© The Royal College of Anaesthetists 2016

Getting Started - Anaesthetic Emergencies

During your novice training you will be working under direct supervision until you have completed your Initial Assessment of Competence. Nevertheless, it is important that you take time to become acquainted with the immediate management of common emergencies encountered in anaesthesia. A clear understanding of the appropriate management steps will aid your decision making process when faced with an emergency situation.

 

Airway Emergencies
Airway management is an inherent part of anaesthesia, which when difficult, can be very stressful. The Difficult Airway Society has developed detailed guidelines on how to manage unanticipated difficult tracheal intubation in both routine and emergency circumstances, as well as, ‘can’t intubate, can’t ventilate’ situations. Familiarize yourself with the different scenarios and equipment options at each step of the flow chart during your early days in anaesthetic practice. Resources available include:

 

Anaphylaxis
The nature of anaesthesia means that we commonly use agents known to be associated with anaphylactic reactions; these include muscle relaxants, antibiotics and latex. Presentation of anaphylaxis can be heterogeneous, thus a high index of suspicion is necessary to establish the diagnosis and ensure prompt management. Resources available include:

 

Local Anaesthetic Toxicity
Intralipid 20% is used for Local Anaesthetic Toxicity and you should ensure that you know where it is kept as well as the dosing and infusion regimens. The AAGBI has produced laminated guidelines which are normally available in most operating theatres or anaesthetic rooms. Resources include:

 

Malignant Hyperthermia
Malignant Hyperthermia (MH) is a rare autosomal dominant condition, that can present as an acute emergency in susceptible individuals following exposure to a trigger agent such as volatile anaesthetic agents or suxamethonium. A thorough preoperative assessment is necessary to identify individuals with a genetic predisposition before theatre. Malignant Hyperthermia is associated with significant mortality and its emergency management is detailed in the AAGBI guidelines. As part of your induction at your new hospital you should ensure that you know where Dantrolene is located. Resources available include:

 

Following successful completion of your Novice Training, you will progress to being 'On Call'. During this time you may also be called to emergencies to aid other health professionals under conditions that can be both stressful and challenging. A fundamental understanding of the acute management of these emergencies including Advanced Life Support and major haemorrhage is essential. In all circumstances it is important to recognise your own limitations and call for help early. Try and develop awareness for situations that present danger and anticipate problems that may arise.

Further guidance for all these emergencies can be found in the Other Resources section of this disk.