Emergencies, Resuscitation and Crisis Management in Anesthesia
What the exam tests
Crisis questions test recognition and first-line treatment: ACLS, anaphylaxis, LAST, malignant hyperthermia, airway fire, and massive hemorrhage.
Core rules
- ACLS: high-quality CPR, early defibrillation for VF/pVT, epinephrine 1 mg every 3-5 min, and treat reversible causes.
- Anaphylaxis: IM epinephrine 0.5 mg adult (0.01 mg/kg pediatric) into the lateral thigh; fluids; remove trigger.
- LAST: stop injection, airway and oxygen, benzodiazepine for seizures, 20% lipid emulsion 1.5 mL/kg bolus, then infusion.
- Malignant hyperthermia: stop triggers, dantrolene 2.5 mg/kg IV, hyperventilate with 100% O2, cool, and treat hyperkalemia.
- Airway fire: stop gas, remove tube, extinguish with saline, reintubate.
- Massive hemorrhage: activate protocol, blood products, tranexamic acid, avoid crystalloid overload.
Worked example
After interscalene block, a patient becomes agitated, then seizes. Reasoning: LAST until proven otherwise. Stop injection, secure the airway, give lipid emulsion 20% 1.5 mL/kg bolus, then 0.25 mL/kg/min infusion; support circulation. Do not give more local anesthetic.
Traps
Giving subcutaneous epinephrine instead of IM; delaying lipid emulsion; using dantrolene for LAST; continuing surgery during MH; using calcium-channel blockers with dantrolene.