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DAANCE Module V - Office Anesthesia Emergencies
Terms in this set (24)
Class I - Mallampati Classification
Visualization of the soft palate, fauces, uvula, anterior and posterior pillars.
Class II - Mallampati Classification
Visualization of the soft palate, fauces and uvula.
Class III - Mallampati Classification
Visualization of the soft palate and the base of the uvula.
Class IV - Mallampati Classification
Soft palate is not visible at all.
A deficiency of oxygen in the body's tissues and can be the end result of significant cardiorespiratory complications.
(Low levels of oxygen in the body's tissues.)
Foreign Bodies - early treatment
a. 100% Oxygen via nasal mask.
b. Placing the patient in a trendelenburg position (Supine with feet 15 - 30 degrees higher than the head.), packing off the surgical site.
c. Digital traction of the tongue with gauze, tongue forceps, a hemostat or sutures.
d. Suctioning the oropharynx.
Foreign Bodies - advanced treatment
a. Abdominal thrusts (if no airflow with ventilation).
b. Direct laryngoscopy (Utilizing a laryngoscope for visualization and retrieval of the foreign body with forceps and/or suction).
c. Cricothyrotomy (Creating a surgical airway).
A procedure involving incision or passage of a large needle through the cricothyroid ligament to create an airway for emergency relief of upper airway obstruction; also called coniotomy.
Treatment by Cricothyrotomy
1. Cleanse the overlying skin.
2. Utilize the emergency cricothyrotomy needle/canula kit or
3. Locate the cricothyrotomy membrane with a large gauge
(ie 22 g) needle puncture, or
4. Stab incision with a surgical blade (ie #15 blade) thru membrane in a horizontal direction.
5. Dilate opening with hemostat.
6. Introduce #4 endotracheal tube.
7. Secure tube and ventilate through bag 100% oxygen.
Chronic Obstructive Pulmonary Disease
A protective reflex of the vocal cords that attempts to prevent passage of foreign matter, such as blood or excessive secretions, into the larynx, trachea and lungs. Partial or complete closure of the vocal cords can occur, resulting in airway obstruction. Crowing sounds and labored respiratory efforts are typical of a partial laryngospasm. A complete laryngospasm is charactorized by cessation of crowing sounds, suprasternal retraction and paradoxical chest movements (a rocking pattern of the chest and abdomen).
Treatment of Laryngospasm
Closely observe the oxygen saturation with pulse oximetry.
1. 100% oxygen via nasal hood.
2. Establish proper head position to maintain/establish airway.
3. Pack off surgical site.
4. Suction of oral cavity and oropharynx with tonsillar suction tip.
5. Positive pressure, 100% oxygen via a bag/mask system.
6. Succinylcholine (Anectine) 10-20 mg. I.V. - support ventilation manually until the efforts of succinylcholine (Anectine) may precipitatie malignant hyperthermia in susceptible individual.
* Occasionally, a light anesthesia plane will help trigger the reflex that causes laryngospasm. Deepening the level of anesthesia may be carefully utilized on a case-by-case basis.
A generalized contraction of the smooth muscles of the small bronchi and brochioles in the lungs, resulting in a restriction of the flow of air to and from the lungs. During which a pt has more difficulty with expiration than with inspiration. Pt exhibits wheezing & often show labored breathing.
Treatment of Bronchospasm
Closely monitor the oxygen saturation via pulse oximetry.
1. 100% oxygen via a bag/mask.
2. Albuterol inhalation (Beta-2 Agonist) 4-8 puffs via inhaleer every 20 minutes for up to 4 hours, then every 1-4 hours as needed.
3. Ipratropium bromide (Atrovent) 2 puffs stat; repeat every 4 hours.
4. Epinephrine injection (alpha & beta Agonist).
a. 0.3-0.5 mg 1:100 S.C. subcutaneous). Repeat every 20 minutes to maximum of 1 mg total.
b. 0.5 mL of 1:1000 solution sublingual (if anaphylaxis is suspected and/or hypotension present).
c. IV epinephrine: 3-5 mL of 1:10,000 solution (reserved for severe bronchospasm only in patient with hypotension present).
5. Intubation/ventilation (endotracheal tube, LMA or combitube).
6. Steroid injection such as dexamethasone (Decadron) 4-6 mg IV or hydrocortisone (SoluCortef) 100 mg IV.
7. Diphenhydramine (Benadryl) 50 mg IV.
8. Aminophylline is no longer considered a first time drug for management of bronchospasms.
9. If a bronchospasm has not completely responded to steps 1 thru 6, EMS should be activated and transport the patient to an acute care facility.
Emesis with Aspiration
Aspiration occurs when the contents of the stomach enter the lungs secondary to emesis (vomiting or passive regurgitation) or when a foreign body or fluid inadvertently enters the lungs from the oral pharyngeal cavity through the larynx.
Treatment of Emesis with Aspiration
Closely monitor the oxygen saturation via pulse oximetry.
1. Activate EMS, protect the integrity of the IV catheter.
2. 100% oxygen via bag/mask.
3. Turn patient on his/her right side with the head down (Trendelenburg position).
4. Tonsil suction of oral cavity/oropharynx.
5. Removal of visible foreign bodies witha laryngoscope and McGill forceps.
6. Intubation (ETT-preferred, LMA, combitube) - with suction bia a suction catheter.
7. Transport to an acute care facility.
Occurs when the pt is breathing at a rate faster than his/her normal breathing pattern or more deeply than the body requires. Results in pt exhaling too much carbon dioxide.
Early Treatment of Hyperventilation
1. Terminate treatment and remove foreign bodies form mouth and surgical instruments from pt view.
2. Maintain the airway.
3. Verbally try to calm the pt.
4. Monitor vital signs.
5. Do NOT give oxygen.
6. Have pt breathe into a bag to recapture exhaled CO2.
Advanced Treatment of Hyperventilation
1. If non-sedated pt fails to respond, can try IV midazolam, diazepam, propofol, etc.
2. Continue to monitor vital signs.
3. Discontinue rebreathing bag as breathing returns to normal.
4. Activate EMS if condition deteriorates.
Absence of breathing.
Treatment for Myocardial Infarction
1. Activate EMS, closely observe vital signs.
2. 100% oxygen via a mask.
3. Make patient comfortable/reassure.
4. Attach AED or defibrulator.
5. Aspirin 325 mg.
6. Establish IV access with normal saline slow drip.
7. Morphine sulfate for pain 2-4 mg IV push. Repeat every 5-10 minutes as needed.
1. (4) Morphine
2. (2) Oxygen
3. (1) Nitroglycerin
4. (3) Aspirin
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