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Emergencies in Anaesthesia PDF

560 Pages·2015·1.84 MB·English
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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 1 Great Clarendon Street, Oxford OX2 6DP Oxford University Press is a department of the University of Oxford. It furthers the University’s objective of excellence in research, scholarship, and education by publishing worldwide in Oxford New York Auckland Cape Town Dar es Salaam Hong Kong Karachi Kuala Lumpur Madrid Melbourne Mexico City Nairobi New Delhi Shanghai Taipei Toronto With offi ces in Argentina Austria Brazil Chile Czech Republic France Greece Guatemala Hungary Italy Japan Poland Portugal Singapore South Korea Switzerland Thailand Turkey Ukraine Vietnam Oxford is a registered trade mark of Oxford University Press in the UK and in certain other countries Published in the United States by Oxford University Press Inc., New York © Oxford University Press 2009 The moral rights of the author have been asserted Database right Oxford University Press (maker) First edition published 2005 Second edition published 2009 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior permission in writing of Oxford University Press, or as expressly permitted by law, or under terms agreed with the appropriate reprographics rights organization. Enquiries concerning reproduction outside the scope of the above should be sent to the Rights Department, Oxford University Press, at the address above You must not circulate this book in any other binding or cover and you must impose this same condition on any acquirer British Library Cataloguing in Publication Data Data available Library of Congress Cataloging in Publication Data Oxford handbook of emergencies in clinical surgery Typeset by Cepha Imaging Private Ltd., Bangalore, India Printed in China on acid-free paper by Asia Pacifi c Offset Limited ISBN 978–0–19–956082–0 10 9 8 7 6 5 4 3 2 1 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 This page intentionally left blank

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