Emergencies in Anaesthesia

560 Pages·2009·5.9 MB·English

by  Keith Allman

4A true life-threatening emergency. Memorizing these conditions may
help. Call immediately for help. Try to remain calm and quickly assess ABC.
Once the problem has been dealt with remember to reassess—other prob-
lems may have been forgotten or missed in the heat of the moment.
3These patients need to be assessed very quickly, because they can
rapidly deteriorate. Consider senior help/advice.
2These conditions require careful assessment and correction but are
unlikely to become life-threatening emergencies.
1These sections cover management guidelines or advice on clinical
dilemmas. The timing of clinical intervention is under the control of the
anaesthetist.
OXFORD MEDICAL PUBLICATIONS
Emergencies in
Anaesthesia
Second edition
Published and forthcoming titles in the Emergencies series:
Emergencies in Anaesthesia
Edited by Keith Allman, Andrew McIndoe, and Iain H. Wilson
Emergencies in Cardiology
Edited by Saul G. Myerson, Robin P. Choudhury, and Andrew Mitchell
Emergencies in Clinical Surgery
Edited by Chris Callaghan, J. Andrew Bradley, and Christopher Watson
Emergencies in Critical Care
Edited by Martin Beed, Richard Sherman, and Ravi Mahajan
Emergencies in Nursing
Edited by Philip Downing
Emergencies in Obstetrics and Gynaecology
Edited by S. Arulkumaran
Emergencies in Oncology
Edited by Martin Scott-Brown, Roy A.J. Spence, and Patrick G. Johnston
Emergencies in Paediatrics and Neonatology
Edited by Stuart Crisp and Jo Rainbow
Emergencies in Palliative and Supportive Care
Edited by David Currow and Katherine Clark
Emergencies in Primary Care
Chantal Simon, Karen O’Reilly, John Buckmaster, and Robin Proctor
Emergencies in Psychiatry
Basant K. Puri and Ian H. Treasaden
Emergencies in Radiology
Edited by Richard Graham and Ferdia Gallagher
Emergencies in Respiratory Medicine
Edited by Robert Parker, Catherine Thomas, and Lesley Bennett
Head, Neck and Dental Emergencies
Edited by Mike Perry
Medical Emergencies in Dentistry
Nigel Robb and Jason Leitch
Oxford University Press makes no representation, express or implied, that
the drug dosages in this book are correct. Readers must therefore always
check the product information and clinical procedures with the most up
to date published product information and data sheets provided by the
manufacturers and the most recent codes of conduct and safety regula-
tions. The authors and publishers do not accept responsibility or legal
liability for any errors in the text or for the misuse or misapplication of
material in this work.
Emergencies
in Anaesthesia
Edited by
Keith G. Allman MD FRCA
Consultant Anaesthetist,
Royal Devon and Exeter NHS Foundation Trust, UK
Andrew K. McIndoe FRCA
Consultant Anaesthetist and Senior Clinical Lecturer,
University Hospitals Bristol NHS Foundation Trust, UK
Iain H. Wilson FRCA
Consultant Anaesthetist,
Royal Devon and Exeter NHS Foundation Trust, UK
1
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Data available
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Oxford handbook of emergencies in clinical surgery
Typeset by Cepha Imaging Private Ltd., Bangalore, India
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ISBN 978–0–19–956082–0
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v
Preface
Welcome to the second edition of Emergencies in Anaesthesia. We were
delighted with the feedback from the fi rst edition and have incorporated
many of the suggestions and comments into this updated text.
The successful management of an emergency arising during anaesthesia
depends on the anaesthetist and their team reacting in a calm and logical
way. Our ability to do this is much improved by experience, training and
preparation of both the individual and the team.
Preparation for emergencies includes gaining the correct knowledge,
skills, equipment and help. Protocols provide a structure, which help us
to focus and treat the likeliest causes, whilst remembering to exclude
the rare.
When all personnel work as a team in a practised approach, and are led
effectively, patient risk is minimised. Teamworking helps reduce the chance
of human factors interfering with performance. There are a number of
ways to prepare for managing emergencies including reading, seminars and
simulation.
Emergencies in Anaesthesia has been written to help anaesthetists an-
ticipate different emergency situations that may arise in various areas of
anaesthesia. We have described topics that may need to be managed
immediately or as soon as practicable. These include problems that may
arise in theatre, preoperatively or in recovery. Each emergency has a de-
scription of the most common presentations, immediate action required,
other potential diagnoses to exclude, and further care required.
We hope that Emergencies in Anaesthesia will stimulate readers to re-
fl ect on their knowledge and readiness to deal with any of the situations
discussed. Additionally, since dealing with emergencies requires all mem-
bers of the team to help, and for the theatres to be properly equipped,
this book may serve to remind us what developments we need in our
workplace. Dealing with the unexpected is always made easier by effec-
tive planning.
We look forward to feedback on the book, good and bad – please
post any comments via the OUP website: www.oup.com/uk/medicine/
handbooks
We would especially like to thank all our authors for their excellent
work and our families for their continued support.
Keith G Allman
Andrew K McIndoe
Iain H Wilson
March 2009
vi
Note on drug dosages
Some of the drugs and dosages are suggested outside of those stated in
the BNF because the book describes the use of drugs in specialist situa-
tions. Always refer of the BNF and product literature before using any
drug with which you are unfamiliar.
vii
Contents
Abbreviations ix
Contributors xvii
1 Cardiovascular 1
2 Respiratory 41
3 Airway 65
4 Paediatrics 105
5 Obstetrics 145
6 Neurosurgery 179
7 Thoracics 209
8 Regional anaesthesia 235
9 Metabolic and endocrine 255
10 Recovery problems 313
11 Emergency department problems 353
12 Equipment problems 379
13 Miscellaneous problems 391
14 Practical procedures 427
Appendix 1 Drugs 505
Appendix 2 Checklist 527
Index 531
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