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OXFORD MEDICAL PUBLICATIONS

Anaesthesia for
Emergency Care
Oxford Specialist Handbooks published and forthcoming
General Oxford Specialist Oxford Specialist Handbooks
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and Diabetes
Oxford Specialist Handbooks Paediatric Gastroenterology,
in Anaesthesia Hepatology, and Nutrition
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Ultrasound Techniques Paediatric Respiratory Medicine
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Disease Surgical Oncology
End of Life in the Intensive Urological Surgery
Care Unit Vascular Surgery
Oxford Specialist
Handbooks in
Anaesthesia
Anaesthesia
for Emergency
Care
Edited by

Jerry Nolan
Consultant in Anaesthesia and Intensive Care Medicine
Royal United Hospital NHS Trust,
Bath, UK

Jasmeet Soar
Consultant in Anaesthesia and Intensive Care Medicine
Southmead Hospital, North Bristol NHS Trust,
Bristol, UK

1
1
Great Clarendon Street, Oxford OX2 6DP,
United Kingdom
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and education by publishing worldwide. Oxford is a registered trade mark of
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First Edition published in 2012
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 v

Preface

Anaesthetizing patients for surgical and medical emergencies can be chal-

lenging. The time critical nature of the intervention may mean proceeding
with a limited medical history and only a brief assessment with minimal
investigations. Ideally, these patients should be fully resuscitated, but in
some circumstances (e.g. after major trauma) anaesthetizing the patient
can be an essential component of the initial resuscitation.
When planning this book, we aimed to include most of procedures
encountered by the ‘on-call’ anaesthetist, both during the day and out-of-
hours. In keeping with the Oxford Handbook series, the style is concise but
we have tried to include the essential information needed to anaesthetize
these patients safely. The first section comprises a series of topics that
are generic to many emergencies and the remaining sections cover
a full range of conditions that may require anaesthesia in the operating
room, emergency department, critical care unit, and radiology suite. In
recognition of the increasing role of doctors in prehospital emergency
medicine, we have included a section on prehospital anaesthesia and
transport. Clearly, every possible scenario cannot be covered in this book.
If there is any doubt about the best way to proceed in an emergency, seek
expert help early.
Although aimed principally at the anaesthetic trainee, this book should
be of value to consultants in anaesthesia and critical care and to trainees
and consultants in emergency medicine.
We would appreciate feedback (to the e mail address below) about this
book, particularly in relation to topics that we have omitted or any errors
that we have missed. Finally, we thank all the authors for their high quality
contributions in the face of pressing deadlines and our wives and children
who now struggle to remember what we look like.

Jerry and Jasmeet

[email protected]
2012
This page intentionally left blank
 vii

Contents

Contributors ix
Symbols and Abbreviations xiii

1 General Principles 1
2 Prehospital 53
3 The Injured Patient 63
4 Anaesthesia for the Critically Ill Patient 109
5 General Surgical Emergencies 137
6 Ear, Nose, and Throat Emergencies 155
7 Maxillofacial Emergencies 171
8 Cardiovascular Emergencies 179
9 Neurological Emergencies 215
10 Plastic Surgery 249
11 Obstetric Emergencies 261
12 Urological Emergencies 289
13 Paediatric Emergencies 297
14 Ophthalmic Emergencies 337
15 Anaesthesia for Emergency Radiological
Procedures 343
16 Anaesthetic Emergencies 355

Index 393
This page intentionally left blank
 ix

Contributors

Anne-Marie Amphlett Charles Deakin

Specialist Trainee Consultant in Cardiac Anaesthesia
Bristol School of Anaesthesia and Intensive Care Medicine
University Hospital Southampton
Monica Baird
Consultant in Anaesthesia Simon Finney
Royal United Hospital NHS Trust Consultant in Anaesthesia and
Bath Intensive Care Medicine
Guy Bayley Royal Brompton Hospital, London
Consultant in Paediatric Andrew Georgiou
Anaesthesia, Specialist Trainee
Bristol Royal Hospital for Children
Bristol School of Anaesthesia
Jonathan Benger
Professor of Emergency Care,
Ben Gibbison
University of the West of England, Specialist Trainee
Bristol and Consultant in Bristol School of Anaesthesia
Emergency Medicine,
University Hospitals Bristol Amit Goswami
NHS Foundation Trust Specialist Trainee
Bristol School of Anaesthesia
Craig Carroll
Consultant in Anaesthesia Richard Griffiths
Salford Royal Hospital NHS Consultant in Anaesthesia
Foundation Trust Peterborough and Stamford
Hospitals NHS Trust
Emma Clow
Specialist Trainee Kim J. Gupta
Bristol School of Anaesthesia Consultant in Anaesthesia and
Intensive Care Medicine,
Tim Cook
Royal United Hospital NHS Trust,
Consultant in Anaesthesia Bath
and Intensive Care,
Royal United Hospital NHS Carl Gwinnutt
Trust, Bath Formerly Consultant in
Anaesthesia
Jules Cranshaw
Salford Royal Hospital NHS
Consultant in Anaesthesia and Foundation Trust
Intensive Care Medicine
Royal Bournemouth Hospital, Clare Hommers
Bournemouth Specialist Trainee
Rhys Davies Bristol School of Anaesthesia
Consultant in Anaesthesia
North Bristol NHS Trust, Bristol
x CONTRIBUTORS

