Anaesthetic Emergency Procedure

Re: Anaesthetic Emergency Procedure

daisy — Tue, 28 Apr 2009 19:06:57 GMT

yes i saw the head shaped dent in the wall LOL

cheers nick

Re: Anaesthetic Emergency Procedure

Nick Shackleton — Tue, 28 Apr 2009 17:15:49 GMT

Hey daisy!

You found the bit of wall I used to bang my head against??? Good luck with the exams....

Re: Anaesthetic Emergency Procedure

daisy — Tue, 28 Apr 2009 14:51:10 GMT

'I have heard the point re double dose with a fluid chaser down the ET ( a central line is optimum) and also deterioration of drawn up drugs, some because they are affected by light (hence the original storage being in amber bottles/vials, or due to reaction with the plastic in syringe.'

i agree with this point, the amount of pre loaded drugs we have to dispose of cus they've gone brown is unbelievible!!!!!!!! (thats when people can be bothered to check emergancy box that is)

but when i pointed this out to a senior member of staff i got told they were fine to use but may need a bit more, i'm sorry but i wudnt want these using on my animal , so i chuck them when nobody looking!

Re: Anaesthetic Emergency Procedure

Siobhan Steven — Tue, 28 Apr 2009 13:35:07 GMT

Just a suggestion, if anyone is interested in learning this in a 'text book' fashion, veteducation.com.au offer online courses in emergency care and critical care (two separate courses) which would help inform and answer a lot of the points raised here.I have done their courses and am only endorsing them because they are so good!

I have heard the point re double dose with a fluid chaser down the ET ( a central line is optimum) and also deterioration of drawn up drugs, some because they are affected by light (hence the original storage being in amber bottles/vials, or due to reaction with the plastic in syringe.

Re: Anaesthetic Emergency Procedure

Linda Moseley — Thu, 23 Apr 2009 20:20:32 GMT

[quote user="Cat Woman"]

One of our vets insists that we breathe into the tube rather than 100% oxygen. It really does work better at waking the patient up - or maybe it was the curry I had the night before....

[/quote]

I've tried both methods and agree that breathing into the tube yourself seems to produce quicker results. Not sure what the H&S police would say re. the risk of inhaling the anaesthetic gas though.

Re: Anaesthetic Emergency Procedure

Cat Woman — Wed, 22 Apr 2009 21:14:59 GMT

One of our vets insists that we breathe into the tube rather than 100% oxygen. It really does work better at waking the patient up - or maybe it was the curry I had the night before....

Re: Anaesthetic Emergency Procedure

Freckle — Wed, 22 Apr 2009 21:10:54 GMT

[quote user="Laura James"]

[quote user="MissVetNurse"]

[quote user="SaskiaVN"]

[quote user="StephB"]

[quote user="SaskiaVN"]

I also find that you need to check and re-stock you crash box regular and definitely after you have just used it.

I have also found it a blessing to have some drugs already drawn up and ready to use, for example adrenalin in a 1ml and a 2.5ml syringe, dopram injection, respiratory/heart stimulants.

Off the top of my head protocol;

If under ga & assuming already intubated - turn off inhalation anaesthesia, maintain on 100% Oxygen, get vet (if not already present), nurse can breathe for dog while vet administers stimulant drugs, when I say breathe, I mean either by inflating and squeezing the bag or what I would do personally, is disconnect et tube from anaesthetic circuit and blow down it myself, not too hard mind, just enough to inflate the lungs a little. Not for the faint hearted I know but when faced with a dying patient, I will resort to any measure to get them back on track.

If not intubated, then do so immediately and follow re above.

Not textbook I would think, but it has worked for me!

[/quote]

Would breathing in yourself not compromise the CO2 content entering the body? Wouldn't it be more beneficial to 'breathe' for them with the bag and O2 if it's an option? As long as the lungs are inflating correctly with the bag isn't that sufficient?

p.s. before i get misunderstood. i'm not saying you are wrong. I'm just asking why and the difference. this is something i'm learning at the moment and i'm interested in the details and knowledge of others.

