Emergency Anaesthesia
Description:
An emergency case, such as a ruptured aortic aneurysm, demands minimum delay to
anaesthetic induction (typically by
RSI), and surgical intervention.
Fluid loss must be countered, with blood replacement for haemorrhage, plasma for
burns victims, and electrolyte solutions for intestinal losses.
The patient
will be taken straight into theatre, where the following must be ready for
induction:
Equipment...
- IV access
- A tilting trolley or table
- Monitoring and temperature probes
- Central Venous Pressure monitoring equipment
- Arterial line equipment
- Intubation equipment plus bougies
- "Difficult" intubation trolley
- Induction and emergency drugs
- Ventilator
- Fluids and warming coil
- Forced air warming device
Note: Suxamethonium is contra-indicated in burns patients.
Blood loss:
A loss of greater than 15% circulating volume causes tachycardia and
vasoconstriction. Although systolic pressure may be maintained, the
vasoconstriction may cause a rise in diastolic pressure, with a consequent fall
in pulse pressure (difference between diastolic and systolic pressures). The
ability to compensate for blood loss is reduced in frail and elderly
patients. If haemorrhage continues, BP and
urine output will fall. Oxygen sats may also fall.
Transfusion:
The priority is to restore circulating blood volume. Initially, give 0.9% saline,
then blood.