Tim Hooper Henry Murdoch

Specialist Trainee Specialist Trainee
Bristol School of Anaesthesia Bristol School of Anaesthesia
Dom Hurford Jerry Nolan
Specialist Trainee Consultant in Anaesthesia and
Bristol School of Anaesthesia Intensive Care Medicine,
Royal United Hospital NHS Trust,
Rob Jackson Bath
Specialist Trainee
Bristol School of Anaesthesia Judith Nolan
Consultant in Paediatric
Chris Johnson Anaesthesia,
Consultant in Anaesthesia Bristol Royal Hospital for Children
North Bristol NHS Trust, Bristol
Sonja Payne
Alistair Johnstone Specialist Trainee
Specialist Trainee Bristol School of Anaesthesia
Bristol School of Anaesthesia
Carol J. Peden
Rebecca Leslie Consultant in Anaesthesia and
Specialist Trainee Intensive Care Medicine,
Bristol School of Anaesthesia Royal United Hospital NHS Trust,
Bath
David Lockey
Consultant in Anaesthesia and Susanna Ritchie-McLean
Intensive Care Medicine, North Specialist Traineee in Anaesthesia,
Bristol NHS Trust and London Peterborough & Stamford
Helicopter Emergency Hospitals NHS Foundation Trust
Medical Service,
Royal London Hospital Edward Scarth
Specialist Trainee
Melanie McDonald Bristol School of Anaesthesia
Specialist Trainee
Bristol School of Anaesthesia Joe Sebastian
Consultant in Anaesthesia
Patrick Magee Salford Royal Hospital NHS
Consultant in Anaesthesia Foundation Trust
Royal United Hospital NHS Trust,
Bath Jasmeet Soar
Consultant in Anaesthesia
Thomas Martin and Intensive Care Medicine,
Specialist Trainee North Bristol NHS Trust,
Bristol School of Anaesthesia Bristol
Lucy Miller Matt Thomas
Specialist Trainee Consultant in Anaesthesia and
Bristol School of Anaesthesia Intensive Care Medicine,
University Hospitals Bristol NHS
Ronelle Mouton Foundation Trust
Consultant in Anaesthesia
Royal United Hospital NHS Trust,
Bath
 CONTRIBUTORS xi
Julian Thompson Andy Weale
Specialist Registrar in Prehospital Consultant Vascular Surgeon
Care, London Helicopter North Bristol NHS Trust, Bristol
Emergency Medical Service,
Royal London Hospital Nicola Weale
Consultant in Anaesthesia
Jenny Tuckey North Bristol NHS Trust, Bristol
Consultant in Anaesthesia
Royal United Hospital NHS Trust, David Windsor
Bath Specialist Trainee
Bristol School of Anaesthesia
Medha Vanarase
Consultant in Anaesthesia Helen Wise
John Radcliffe Hospital, Oxford Consultant in Anaesthesia, Poole
Hospital NHS Foundation Trust
Michelle White
Consultant in Anaesthesia,
Mercy Ships, formerly Consultant
in Paediatric Anaesthesia,
Bristol Royal Hospital for Children
This page intentionally left blank
 xiii

Symbols and Abbreviations

b cross reference
i increased
d decreased
~ approximately
l leading to
± plus/minus
2 important
# fracture
#NOF fractured neck of femur
M website
A–a alveolar–arterial
AAA abdominal aortic aneurysm
AAGBI Association of Anaesthetists of Great Britain and Ireland
ABCDE airway, breathing, circulation, disability, exposure
ABG arterial blood gas
ACEI angiotensin converting enzyme inhibitor
ADH anti-diuretic hormone
AKI acute kidney injury
ALI acute lung injury
ALS advanced life support
APTT activated partial thromboplastin time
ARDS acute respiratory distress syndrome
ASA American Society of Anesthesiologists
AV atrioventricular
BP blood pressure
Ca calcium
CABG coronary artery bypass grafting
CBF cerebral blood flow
CDH Congenital diaphragmatic hernia
CEA carotid endarterectomy
CICV can’t intubate, can’t ventilate’
cLMA classic laryngeal mask airway
CMRO2 cerebral metabolic rate of O2
CNB central neuraxial block
CNS central nervous system
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