[/quote]

You could have a point there, I'm not sure to be honest. I have actually seen a result a lot quicker by doing it this way as opposed to inflating the bag. BUT, I am open to suggestions

[/quote]

I've used Paula's method also and had success, more so than just o2 IPPV, not sure why this is but I was going to ask also

[/quote]

I may be wrong, but something from a lecture makes me think its because of the amount of CO2 entering the brain that stimulates breathing rather than oxygen - so as you're increasing the amount of CO2 that enters the brain (by breathing down the ET tube) your stimulating it more than if you're doing IPPV with 100% oxygen

[/quote]

I was also going to post that. I seem to recall (from discussions with a vet anaesthetist) that it is the levels of CO2 in the brain which stimulate the animal to breathe for itself, so your breath, rather than 100% O2, is more likely to do this.

Re: Anaesthetic Emergency Procedure

Saskia Quinn — Wed, 22 Apr 2009 20:47:14 GMT

photos didnt scan so well I'm afraid

The ones I had were showing an Ambu bag and defibrillator. If anyone really wants to see them, let me know and I will see what I can do.

Re: Anaesthetic Emergency Procedure

Saskia Quinn — Wed, 22 Apr 2009 19:30:10 GMT

You are most welcome Cat

Re: Anaesthetic Emergency Procedure

Cat Woman — Wed, 22 Apr 2009 17:17:12 GMT

Thank you so much SaskiaVN - you are a star!

Re: Anaesthetic Emergency Procedure

Saskia Quinn — Wed, 22 Apr 2009 00:47:59 GMT

Emergency Anaesthetic Procedure has been uploaded to the Wiki section of the site

Photographs demonstrating will follow tomorrow, I am too tired now and need my bed!!

Re: Anaesthetic Emergency Procedure

Saskia Quinn — Wed, 22 Apr 2009 00:08:38 GMT

I am in the process of finishing this and I will upload it to Wiki when I have. I will also try and scan in some photographs too

Re: Anaesthetic Emergency Procedure

Saskia Quinn — Tue, 21 Apr 2009 23:01:24 GMT

hehe no problems!! Yes, its from a book I have which is brilliant - Anaesthesia for veterinary nurses by Elizabeth Welsh

Re: Anaesthetic Emergency Procedure

Laura James — Tue, 21 Apr 2009 22:45:15 GMT

[quote user="MissVetNurse"]

[quote user="SaskiaVN"]

[quote user="StephB"]

[quote user="SaskiaVN"]

I also find that you need to check and re-stock you crash box regular and definitely after you have just used it.

I have also found it a blessing to have some drugs already drawn up and ready to use, for example adrenalin in a 1ml and a 2.5ml syringe, dopram injection, respiratory/heart stimulants.

Off the top of my head protocol;

If not intubated, then do so immediately and follow re above.

Not textbook I would think, but it has worked for me!

[/quote]

You could have a point there, I'm not sure to be honest. I have actually seen a result a lot quicker by doing it this way as opposed to inflating the bag. BUT, I am open to suggestions

[/quote]

I've used Paula's method also and had success, more so than just o2 IPPV, not sure why this is but I was going to ask also

[/quote]

Re: Anaesthetic Emergency Procedure

Cat Woman — Tue, 21 Apr 2009 22:34:23 GMT

Keep typing SaskiaVN! Tell me you're reading this from somewhere & not just making it up as you go along!!! All seems very professional.

Re: Anaesthetic Emergency Procedure

Saskia Quinn — Tue, 21 Apr 2009 22:12:43 GMT

[quote user="Cat Woman"]

But what about our inspection & a standard written procedure?? has anyone come across this before?

[/quote]

The Mnemonic ABCDEF is useful in remembering the elements of CPR. Each member of the team can then take responsibility for the treatment priorties of life support.

Airway (A)

Establish a patent airway. Intubate the patient with a well-fitting, cuffed endotracheal tube. Check that an existing tube is in the correct position and has not become blocked. In the event of upper airway obstruction, a long cannula can be passed to the tracheal bifuraction and oxygen insufflated until an emergency tracheostomy can be performed.

