Book contents
- Frontmatter
- Contents
- Contributors
- Preface
- Foreword
- Acknowledgements
- Introduction
- Chapter 1 The operating department practitioner, the patient and the law
- Chapter 2 Aspects of health and safety in the operating department
- Chapter 3 The caring practitioner
- Chapter 4 Strategies for infection control in the operating department
- Chapter 5 Sterilization, decontamination and the surgical field
- Chapter 6 The fundamentals of cardiovascular physiology
- Chapter 7 Fundamentals of respiratory physiology
- Chapter 8 Scientific principles in relation to the anaesthetic machine
- Chapter 9 Fundamentals of artificial ventilation of the lung
- Chapter 10 Scientific principles in relation to monitoring equipment
- Chapter 11 Scientific principles in relation to endoscopic, laser and radiological equipment
- Chapter 12 Pharmacological principles of drug administration
- Chapter 13 The pharmacology of drugs used in general anaesthesia
- Chapter 14 The local anaesthetic drugs - does the ideal agent exist?
- Chapter 15 The safe positioning of patients for surgery
- Chapter 16 Principles involved in the management and use of equipment
- Chapter 17 Understanding suture materials
- Chapter 18 Fundamentals ofpaediatric surgery and anaesthesia
- Chapter 19 Fundamentals of hyperthermia and hypothermia
- Chapter 20 Fundamentals of fluid and electrolyte balance during surgery
- Chapter 21 The physiology of blood and its administration
- Chapter 22 Fundamentals of pain relief
- Chapter 23 Fundamentals of dressings and drains in relation to wound healing
- Chapter 24 The recovery of patients from anaesthesia and surgery
- Chapter 25 Fundamentals of emergency and obstetric anaesthesia
- Chapter 26 Identification and management of anaesthetic emergencies
- Chapter 27 The fundamentals of emergency resuscitation
- Appendixes
- Index
Chapter 26 - Identification and management of anaesthetic emergencies
Published online by Cambridge University Press: 05 October 2015
- Frontmatter
- Contents
- Contributors
- Preface
- Foreword
- Acknowledgements
- Introduction
- Chapter 1 The operating department practitioner, the patient and the law
- Chapter 2 Aspects of health and safety in the operating department
- Chapter 3 The caring practitioner
- Chapter 4 Strategies for infection control in the operating department
- Chapter 5 Sterilization, decontamination and the surgical field
- Chapter 6 The fundamentals of cardiovascular physiology
- Chapter 7 Fundamentals of respiratory physiology
- Chapter 8 Scientific principles in relation to the anaesthetic machine
- Chapter 9 Fundamentals of artificial ventilation of the lung
- Chapter 10 Scientific principles in relation to monitoring equipment
- Chapter 11 Scientific principles in relation to endoscopic, laser and radiological equipment
- Chapter 12 Pharmacological principles of drug administration
- Chapter 13 The pharmacology of drugs used in general anaesthesia
- Chapter 14 The local anaesthetic drugs - does the ideal agent exist?
- Chapter 15 The safe positioning of patients for surgery
- Chapter 16 Principles involved in the management and use of equipment
- Chapter 17 Understanding suture materials
- Chapter 18 Fundamentals ofpaediatric surgery and anaesthesia
- Chapter 19 Fundamentals of hyperthermia and hypothermia
- Chapter 20 Fundamentals of fluid and electrolyte balance during surgery
- Chapter 21 The physiology of blood and its administration
- Chapter 22 Fundamentals of pain relief
- Chapter 23 Fundamentals of dressings and drains in relation to wound healing
- Chapter 24 The recovery of patients from anaesthesia and surgery
- Chapter 25 Fundamentals of emergency and obstetric anaesthesia
- Chapter 26 Identification and management of anaesthetic emergencies
- Chapter 27 The fundamentals of emergency resuscitation
- Appendixes
- Index
Summary
An anaesthetic emergency is usually an unexpected crisis event, which may lead to the imminent death of the patient. Crises may easily develop into panic scenarios affecting all theatre workers, both medical and non-medical, and it is therefore important that not only the anaesthetist but the assistant to the anaesthetist has a clear understanding of how these events maybe managed.
MASSIVE BLOOD LOSS
BLOOD VOLUME
The blood volume of an adult is approximately 7ml/kg of body weight (about 8-9ml/kg in children). Thus the circulating blood volume of a 70kg patient is about 5 litres. This is not significantly increased in obesity as this calculation is based on ideal body weight.
RECOGNITION
The initial problem in the management of haemorrhage is its recognition. Blood loss during a major vascular procedure, for example, may be immediately obvious but this is not always the case and bleeding may often be occult, i.e. hidden. This may occur during minimal access surgery (such as transanal endoscopic procedures) or following trauma (with unrecognized bleeding into one or more body compartments, e.g. abdomen, retroperitoneal space, soft tissues of the thighs, etc.). Obviously definitive management of the patient will depend on identification of the source of blood loss.
Uncontrolled haemorrhage causes loss of both circulating blood volume and oxygen-carrying capacity and finally leads to hypotension and hypoxic cellular damage. The body has developed compensatory mechanisms that try and prevent this. Blood loss of up to about 15% of circulating volume (i.e. about 700 ml) may produce no change in blood pressure and only a mild reflex tachycardia but with further uncorrected haemorrhage (up to about 1500 ml), tachycardia will become obvious. However, although systolic blood pressure may be maintained, vasoconstriction may cause a rise in diastolic pressure with a consequent fall in pulse pressure (i.e. the difference between systolic and diastolic pressures gets smaller).
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- Fundamentals of Operating Department Practice , pp. 287 - 298Publisher: Cambridge University PressPrint publication year: 1999
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