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Establish responsiveness
Airway assessment: look, listen and feel
Airway opening and maintenance
◦ Jaw thrust vs head tilt, chin lift
◦ Suction airway adjunct (OPA, NPA)
◦ Definitive: ETT, surgical airway
Maintenance of ventilation
Common problems encountered:
◦ Tongue obstruction (fall back)
◦ Secretion
◦ Laryngospasm
Initial Assessment: Primary Survey
Altered consciousness
Intoxicated
Distracting
injuries
Initial Assessment: Primary Survey
NO
Difficult to diagnose
Suspicious in patient who is pale and
hypotensive with no obvious source of
bleeding
Imaging modalities: pelvic x-ray
Initial Assessment: Secondary Survey
Muscle relaxant
◦ Use suxamethonium unless contraindicated
◦ Alternative: rocuronium
Maintenance
◦ Avoid nitrous oxide in hypotension, hypovolaemic,
hypoxia
Fluid resuscitation
◦ Secure large bore IV line prior to starting operation
◦ Blood products readily available when needed
◦ Volume status must be continuously assessed
throughout and after operation
Anaesthetic Considerations
Monitoring
◦ ECG
◦ NIBP or IABP in critical patient
◦ SpO2
◦ End tidal CO2
◦ Temperature
◦ Urine output
◦ CVP
Consider intra-op investigation
◦ E.g. ABG may help with resuscitation process
Anaesthetic Considerations