Breathing (B)

Perform intermittent positive pressure ventilation (IPPV) with 100% oxygen and an appropriate anaesthetic breathing system. Alternatively an Ambu bag can be used which will allow manual lung inflation with either air or 100% oxygen. Initially give the patient two breaths rapidly of 1-1.5 sec duration, and then ventilate once every 3-5 secs, interspersed with external chest compression. Inflation of the lungs should provide supranormal chest wall expansion. It is allso important to allow the lungs to deflate fully after each ventilation to facilitate venous return.

Before I continue typing, is this the sort of protocol you are after catwoman?

Re: Anaesthetic Emergency Procedure

Cat Woman — Tue, 21 Apr 2009 18:56:52 GMT

Thanks daisy, that would be great.

Re: Anaesthetic Emergency Procedure

daisy — Tue, 21 Apr 2009 18:01:40 GMT

yes nick were ARE still doing that and guess who wont change the practice LOL

Cat Woman

you can get a poster to explain protocol but im not sure who has done it but i can find out for you when im next at work, it really is good it explains everything from start to finish.

Re: Anaesthetic Emergency Procedure

Cat Woman — Tue, 21 Apr 2009 17:25:40 GMT

But what about our inspection & a standard written procedure?? has anyone come across this before?

Re: Anaesthetic Emergency Procedure

Nick Shackleton — Tue, 21 Apr 2009 12:44:38 GMT

You still doing that Daisy!!!! According to our anaesthetist the syringes need replacing weekly!! So false economy if you ask me! In the 2.5 yrs I was there I never used them! There were always enough bodies about for someone to be availble to draw up drugs in an emergacy!

Re: Anaesthetic Emergency Procedure

daisy — Tue, 21 Apr 2009 11:27:50 GMT

re the comment about having pre loaded syringes of emergancy drugs:

this is a protocol we follow in practice BUT in my research for my diploma this method is not recommended as the drugs lose their efficiency and it is imposible to dose accuratly and we also got informed when we had the RCVS insection that we could cease this protocol immediatly but the senior partner is not willing to change this practice!!!!

in my old practice this protocol was not followed and i must say i havnt noticed any real time saving or succes by having pre loaded syringes if a full team are working together

Re: Anaesthetic Emergency Procedure

Claire Cameron — Tue, 21 Apr 2009 10:46:13 GMT

[quote user="SaskiaVN"]

[quote user="StephB"]

[quote user="SaskiaVN"]

I also find that you need to check and re-stock you crash box regular and definitely after you have just used it.

I have also found it a blessing to have some drugs already drawn up and ready to use, for example adrenalin in a 1ml and a 2.5ml syringe, dopram injection, respiratory/heart stimulants.

Off the top of my head protocol;

If not intubated, then do so immediately and follow re above.

Not textbook I would think, but it has worked for me!

[/quote]

You could have a point there, I'm not sure to be honest. I have actually seen a result a lot quicker by doing it this way as opposed to inflating the bag. BUT, I am open to suggestions

[/quote]

I've used Paula's method also and had success, more so than just o2 IPPV, not sure why this is but I was going to ask also

Re: Anaesthetic Emergency Procedure

Saskia Quinn — Tue, 21 Apr 2009 08:26:55 GMT

[quote user="StephB"]

[quote user="SaskiaVN"]

I also find that you need to check and re-stock you crash box regular and definitely after you have just used it.

I have also found it a blessing to have some drugs already drawn up and ready to use, for example adrenalin in a 1ml and a 2.5ml syringe, dopram injection, respiratory/heart stimulants.

Off the top of my head protocol;

If not intubated, then do so immediately and follow re above.

Not textbook I would think, but it has worked for me!

[/quote]

You could have a point there, I'm not sure to be honest. I have actually seen a result a lot quicker by doing it this way as opposed to inflating the bag. BUT, I am open to suggestions

Re: Anaesthetic Emergency Procedure

Nick Shackleton — Tue, 21 Apr 2009 07:38:25 GMT

[quote user="STRVN"]

If you need to use adrenalin, I have seen it work better blowing it down the ET tube.

[/quote]

I believe you need double the dose and dilute with H2O?

Re: Anaesthetic Emergency Procedure

Nick Shackleton — Tue, 21 Apr 2009 07:37:40 GMT

[quote user="SaskiaVN"]

10cm/H2O is enough