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i
ADVANCED PERIOPERATIVE CRISIS
MANAGEMENT
ii
ADVANCED PERIOPERATIVE CRISIS
MANAGEMENT
EDITED BY
Matthew D. McEvoy, MD
VICE- CHAIR FOR EDUCATIONAL AFFAIRS
DIRECTOR OF CIPHER (CENTER FOR INNOVATION IN PERIOPERATIVE HEALTH,
EDUCATION, AND RESEARCH)
DEPARTMENT OF ANESTHESIOLOGY
VANDERBILT UNIVERSITY MEDICAL CENTER
PROFESSOR OF ANESTHESIOLOGY
VANDERBILT UNIVERSITY SCHOOL OF MEDICINE
NASHVILLE, TN
Cory M. Furse, MD, MPH, FAAP
ASSOCIATE PROFESSOR OF ANESTHESIOLOGY
DEPARTMENT OF ANESTHESIA AND PERIOPERATIVE MEDICINE
MEDICAL UNIVERSITY OF SOUTH CAROLINA
CHARLESTON, SC
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other professional advice. Treatment for the conditions described in this material is highly dependent on
the individual circumstances. And, while this material is designed to oer accurate information with respect
to the subject matter covered and to be current as of the time it was written, research and knowledge about
medical and health issues is constantly evolving and dose schedules for medications are being revised continually,
the product information and clinical procedures with the most up-to-date published product information
and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulation.
e publisher and the authors make no representations or warranties to readers, express or implied, as to
the authors make no representations or warranties as to the accuracy or ecacy of the drug dosages mentioned in
Oxford University Press is a department of the University of Oxford. It furthers
the University’s objective of excellence in research, scholarship, and education
by publishing worldwide. Oxford is a registered trade mark of Oxford University
Press in the UK and certain other countries.
Published in the United States of America by Oxford University Press
198 Madison Avenue, New York, NY 10016, United States of America.
© Oxford University Press 2017
All rights reserved. No part of this publication may be reproduced, stored in
a retrieval system, or transmitted, in any form or by any means, without the
prior permission in writing of Oxford University Press, or as expressly permitted
by law, by license, or under terms agreed with the appropriate reproduction
rights organization. Inquiries concerning reproduction outside the scope of the
above should be sent to the Rights Department, Oxford University Press, at the
address above.
You must not circulate this work in any other form
and you must impose this same condition on any acquirer.
CIP data is on le at the Library of Congress
ISBN 978– 0– 19– 022645– 9
is material is not intended to be, and should not be considered, a substitute for medical or
with new side eects recognized and accounted for regularly. Readers must therefore always check
the accuracy or completeness of this material. Without limiting the foregoing, the publisher and
the material. e authors and the publisher do not accept, and expressly disclaim, any responsibility
for any liability, loss or risk that may be claimed or incurred as a consequence of the use
and/or application of any of the contents of this material.
1
Printed by Sheridan Books, Inc., United States of America
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Matt:
To all of my colleagues, mentors, and friends who have
shaped my career and aided in creating the content and
experiences of this book over many years— thank you.
Even more so to my amazing wife, Amy, our wonderful
5 ‘arrows’, and my parents, all of whom put up with my
crazy schedule and mentor me daily— thank you. Finally,
Soli Deo Gloria.
Cory:
To my parents and grandparents for your acceptance, love
and support, thank you. Thanks also to my friends, my
family, und meinen lieben Schwiegereltern. To my sons
Sven and Oliver, and my loving and lovely wife Berrit-Ich
dreh mich um dich.
