DAANCE- Module 5- Office Anesthesia Emergencies

DAANCE- Module 5- Office Anesthesia Emergencies Mallampti Classification - ANSWER Visual analysis of the oral/oropharyngeal anatomy Mallampti Class I - ANSWER Visualization of the soft palate, fauces, uvula, anterior and posterior pillars Mallampti Class II - ANSWER Visualization of the soft palate, fauces, and uvula Mallampti Class III - ANSWER Visualization of the soft palate and the base of the uvula Mallampti Class IV - ANSWER Soft palate is not visible at all. Signs of Airway Obstruction - ANSWER Choking, gagging, substernal notch retraction, labored breathing, rapid pulse initially, then decreased pulse, respiratory arrest, and cardiac arrest Treatment of Airway Obstruction - ANSWER 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? - ANSWER 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 - ANSWER 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 - ANSWER 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 - ANSWER Patients with history of allergies, asthma, COPD, and bronchitis Diagnosis of Bronchospasm - ANSWER Labored breathing, aspirational difficulty, signs of diminishing respiratory status (cyanosis or decreased ventilation patterns on capnograph) Treatment of Bronchospasm - ANSWER 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 - ANSWER 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 - ANSWER 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 - ANSWER 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 - ANSWER 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 - ANSWER 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 Acute Coronary Syndrome - ANSWER Two components: 1. Angina: damage to myocardium from dimished blood flow through coronary arteries. 2. Myocardial infarction: death of myocardial tissue when coronary arteries become occlueded. Treatment of Angina Attack- what are the steps, and what can we assume after a certain amount of treatment? - ANSWER Stop surgery, give Nitroglycerine and 100% oxygen, make patient comfortable. If 3 doses of nitroglycerin does not provide relief, it should be assumed the patient is having a myocardial infarction Treatment of Miocardial infarction - ANSWER Stop surgery, remove foreign bodies from mouth, place in comfy position, oxygen, activate EMS when surgeon tells you too Treatment of Acute Coronary Syndrome - ANSWER Activate EMS and closely observe vitals, 100% O2 via mask, make patient comfy/reassure, attach AED defibrillator, Aspirin 325 mg, establish IV access with normal saline slow drip, morphine for pain MONA - ANSWER Morphine (helps with pain, decreases BP, and workload of heart) Oxygen (heart needs oxygen) Nitroglycerin (dilates blood vessels) Aspirin (thins blood) Treatment of Symptomatic Bradycardia - ANSWER Terminate the procedure, 100% O2, establish IV, Atropine, May need to be transported to the ER for transcutaneous pacing Treatment of Supraventricular Tachycardia - ANSWER Place patient in supine position, give adenosine, rapidly flush after with saline, repeat up to three times. Treatment of Premature Ventricular Contractions (PVCs) - ANSWER Try to determine cause and correct, lidocaine .5-1.5mg, repeat every 5 to 10 minutes up to 3mg Treatment of Ventricular Tachycardia - ANSWER If unstable treat as V. Fib. If stable: 100% O2, Amiodarone 150mg over 10 minutes, prepare for synchronous cardioversion Treatment of Ventricular Fibrillation - ANSWER Activate EMS immediately, CPR/mechanical defibrillation Continue CPR, establish IV and give epi 1mg, CPR/repeat shock as above, may give a single dose of vasopressin to replace 1 and 2 doses of epi. Amiodarone, lidocaine and magnesium may be considered as well. Continue CPR and recheck rhythm after 5 cycles Treatment of Asystole - ANSWER Administer CPR, epinephrine 1mg. IV. May repeat every 3-5 minutes. May give one does of vasopressin to replace 1st or 2nd dose of epi