Operating Department Practitioner
Emergencies

Advanced Life Support

Guidelines for resuscitation of an  adult or  child who is unconscious and not breathing, are given by the Resuscitation Council.

Anaphylactic shock

A severe hypersensitivity reaction to drugs or allergens, which can lead to asphyxia, cardiovascular collapse, and cardiac arrest. The reaction is sudden, severe, and involves the whole body.
  Resuscitation Council   ||   More

Aspiration

 Details

Asystole

Absence of electrical and mechanical activity in the heart - a non-shockable cardiac arrest.   Algorithm

Atrial Fibrillation

An arryhthmia: Rapid and asynchronous contractions of the atrium, causing irregular contraction of the ventricles. The pulse will be irregular in rate and strength, and the wrist and Apex pulse rates will be asymmetrical.  More

Barotrauma

Injury due to excess pressure in tissues.

Basic Life Support

Support Guidelines for resuscitation of an  adult or a  child who is unresponsive and not breathing, are given by the Resuscitation Council. There is also an algorithm for  newborn infants.

Beta (β) blockers

Negative inotropic drugs which block the affect of Adrenaline on the heart and blood vessels, by weakening effects of the Sympathetic Nervous System on heart conductivity, and reducing blood pressure and heart rate.  More

Bradycardia

Slow heart rate/pulse. Antimuscarinics, such as Glycopyrronium and Atropine, can be used to counter the bradycardia caused by Neostigmine.  Algorithm

Bronchospasm

Sudden difficulty in breathing caused by constriction of plain muscle in the walls of the bronchi. Spontaneously breathing patients may have an audible wheeze.  More

Can't intubate, can't ventilate

When intubation fails, and the patient suffers hypoxaemia and difficult ventilation, a rescue algorithm must be followed, as described by the  Difficult Airway Society

Cardiac arrest

The heart stops pumping blood around the body, resulting in unconsciousness and abnormal breathing, which requires immediate cardiopulmonary resuscitation.  More

Cardiac (pericardial) tamponade)

A condition in which gas or fluid, such as blood or pus, accumulates in the pericardium faster than the pericardial sac can stretch. If the fluid/gas significantly elevates the pressure on the heart, it will prevent the heart's ventricles from filling properly, leading to a low stroke volume, shock, and death.  More

Choking

The Resuscitation Council provides the algorithms for treating choking in  adults and  children over 1 year.

Code Red

A protocol for managing massive haemorrhage. (Blood bank: 3640)  More

Cricothyroidotomy

(Cricothyrotomy) An emergency procedure, to provide a temporary emergency airway, via the cricothyroid membrane (in the adult: 10 mm high, 22 mm wide), when there is obstruction at, or above, the larynx.   More

Difficult intubation

When routine intubation failure is unanticipated, any further attempts must be made according to the algorithm provided by the  Difficult Airway Society.
Note: ventilating the patient has priority over intubation.

Eclampsia

Hypertensive disorder of pregnancy and toxaemia of pregnancy. Pre-eclampsia is characterized by high blood pressure and significant amounts of protein in the urine, and this can develop into Eclampsia, where the patient may suffer tonic-clonic seizures.
 NICE guidelines

Emergency airway

 More

Emergency anaesthesia

An emergency case, such as a ruptured aortic aneurysm, demands minimum delay to anaesthetic induction (typically by RSI), and surgical intervention.  More

Epileptic fit

A neurological disorder marked by sudden recurrent episodes of sensory disturbance, loss of consciousness, or convulsions.
 First aid

Failed Rapid Sequence Induction

When routine RSI is unanticipated, follow the algorithm, as described by the  Difficult Airway Society.

Febrile convulsion

A seizure (rarely serious) which occurs in a child with a fever over 39°C (102.2°F).  More

Gastric reflux

Reflux of gastric contents. If the contents reach the lungs, permanent damage may occur. If the contents are very acidic, death can result.  More

Glasgow Coma Score

A system for rating a patient's level of consciousness, based on an assessment of 3 response types: Eye opening, Motor response, and Verbal response.  More

Heart block

Impaired conduction between the atria and ventricles.

Heart failure (congestive heart failure)

Heart failure is a global term for the state in which cardiac output is insufficient in meeting the needs of the body. Most commonly caused when cardiac output is low, and the body becomes congested with fluid.

Hypercapnia (hypercarbia)

Increased level of carbon dioxide in the blood.

