Anaesthesia, Emergency and Critical Care: First Minutes
What you must know
Airway assessment (mouth opening, Mallampati, thyromental distance), ASA physical status, spinal versus general anaesthesia, and safe local anaesthesia including maximum doses. Emergency care covers triage, the ABCDE approach, shock types, the sepsis bundle, basic and advanced life support, and the Glasgow Coma Scale.
Classic traps
- Local anaesthetic systemic toxicity: circumoral tingling, tinnitus, seizures and arrhythmias. Stop injection, secure the airway and give 20% lipid emulsion.
- Ketamine preserves airway reflexes and supports blood pressure, useful in hypovolaemia; propofol and thiopentone cause hypotension.
- In sepsis, take cultures, give antibiotics within the first hour, give fluids and measure lactate.
- Do not give blind fluid boluses to a patient with cardiogenic pulmonary oedema.
- Spinal anaesthesia causes hypotension through sympathectomy; preload and have vasopressors ready.
Rule of thumb
In any collapsed patient follow ABCDE and treat as you go. In anaphylaxis, adrenaline 0.5 mg intramuscularly (1:1000) into the anterolateral thigh is the first and most important drug, repeated after five minutes if needed.