, plus a concise drug formulary.L L The booklet presents advisor and trainee anesthetists, working division body of workers and anaesthetic nurses with an invaluable resource of data and assistance that may be carried within the pocket, purse, or briefcase.

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Consider femoral vessel cannulation under LA. • General aim is to maintain low PVR to offload right ventricle (but NOT cause excessive systemic vasodilatation), maintain cardiac output, and maintain coronary flow. • If inotropes required, adrenaline may be the best compromise. • Aggressive fluid therapy to maintain circulating blood volume (increased central blood volume causes pulmonary dilatation; little risk of pulmonary oedema but further RV failure possible). • Avoid hypoxaemia and hypercapnia (more important than the increase in intrathoracic pressure during IPPV) as this will reduce PVR.

If torsade de pointes is present, give magnesium 2 g IV and correct any electrolyte abnormalities such as hypokalaemia. g. electrolyte abnormalities in the presence of a prolonged QT interval). Stop drugs that prolong the QT interval. BROAD-COMPLEX TACHYCARDIA • Persistent or recurrence of a broad-complex tachycardia will necessitate urgent referral to a cardiologist—may use alternative anti-arrhythmic drugs or overdrive pacing. Investigations ECG, U&Es, ABGs Risk factors Causes of VT include: • Ischaemic heart disease • Ventricular scarring after myocardial infarction or previous cardiac surgery • Right ventricular failure • Electrolyte abnormalities in patients with prolonged QT interval (tricyclic antidepressants, antihistamines, phenothiazines; or Brugada syndrome).

Subsequent management • Consider insertion of inferior vena cava filter if anticoagulation is contraindicated. • Surgical embolectomy—if severe, deteriorating state, failed medical treatment, collapse, arrest, and in a centre that has this facility. • Transvenous embolectomy (in a centre with this facility). Investigations • Arterial blood gases (hypoxaemia, hypercapnia or respiratory alkalosis, metabolic acidosis) PULMONARY EMBOLUS • Immediate transthoracic echocardiography • Chest X-ray (oligaemic lung fields, prominent PA) • ECG: • ‘SI QIII TIII’ 20–50% • T-wave inversion anteriorly 85% • right heart strain 75% • CT pulmonary angiogram (CTPA) • Troponin—an elevated value may identify those with submassive PE who may benefit from thrombolysis.

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