Hyperkalaemia

A high level of serum potassium. Typically treated with IV calcium chloride.

Hypertension

Blood pressure which is above the normal range for a particular category of person, according to such factors as age and weight. Typical treatment is by a Beta-blocker, such as Atenolol, Esmolol, or Labetalol.

Hyperventilation (hyperpnoea)

Abnormally deep breathing or excessive ventilation of the lungs, usually accompanying emotional stress.  More

Hypokalaemia

A low level of serum potassium.

Hypotension

Blood pressure which is below the normal range for a particular category of person, according to such factors as age and weight. Typically treated by a Vasoconstrictor. Nausea can be a sign of hypotension.

Example Vasoconstrictors...
  • Mataraminol
  • Ephedrine
  • Noradrenaline
  • Phenylepharine
More

Hypothermia

Core body temperature below (35°C). Consequences can vary from minor to severe.  More

Hypoventilation (hypopnoea)

Hypoventilation refers to inadequate breathing and impaired gas exchange, which prevents the body from being able to remove carbon dioxide appropriately. As a consequence, there develops an increase in the level of carbon dioxide (hypercapnia) in the blood, together with a decreased level of oxygen.  More

Hypovolaemia

Reduced circulating blood volume.

Symptoms...
  • Dry mouth
  • Dry axillary skin
  • Thirst
  • Postural hypotension

The immediate goal is to raise systolic blood pressure to 100 mmHg, by administering 250-1,000 ml isotonic (0.9%) saline solution.

Hypoxia

Low level of oxygen in the tissues (cellular level).  More

Laryngospasm

A reflexive prolonged contraction of the laryngeal muscles, and closing of the vocal chords, characterised by noisy inspiration. If the vocal chords are completely closed, there will not be any airway noise.  More

Local anaesthetic toxicity

See  AAGBI guidelines.

Malignant Hyperthermia

An abnormality of the muscle fibre membrane. The two most powerful triggers are Suxamethonium and volatile agents, such as Halothane. Also triggered by Lignocaine, Atropine, Diazepam, Pancuronium, Phenothiazines, and stress.  More

Myocardial Infarction (heart attack)

Heart attack Necrosis of part of the heart muscle, due to interrupted blood supply, usually following a coronary thrombosis (artery occlusion).  More

Obstetrics

Complications  ||   Anaesthesia

Opioid overdose

Causes respiratory depression, signified by a low minute volume, with resultant hypercapnia.

Symptoms...
  • Pin-point pupils
  • Slow respiratory rate
  • Sighing
  • Hypercapnia, then hypoxia

Reverse with Naloxone, or stimulate respiration with eg, Doxapram.

Oxygen toxicity

A condition resulting from the harmful effects of breathing molecular oxygen at elevated partial pressures (hyperoxia). Severe cases can result in cell damage and death, with effects most often seen in the central nervous system, lungs and eyes. Oxygen toxicity is a concern for those on high concentrations of oxygen (particularly premature babies), and those undergoing hyperbaric oxygen therapy. Symptoms may include disorientation, breathing problems, burning sensation with deep breathing, anxiety, vomiting, and vision changes.

Paediatric Immediate Life Support

Algorithm

Panic attack

Psychological state, indicated by hyperventilation, tachycardia, and erythematous rash (redness), but without hypotension, pallor, wheeze, or urticarial rash.

Peri-arrest

Conditions which may precede or follow a cardiac arrest. Resuscitation Council

Pericardiocentesis

Aspiration of fluid through fifth intercostal space.

Pneumothorax

Accumulation of air (or other gas) in the pleural cavity, which may lead to collapse of the lung. Usually accompanied by sudden sharp pain in one side of the chest, during inspiration. The pneumothorax can clear of it's own accord.  More

Post operative nausea and vomiting

A side effect of general anaesthesia, suffered by 1 in 4 patients. If unmanaged, can lead to pulmonary aspiration of gastric contents. Younger patients are more susceptible than older ones, as are gynaecological, urological, strabismus correction, and middle ear surgery patients. Treatment is by  antiemetics, dispensing a combination of agents, until efficacy is achieved.  More

Postpartum Haemorrhage (PPH)

The loss of 500 ml or more of blood from the genital tract, within 24 hours of giving birth.   Description

Precordial thump

An attempt to interrupt an arrhythmia, such as Ventricular Fibrillation or pulseless Ventricular Tachycardia, by making a single strike, with the fist, to the centre of the patient's sternum. The thump is only effective if made at the onset of a witnessed and monitored adverse rhythm (VF/pVT), and a defibrillator is not immediately available. Latest resuscitation guidelines de-emphasise use of the precordial thump.