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vii
CONTENTS
Preface xi
Contributors xiii
PART I. CRISIS RESOURCE MANAGEMENT:
NONTECHNICAL SKILLS OF TEAM PERFORMANCE
1. A CRITICAL THINKING APPROACH TO THE UNSTABLE
PATIENT 3
Mark E. Nunnally, Arna Banerjee and Matthew D. McEvoy
2. TEAMWORK AND CRISIS RESOURCE MANAGEMENT 6
Scott C. Watkins, Christopher L. Cropsey and Cory M. Furse
3. COGNITIVE AIDS IN CURRENT PRACTICE 9
Christopher L. Cropsey, Scott C. Watkins,
and Matthew D. McEvoy
PART II. CARDIAC CRISES
4. INTRODUCTION TO PERIOPERATIVE CARDIAC
URGENCIES AND EMERGENCIES 15
Jason B. O’Neal and Andrew Shaw
5. MYOCARDIAL ISCHEMIA 23
Jeremy Bennett and Kara Siegrist
6. AORTIC DISRUPTION 30
Adam J. Kingeter and Bantayehu Sileshi
7. CARDIAC DYSRHYTHMIAS 35
Mark Henry and Robert J. Deegan
8. SEVERE VALVULAR DISEASE 53
Yafen Liang and Andrew Shaw
PART III. SHOCK
9. INTRODUCTION TO SHOCK 67
Babar Fiza and Vivek Moitra
10. CARDIOGENIC SHOCK 75
Martin Chen and Muoi Trinh
11. DISTRIBUTIVE SHOCK 84
Angela Lee and Gebhard Wagener
12. HYPOVOLEMIC SHOCK 102
Paul David Weyker, Christopher Allen- John Webb
and Tricia E. Brentjens
13. OBSTRUCTIVE SHOCK 112
Julia Sobol and Jack Louro
PART IV. PULMONARY CRISES
14. INTRODUCTION TO PULMONARY URGENCIES AND
EMERGENCIES 121
John D. Mitchell and Marek Brzezinski
15. DIFFICULT AIRWAY 126
Romina G. Ilic
16. LARYNGOSPASM 134
Cory M. Furse and Matthew D. McEvoy
17. ASPIRATION PNEUMONITIS 139
Agnieszka Trzcinka
18. PHYSIOLOGIC AIRFLOW DISRUPTION:
BRONCHOSPASM, OBSTRUCTIVE
LUNGDISEASE,ASTHMA, AND STATUS
ASTHMATICUS 143
Kinza Sentissi and Stephanie Yacoubian
19. MECHANICAL AIRFLOW DISRUPTION 150
Alissa Sodickson and James Hardy
20. DISRUPTION OF DIFFUSION: INFLAMMATION 156
Shahzad Shaefi and Aaron Mittel
21. DISRUPTION OF DIFFUSION: AIRSPACE DISEASES 164
Nayema Khan and John Pawlowski
22. PNEUMOTHORAX 171
Jennifer Oliver and K. Annette Mizuguchi
23. HYPOXIA DURING ANESTHESIA: MACHINE AND
MONITOR ISSUES 176
Natacha Zamor
24. AIRWAY FIRE 182
Ju- Mei Ng
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PART V. METABOLIC AND ENDOCRINE CRISES
25. INTRODUCTION TO METABOLIC AND ENDOCRINE
40. HYPOMAGNESEMIA/ HYPERMAGNESEMIA 280
Aali Shah
DISEASES 189
Stephen F. Dierdorf
SECTION A. METABOLIC DISTURBANCES 191
26. MALIGNANT HYPERTHERMIA 193
PART VI. OBSTETRIC CRISES
41. INTRODUCTION TO PERIPARTUM URGENCIES AND
EMERGENCIES FOR THE ANESTHESIA PROVIDER 289
Rachel M. Kacmar
Christopher L. Heine
27. PORPHYRIA 200
Stephen F. Dierdorf
28. UNDIAGNOSED PHEOCHROMOCYTOMA 205
Andrew F. Stasic
29. PERIOPERATIVE ADRENAL CRISIS 211
Jing Tao and Jeffrey J. Schwartz
30. CUSHING’S DISEASE 217
Doris M. Hardacker
SECTION B. ENDOCRINE DISTURBANCES 223
31. DIABETIC KETOACIDOSIS 225
Anne Newcomer and Michael Gropper
32. HYPERGLYCEMIC HYPEROSMOLAR STATE 232
Shamsuddin Akhtar
33. HYPOGLYCEMIA 238
Doris M. Hardacker
34. THYROTOXICOSIS 242
Nichole D. Horn
35. MYXEDEMA COMA 247
Jacquelyn E. Allison and Julie D. Dunlap
36. ACUTE LIVER FAILURE 252
Cynthia Wang and Michelle Y. Braunfeld
SECTION A. MATERNAL COLLAPSE 293
42. OBSTETRIC LIFE SUPPORT: PULSELESS ELECTRICAL
ACTIVITY/ ASYSTOLE AND PULSELESS VENTRICULAR
TACHYCARDIA/ FIBRILLATION 295
Nathaniel N. Hsu and Richard C. Month
43. PERIMORTEM CESAREAN DELIVERY FOR MATERNAL
CARDIAC ARREST 303
Benjamin Cobb and Steven Lipman
44. STAT CAESAREAN DELIVERY: PREPARATION,
