DAANCE- Module 5- Office Anesthesia Emergencies
Mallampti Classification - ✔✔Visual analysis of the oral/oropharyngeal anatomy
Mallampti Class I - ✔✔Visualization of the soft palate, fauces, uvula, anterior and posterior pillars
Mallampti Class II - ✔✔Visualization of the soft palate, fauces, and uvula
Mallampti Class III - ✔✔Visualization of the soft palate and the base of the uvula
Mallampti Class IV - ✔✔Soft palate is not visible at all.
Signs of Airway Obstruction - ✔✔Choking, gagging, substernal notch retraction, labored breathing, rapid
pulse initially, then decreased pulse, respiratory arrest, and cardiac arrest
Treatment of Airway Obstruction - ✔✔Early Treatment: 100% O2 via nasal mask, trendelenburg position
(pack of surgical site), digital traction of tongue (with gauze, tongue forceps, hemostat, or sutures),
suctioning of the oropharynx.
Advanced Treatment: Abdominal thrusts, laryngoscopy, cricothrotomy.
Larygospasm- what is it, and what can a partial or complete closure result in? - ✔✔Protective reflex of
the vocal cords that attempts to stop foreign matter getting into the larynx, trachea, and lungs. Partial or
complete closure of the vocal cords can occur resulting in airway obstruction.
Treatment of Laryngospasm - ✔✔100% O2 via nasal hood, maintain/establish airway, pack off surgical
site, suction of oral cavity and oropharynx, positive pressure, 100% oxygen via bag/mask system,
succinylcholine
(Deepening the level of anesthesia may also help)
Bronchospasm - ✔✔Generalized contraction of the smooth muscles of the small bronchi and bronchioles
of the lungs, resulting in restriction of airflow to and from the lungs. Patient will have more difficulty
with expiration than inspiration.
, Patients more susceptible to bronchospasm - ✔✔Patients with history of allergies, asthma, COPD, and
bronchitis
Diagnosis of Bronchospasm - ✔✔Labored breathing, aspirational difficulty, signs of diminishing
respiratory status (cyanosis or decreased ventilation patterns on capnograph)
Treatment of Bronchospasm - ✔✔100% Oxygen via bag/mask, albuterol, atrovent, epinephrine injection,
intubation/ventilation, steroid injection, diphenhydramine, aminophylline. (Activate EMS after steroid
injection if it has not been resolved)
Aspiration - ✔✔Occurs when the contents of the stomach enter the lungs secondary to emesis, or when
a foreign body or fluid inadvertently enters the lungs from the oral pharyngeal cavity through the larynx.
Treatment of Emesis with Aspiration - ✔✔Activate EMS, 100% O2 via bag/mask, turn patient on right
side with head down (trendelenburg position), tonsil suction, removal of visible foreign bodies,
intubation, transport to acute care facility
Hyperventilation - ✔✔Occurs when the patient is breathing at a rate faster than his/her normal
breathing pattern or breathing more deeply than the body requires. Triggered by a change in body's
natural balance of oxygen and carbon dioxide. Patient exhales too much carbon dioxide and will begin to
feel light headed.
Treatment of Hyperventilation - ✔✔Early: terminate treatment and remove foreign bodies from mouth
and remove surgical instruments from view, maintain airway, verbally try to calm the patient, monitor
vitals, DO NOT GIVE OXYGEN, have patient breathe into a bag to recapture exhaled CO2
Advanced: If patient is not sedated try IV midazolam, diazepam, propofol, etc., continue to monitor
vitals, discontinue breathing bag as breathing returns to normal, activate EMS if condition deteriorates
Respiratory Depression and Apnea - ✔✔Can be the result of many different causes and can result in
increased heart rate and the development of hypoxia and cyanosis. Many of the drugs administered for
sedation can depress or stop the patient's ability to breathe
Mallampti Classification - ✔✔Visual analysis of the oral/oropharyngeal anatomy
Mallampti Class I - ✔✔Visualization of the soft palate, fauces, uvula, anterior and posterior pillars
Mallampti Class II - ✔✔Visualization of the soft palate, fauces, and uvula
Mallampti Class III - ✔✔Visualization of the soft palate and the base of the uvula
Mallampti Class IV - ✔✔Soft palate is not visible at all.
Signs of Airway Obstruction - ✔✔Choking, gagging, substernal notch retraction, labored breathing, rapid
pulse initially, then decreased pulse, respiratory arrest, and cardiac arrest
Treatment of Airway Obstruction - ✔✔Early Treatment: 100% O2 via nasal mask, trendelenburg position
(pack of surgical site), digital traction of tongue (with gauze, tongue forceps, hemostat, or sutures),
suctioning of the oropharynx.
Advanced Treatment: Abdominal thrusts, laryngoscopy, cricothrotomy.
Larygospasm- what is it, and what can a partial or complete closure result in? - ✔✔Protective reflex of
the vocal cords that attempts to stop foreign matter getting into the larynx, trachea, and lungs. Partial or
complete closure of the vocal cords can occur resulting in airway obstruction.
Treatment of Laryngospasm - ✔✔100% O2 via nasal hood, maintain/establish airway, pack off surgical
site, suction of oral cavity and oropharynx, positive pressure, 100% oxygen via bag/mask system,
succinylcholine
(Deepening the level of anesthesia may also help)
Bronchospasm - ✔✔Generalized contraction of the smooth muscles of the small bronchi and bronchioles
of the lungs, resulting in restriction of airflow to and from the lungs. Patient will have more difficulty
with expiration than inspiration.
, Patients more susceptible to bronchospasm - ✔✔Patients with history of allergies, asthma, COPD, and
bronchitis
Diagnosis of Bronchospasm - ✔✔Labored breathing, aspirational difficulty, signs of diminishing
respiratory status (cyanosis or decreased ventilation patterns on capnograph)
Treatment of Bronchospasm - ✔✔100% Oxygen via bag/mask, albuterol, atrovent, epinephrine injection,
intubation/ventilation, steroid injection, diphenhydramine, aminophylline. (Activate EMS after steroid
injection if it has not been resolved)
Aspiration - ✔✔Occurs when the contents of the stomach enter the lungs secondary to emesis, or when
a foreign body or fluid inadvertently enters the lungs from the oral pharyngeal cavity through the larynx.
Treatment of Emesis with Aspiration - ✔✔Activate EMS, 100% O2 via bag/mask, turn patient on right
side with head down (trendelenburg position), tonsil suction, removal of visible foreign bodies,
intubation, transport to acute care facility
Hyperventilation - ✔✔Occurs when the patient is breathing at a rate faster than his/her normal
breathing pattern or breathing more deeply than the body requires. Triggered by a change in body's
natural balance of oxygen and carbon dioxide. Patient exhales too much carbon dioxide and will begin to
feel light headed.
Treatment of Hyperventilation - ✔✔Early: terminate treatment and remove foreign bodies from mouth
and remove surgical instruments from view, maintain airway, verbally try to calm the patient, monitor
vitals, DO NOT GIVE OXYGEN, have patient breathe into a bag to recapture exhaled CO2
Advanced: If patient is not sedated try IV midazolam, diazepam, propofol, etc., continue to monitor
vitals, discontinue breathing bag as breathing returns to normal, activate EMS if condition deteriorates
Respiratory Depression and Apnea - ✔✔Can be the result of many different causes and can result in
increased heart rate and the development of hypoxia and cyanosis. Many of the drugs administered for
sedation can depress or stop the patient's ability to breathe