Pregnancy complications

See  NI Direct

Primary survey

Steps to take when assessing an unconscious patient.

Order of steps
StepDescription
DangerAssess Dangers to yourself and casualties
ResponseUse the Glasgow Coma Scale to ascertain the level of consciousness
AirwayExamine the Airway for obstructions
BreathingLook, listen, and feel for adequate respiratory effort. Supplement with oxygen to correct hypoxia, if saturations are below 95%
CirculationIf a carotid pulse is not palpable, then resuscitation should be commenced

Pulmonary embolism

An embolism which usually originates from the proximal veins of the thigh and pelvis.
Details   ||   More

Pulseless Electrical Activity (PEA)

A cardiac arrest where the patient has cardiac electrical activity, which would otherwise produce cardiac output and an obvious pulse. PEA usually has an underlying treatable cause which, in emergency situations, is most often hypovolemia. Performing a pulse check after a rhythm/monitor check will ensure that PEA is identified.  More

QuickTrach Cricothyrotomy kit

For making an airway opening during a "can't ventilate" emergency. 

Secondary survey

A more in depth survey of the patient than the primary survey.  More

Shock

Failure of the cardiovascular system to deliver adequate blood flow necessary to properly supply oxygen and nutrients to vital organs, particularly to the kidneys and brain. This inadequate tissue perfusion causes an accumulation of lactic acid in the tissues. If untreated, shock can lead to multiple organ failure.  More

Stridor

A harsh vibrating sound, during inspiration, caused by tumour, infection, or partial obstruction of the larynx or trachea.

Treatments...
• Oxygen and positioning the head of the bed 45 - 90 degrees.

• Nebulized racemic Adrenaline (0.5 to 0.75 ml of 2.25% racemic Adrenaline added to 2.5 to 3 ml of normal saline) in cases where airway oedema may be the cause of the stridor.

• Dexamethasone (Decadron) 4-8 mg IV q 8 - 12 h in cases where airway oedema may be the cause of the stridor; note that some time (hours) may be needed for dexamethasone to work fully.

• Inhaled Heliox (70% helium, 30% oxygen); the effect is almost instantaneous. Helium, being a less dense gas than nitrogen, reduces turbulent flow through the airways.

• Always ensure an open airway.

Suxamethonium apnoea

Prolonged effect of Suxamethonium, which means a patient may reverse from anaesthesia, but remain paralysed.  More

Syncope

A brief period of unconsciousness, due to reduced blood flow to the brain.

Tachycardia

Fast heart rate/pulse.

Causes include...
  • Anaemia
  • Fever
  • Hypovolaemia
  • Myocarditis
  • Pain
  • Vasodilation
  • Vagolytic drugs, such as Atropine

  Treatment  algorithm

Tension pneumothorax

Pneumothorax due6 to air escaping into the pleural cavity, typically as a consequence of a penetrating injury.   More

Thoracocentesis

Puncturing the Thorax to aspirate pleural fluid or gas.

Tracheotomy

A procedure to make an airway opening through the second or third tracheal ring, typically because of upper airway obstruction.
  • A lateral cut is made, superior to the sternal notch.
  • The skin is separated and surrounding tissues dissected, exposing the trachea.
  • The 2nd or 3rd tracheal ring is incised, and the tracheostomy tube placed.
  • The tube cuff is then inflated (2-5 ml).
  • The incision is sutured at the side of the tracheostomy tube.

Ventricular Fibrillation (VF)

VFHeart rhythm is chaotic - the heart is in a state of electrical chaos. No blood is pumped from the heart, and the patient has no pulse. The ECG trace lacks P-waves, QRS complexes, or T-waves. Action is electrical defibrillation.
See  Advanced Life Support

Ventricular Tachycardia (VT)

VTA pulseless ryhthm, characterised by regular fast beating of the ventricles (120 beats/min), which is too fast for them to fill with sufficient blood betweeen beats. Pulseless VT can lead to Ventricular Fibrillation, which is a more serious condition. Action for pulseless VT is electrical defibrillation.
See  Advanced Life Support