PLANNING, AND TEAM PERFORMANCE 308
Michael G. Richardson
SECTION B. CARDIAC CRISES 317
45. HIGH OR TOTAL SPINAL/ EPIDURAL 319
Feyce Peralta
46. PERIPARTUM CARDIOMYOPATHY 323
Emily J. Baird
47. PERIPARTUM EMBOLISM 332
Elizabeth M. S. Lange and Paloma Toledo
48. SYSTEMIC INFLAMMATORY RESPONSE SYNDROME
AND SEPSIS IN THE PREGNANT PATIENT 340
Daria M. Moaveni
49. SEVERE PREECLAMPSIA 347
Uma Sasso and Emily McQuaid- Hanson
50. SEVERE PERIPARTUM HEMORRHAGE 354
Joy L. Hawkins
SECTION C. ELECTROLYTE DISTURBANCES 259
37. HYPERKALEMIA/ HYPOKALEMIA 261
Stephen F. Dierdorf
38. HYPONATREMIA/ HYPERNATREMIA 268
Brian N. Egan
39. HYPOCALCEMIA/ HYPERCALCEMIA 274
Stephen F. Dierdorf
51. VALVULAR DISEASE: SPECIFIC CONSIDERATIONS FOR
MANAGEMENT DURING LABOR AND DELIVERY 363
Shobana Chandrasekhar and C. LaToya Mason
52. VESSELS: CORONARY ARTERY DISEASE IN
PREGNANCY AND PERIPARTUM ACUTE CORONARY
SYNDROME 371
Eleni Kotsis, Jamie M. Zorn and Grace Lim
53. VOLTAGE DISTURBANCES DURING PREGNANCY 378
Heather C. Nixon
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SECTION C. PULMONARY/ AIRWAY CRISES 385
54. DIFFICULT AIRWAY: SPECIAL CONSIDERATIONS
IN PREGNANCY 387
Rania Elkhateb and Jill M. Mhyre
55. ASTHMA AND PREGNANCY 395
Grant C. Lynde
67. TRAUMATIC BRAIN INJURY: TRAUMATIC SUBDURAL
HEMORRHAGE/ EPIDURAL HEMORRHAGE 483
Sheena M. Weaver
68. REFRACTORY INTRACRANIAL HYPERTENSION 492
Letha Matthews and John Barwise
69. CEREBRAL SALT WASTING 499
Mark A. Henry and Avinash B. Kumar
SECTION D. NEUROLOGIC CRISES 401
56. STROKE/ SUBARACHNOID HEMORRHAGE AND
PREGNANCY 403
70. ACUTE LOSS OF INTRAOPERATIVE EVOKED POTENTIAL
SIGNALS 504
Leslie Jameson
Cristina Wood
57. POST– DURAL PUNCTURE HEADACHE 412
Philip Rubin
SECTION E. METABOLIC/ ENDOCRINE CRISES 419
58. DIABETIC EMERGENCIES IN PREGNANCY 421
Maribeth Guletz and Rebecca Minehart
SECTION F. TOXINS 429
59. MAGNESIUM TOXICITY 431
Anthony T. Chau
60. LOCAL ANESTHETIC SYSTEMIC TOXICITY IN
PREGNANCY 436
Brian F. S. Allen
PART VII. NEUROLOGIC CRISES
61. INTRODUCTION TO ACUTE NEUROLOGIC EVENTS IN
THE PERIOPERATIVE PERIOD 445
Lorri A. Lee
SECTION A. CEREBRAL ORIGIN 447
62. DELIRIUM 449
Bret D. Alvis and Christopher G. Hughes
63. NONTRAUMATIC INTRACRANIAL
HEMORRHAGE 456
SECTION B. SPINAL CORD, PERIPHERAL NERVOUS
SYSTEM, AND NEUROMUSCULAR JUNCTION ORIGIN 511
71. AUTONOMIC DYSREFLEXIA 513
Koffi Kla
72. NEUROGENIC SHOCK 517
Arnoley S. Abcejo and Jeffrey J. Pasternak
73. MUSCLE WEAKNESS 522
L. Jane Easdown
74. NERVE INJURIES FROM POSITIONING
AND REGIONAL BLOCKS 529
Rajnish K. Gupta and Alexandria N. Nickless
SECTION C. SYSTEMIC ORIGIN 537
75. HEPATIC ENCEPHALOPATHY 539
Bret Alvis and Amy Rober tson
PART VIII. PEDIATRIC CRISES
76. INTRODUCTION TO PEDIATRIC CRISES 547
Scott C. Watkins
SECTION A. CARDIAC CRISES 553
77. EMERGENCY NONCARDIAC SURGERY IN THE
CONGENITAL HEART DISEASE PATIENT 555
Marc Hassid and Amanda T. Redding
Deepak Sharma and Julia Metzner
64. ACUTE STROKE 463
Laurel E. Moore
65. POSTOPERATIVE VISUAL LOSS 470
Lorri A. Lee
66. SEIZURES AND STATUS EPILEPTICUS 478
Neha Aggarwala and Pirjo H. Manninen
SECTION B. PULMONARY CRISES 561
78. EPIGLOTTITIS, CROUP, AND STRIDOR 563
Michel Sabbagh and John J. Freely Jr.
79. ACUTE SEVERE ASTHMA AND BRONCHOSPASM 566
Amanda T. Redding and Marc Hassid
80. POST- TONSILLECTOMY BLEEDING 571
Michelle Sher Rovner
CONTENTS IX
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