Definition: A life-threatening state of adrenocorticosteroid hormone deficiency leading to hypotension and hemodynamic shock.
Hypotension/shock, orthostatic hypotension
Shock: septic, cardiogenic, spinal
Other causes of hypotension (see Hypotension)
Ensure adequate airway and gas exchange
Administer high-flow oxygen/100% oxygen
Expand the circulating volume rapidly with dextrose in normal saline (D5NS) → up to 2 to 3 L may be required
Draw blood for random cortisol and ACTH levels
Immediately following this, administer IV glucocorticoid: hydrocortisone 100 mg (and continue q6h as needed)
Support systemic blood pressure with vasopressors
Correct any of the following common electrolyte disturbances:
Identify precipitating cause (eg, iatrogenic adrenal insufficiency due to exogenous corticosteroid administration)
Rule out other causes on the differential diagnosis (especially those that are rapidly correctable):
- tension pneumothorax
- massive hemorrhage
- syringe swap
- myocardial ischemia/infarction
Definition: Physiologic response to a noxious chemical, thermal or mechanical stimulus; associated with invasive procedures, trauma, and disease; generally time-limited until injury heals.
Pain varies greatly—mild to severe (0-10 scale)
Location—site of injury, radiation, or referred pain
Duration—continuous, intermittent, relapsing
Associated features tachycardia, tachypnea, hypertension, diaphoresis
- disease process
- somatic—muscles, bones, skin, connective tissue, blood vessels
- visceral—viscera (organs)
- peripheral nervous system
- central nervous system
- CRPS I/II
Acute on chronic pain
Anxiety, panic attack
Treat pain and determine underlying cause:
- acute surgical pain typically requires intravenous opioids (consider bolus, infusion, or patient-controlled analgesia as appropriate)
- pain out of proportion to surgery/procedure or new onset pain requires history, physical exam, and appropriate laboratory investigations, imaging, and surgical consultation
Adjust therapy if patient is tolerant to analgesic medications:
- chronic opioid use for chronic pain/addiction
Consider multimodal analgesia as clinical situation permits:
- nonopioid analgesics (acetaminophen/paracetamol, NSAIDs)
- α2 agonists (clonidine, dexmedetomidine)
- NMDA antagonists (ketamine, methadone)
- local anesthetics
- peripheral nerve blockade (single shot or indwelling catheter)
- neuraxial blockade
Definition: Passage of amniotic fluid into the maternal circulation typically resulting in sudden, profound, and unexpected shock, and cardiopulmonary collapse.
Hypotension, cardiopulmonary arrest
- acute hemorrhage
- placental abruption
- uterine atony
- peripartum cardiomyopathy
- high/total spinal
- local anesthetic systemic toxicity
- pulmonary thromboembolism
- venous air embolism
- intracranial hemorrhage
- transfusion reaction
Call for assistance (another anesthesiologist) and inform obstetrician:
- prompt delivery of the fetus improves maternal resuscitation outcomes
Ensure adequate oxygenation and ventilation:
- intubate trachea and ventilate with 100% ...
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