DAANCE - Office Anesthesia Emergencies Study Guide Latest

DAANCE - Office Anesthesia Emergencies Study Guide Latest Hypoxia - deficiency of oxygen in the body's tissues and can be the end result of significant cardiorespiratory complications Airway obstruction secondary to posterior positioning of the tongue or a foreign body - -100% oxygen via nasal mask -place the patient in Trendelenburg position and pack off the surgical site -digital traction of the tongue with gauze, tongue forceps, a hemostat or tongue suture -suction of the oropharynx -a nasopharyngeal airway -a oropharyngeal airway -LMA, igel or other supraglottic airway -endotracheal intubation -cricothyrotomy Cricothyrotomy - only after all conventional methods for establishing an airway have failed accomplished by making an opening through the thin cricothyroid membrane between the cricoid and the thyroid cartilages of the larynx Tracheostomy - surgical airway below the level of the larynx into the trachea may be performed by OMS but usually performed in a hospital setting Laryngospasm - protective reflex of the vocal cords that attempts to prevent passage of foreign matter into the larynx, trachea and lungs. partial or complete Complete laryngospasm - characterized by cessation of crowing sounds, suprasternal retraction and paradoxical chest movements Treatment of laryngospasm - -100% oxygen with nasal hood -proper head position/establish airway -pack surgical site -suction of oral cavity and oropharynx with tonsil suction tip -positive pressure, 100% oxygen via bag/mask system -administer succinylcholine (Anectine) 10-20mg IV support ventilation manually until the effects of the drug have dissipated and strong spontaneous respiration has resumed -Succs may precipitate malignant hypothermia in a susceptible individual When giving children succinylcholine, what drug should be administered to prevent bradycardia and life-threatening dysrhythmias? - atropine Bronchospasm - -generalized contraction of the smooth muscles of the small bronchi and bronchioles in the lungs, resulting in a restriction of the flow of air to and from the lungs -more difficulty with expiration than inspiration Treatment of bronchospasm - -100% oxygen via bag/mask - albuterol inhalation (Beta-2 agonist) 4-8 puffs via inhaler every 20 minutes for up to 4 hours, then every 1-4 hours as needed -Ipratropium bromide (Atrovent) 2 puffs stat; repeat every 4 hours -Epinephrine injection (alpha and beta agonist) - Intubation/ventilation (endotracheal tube, LMA, igel or combitube) -Steroid injection such as dexmesthasone 4-6mg IV or hydrocortisone 100mg IV -Diphenhydramine 50mg IV -Aminophylline is no loner considered a first-time drug for management of bronchospasm -EMS Emesis with aspiration - occurs when the contents of the stomach enter the lungs secondary to emesis (vomiting or passive regurgitation) According to ASA, solid foods should not be eaten for how many hours prior to surgery? and clear liquids? - six ; two Treatment of aspiration - -activate EMS, protect the IV catheter -100% oxygen via bag/mask -turn patient on his/her right side with head down -tonsil suction of oral cavity/oropharynx -removal of visible foreign bodies with a laryngoscope and Magill forceps -Intubation (ETT-preferred, LMA, igel, or combitube) with suction via suction catheter -transport to an acute care facility Hyperventilation - occurs when the patient is breathing at a faster rate than normal, or breathing more deeply than the body requires; exhaling too much carbon dioxide Treatment of hyperventilation - *early* -terminate treatment and remove foreign bodies from mouth and remove surgical instruments from view -maintain the airway -verbally try to calm the patient -monitor vital signs -do NOT give oxygen -have patient breathe into a bag to recapture exhaled CO2