Table Of ContentAnesthesia
Emergencies
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Anesthesia
Emergencies
K eith J . R uskin, MD
Professor of Anesthesiology and Neurosurgery
Yale University School of Medicine
New Haven, Connecticut
S tanley H . R osenbaum, MD
Professor of Anesthesiology, Medicine, and Surgery
Yale University School of Medicine
New Haven, Connecticut
1
3
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Library of Congress Cataloging-in-Publication Data
Anesthesia emergencies / [edited by] Keith J. Ruskin, Stanley H. Rosenbaum.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-0-19-539671-3
1. Anesthetic emergencies—Handbooks, manuals, etc. I. Ruskin,
Keith. II. Rosenbaum, Stanley H.
[DNLM: 1. Anesthesia—Handbooks. 2. Emergencies—Handbooks. WO 39
A579 2011]
RD82.5.A55 2011
617.9´6042—dc22
2010003454
9 8 7 6 5 4 3 2 1
Printed in the United States of America
on acid-free paper
Contents
Series Preface vii
Preface ix
Managing Emergencies: Lessons Learned from Aviation xi
Contributors xv
1 Airway Emergencies
Sekar S. Bhavani and D. John Doyle
1
2 Cardiovascular Emergencies
Ajoy Katari and Benjamin A. Kohl
25
3 Equipment Problems
James B. Eisenkraft
63
4 Ethical Considerations
Robert B. Schonberger and
Stanley H. Rosenbaum
77
5 Metabolic and Endocrine Emergencies
Lewis J. Kaplan
85
6 Miscellaneous Problems
Keith J. Ruskin
127
7 Neurosurgical and Neurologic Emergencies
Ira J. Rampil
143
8 Obstetric Emergencies
Robert Gaiser
165
vi
CONTENTS
9 Pediatric Emergencies
Jessica L. Wagner
203
10 Postanesthesia Care Unit
Sean M. Quinn and Keith A. Candiotti
239
11 Procedures
Ramachandran Ramani and Ala Haddadin
267
12 Regional Anesthesia Complications
Raymond S. Sinatra and Dan B. Froicu
297
13 Respiratory Emergencies
Vivek K. Moitra and Tricia E. Brentjens
313
14 Surgical Emergencies
Linda L. Maerz and Stephen M. Luczycki
337
15 Thoracic Emergencies
Marc S. Azran and Michael Nurok
363
Index 389
vii
Series Preface
Emergency physicians care for patients with any condition that may
be encountered in an emergency department. This requires that
they know about a vast number of emergencies, some common
and many rare. Physicians who have trained in any of the subspe-
cialties – cardiology, neurology, OBGYN and many others — have
narrowed their fi elds of study, allowing their patients to benefi t
accordingly. The Oxford University Press Emergencies series has
combined the very best of these two knowledge bases, and the
result is the unique product you are now holding. Each handbook
is authored by an emergency physician and a sub-specialist, allow-
ing the reader instant access to years of expertise in a rapid access
patient-centered format. Together with evidence-based recom-
mendations, you will have access to their tricks of the trade, and
the combined expertise and approaches of a sub-specialist and an
emergency physician.
Patients in the emergency department often have quite different
needs and require different testing from those with a similar emer-
gency who are in-patients. These stem from different priorities; in the
emergency department the focus is on quickly diagnosing an undiffer-
entiated condition. An emergency occurring to an in-patient may also
need to be newly diagnosed, but usually the information available is
more complete, and the emphasis can be on a more focused and
in-depth evaluation. The authors of each Handbook have produced
a guide for you wherever the patient is encountered, whether in
an out-patient clinic, urgent care, emergency department or on the
wards.
A special thanks should be extended to Andrea Seils, Senior Editor
for Medicine at Oxford University Press for her vision in bringing
this series to press. Andrea is aware of how new electronic media
have impacted the learning process for physician-assistants, medical
students, residents and fellows, and at the same time she if a fi rm
believer in the value of the printed word. This series contains the
proof that such a combination is still possible in the rapidly changing
world of information technology.
Over the last twenty years, the Oxford Handbooks have become
an indispensable tool for those in all stages of training throughout the
world. This new series will, I am sure, quickly grow to become the
viii
SERIES PREFACE
standard reference for those who need to help their patients when
faced with an emergency.
Jeremy Brown, MD
Series Editor
Associate Professor of Emergency Medicine
The George Washington University Medical Center
ix
Preface
Anesthesiology is unique among medical specialties, in that most
anesthetics and surgical procedures are uneventful. Critical events
can, however, occur without warning, are usually sudden, and may
be life-threatening. Anesthesiologists must be ready to detect and
manage unpredicted emergencies at any time.
The initial response to a critical event may determine its outcome.
A recent study found that early recognition and effective manage-
ment of complications were as important as their avoidance in
improving mortality during surgery. 1 The use of checklists and estab-
lished procedures, long an accepted practice in aviation, can help
health care providers quickly establish a diagnosis and begin treat-
ment. Anesthesia Emergencies can be used to prepare for emergen-
cies that may occur in the future, and to deal with critical events as
they happen.
Anesthesia Emergencies is written to help an anesthesia provider
deal with common complications or unforeseen emergencies during
the perioperative period. Chapters have been organized alphabet-
ically, and each section within a chapter is arranged alphabetically
by type of problem. Critical information has been highlighted. Each
chapter contains one or more references to textbook chapters or
review articles that will provide additional information.
Emergency readiness requires that the caregiver have the knowl-
edge, skills, and equipment necessary to resolve the problem. This
book will ideally be used to prepare for emergencies before they
occur. The authors recommend that if a specifi c type of problem
can be anticipated (e.g., massive hemorrhage in a postpartum patient
being brought to the operating room) the appropriate chapter should
be reviewed beforehand. All personnel on the care team should be
briefed on the critical events most likely to occur, and the actions
that will be taken during an emergency. This book can be used out-
side of the operating room to prepare for future events by reviewing
a section and thinking through the steps that would be needed for
successful resolution of the problem.
Ideally, Anesthesia Emergencies will be one part of an organized
approach that includes simulation and training in crisis resource
management. The authors recommend that when an emergency
occurs, the anesthesia provider call for help as quickly as possible and
1. Ghaferi AA, Birkmeyer JD, Dimick JB. Variation in hospital mortality associated
with inpatient surgery. N Engl J Med . 2009 Oct 1;361(14):1368–1375.
