(10) SEVERE HYPOTENSION Differential Diagnosis: MAP = CO X SVR and CO = SV X HR SV depends on preload, contractility, and afterload CALL FOR HELP CODE CART Preload: ↓ Hemorrhage Hemorrhage algorithm Management Hypovolemia Ensure and regular rate and rhythm If not, go to Auto-PEEP: D/C circuit ACLS IVC Compression: Decrease tidal volume, Inspect field for blood loss or Reposition patient If non-bleeding cause: Pause surgery Embolism (Air/Fat/Blood/AFE): Go to algorithm If bleeding Hemorrhage algorithm Pneumothorax Pneumothorax algorithm IV Fluid bolus Pneumoperitoneum or Surgical manipulation Pressors Contractility: Phenylephrine and Ephedrine ↓ MI/Ischemia myocardial ischemia algorithm If severe: Epinephrine 10-100 mcg, Vasopressin Low EF: Inotrope 1-4 units Valvular disease, HOCM 100% O2 High flow Hypoxemia Turn down/off anesthetic agent Medications Talk to surgeon Local anesthetic toxicity Go to Other management Arrythmias Afterload: management: ↑ Pneumoperitoneum or surgical manipulation Algorithms for ACLS, Anaphylaxis, Hemorrhage, Medications Hypoxemia, Local anesthetic toxicity, Myocardial HR: ischemia, Pneumothorax, Total spinal anesthesia, ↓ Vagal stimulus: Pause surgery if needed Transfusion rxn, VAE SVR: TEE ↓ High volatile anesthetic More IV access and Arterial line Neuraxial blockade Steroid for adrenal insufficiency (Hydrocortisone 100mg Anaphylaxis Go to algorithm IV) Medications Send labs: ABG, Hgb, Electrolytes, T&C Shock: Sepsis, Spinal Neurogenic Foley catheter to monitor UOP Endocrine abnormalities Steroids
(10) SEVERE HYPOTENSION CALL FOR HELP CODE CART Management Ensure and regular rate and rhythm If not, go to ACLS Inspect field for blood loss or If non-bleeding cause: Pause surgery If bleeding Hemorrhage algorithm IV Fluid bolus Pressors Phenylephrine and Ephedrine If severe: Epinephrine 10-100 mcg, Vasopressin 1-4 units 100% O2 High flow Turn down/off anesthetic agent Talk to surgeon Go to Other management management: Algorithms for ACLS, Anaphylaxis, Hemorrhage, Hypoxemia, Local anesthetic toxicity, Myocardial ischemia, Pneumothorax, Total spinal anesthesia, Transfusion rxn, VAE TEE More IV access and Arterial line Steroid for adrenal insufficiency (Hydrocortisone 100mg IV) Send labs: ABG, Hgb, Electrolytes, T&C Foley catheter to monitor UOP Differential Diagnosis: MAP = CO X SVR and CO = SV X HR SV depends on preload, contractility, and afterload ↓ Preload: Hemorrhage Hemorrhage algorithm Hypovolemia Auto-PEEP: D/C circuit IVC Compression: Decrease tidal volume, Reposition patient Embolism (Air/Fat/Blood/AFE): Go to algorithm Pneumothorax Pneumothorax algorithm Pneumoperitoneum or Surgical manipulation ↓ Contractility: MI/Ischemia myocardial ischemia algorithm Low EF: Inotrope Valvular disease, HOCM Hypoxemia Medications Local anesthetic toxicity Arrythmias ↑ Afterload: Pneumoperitoneum or surgical manipulation Medications ↓ HR: Vagal stimulus: Pause surgery if needed ↓ SVR: High volatile anesthetic Neuraxial blockade Anaphylaxis Go to algorithm Medications Shock: Sepsis, Spinal Neurogenic Endocrine abnormalities Steroids
Emergency%20Protocols.docx