Hypoxia / desaturation / cyanosis
Using these steps from start to end should identify any cause of unexpected hypoxia in theatre. Avoid spending excessive time and attention on one aspect until you have run through the whole drill.
If problem worsens significantly or a new problem arises, call for help and go to START of GUIDELINE 1-1 Key basic plan.
Ventilate using self-inflating bag connected DIRECTLY to tracheal tube connector. DO NOT use HME filter, angle piece or catheter mount:
If problem resolves: assume problem with machine, circuit, HME, filter, angle piece or catheter mount: check and replace.
If increased pressure manually confirmed: re-connect machine.
Remember that airway "feel" depends on your APL valve setting. You can only "feel" a maximum of what the APL valve is set to. Measured expired tidal volume gives additional information.
Hypoxia with increased airway pressure → 2-3
Inadequate movement or expired volume: assist/increase ventilation.
Asymmetrical chest expansion: exclude bronchial intubation/foreign body/pneumothorax.
Consider potential actions: tracheal/bronchial suction; bronchodilator; PEEP; diuretic; bronchoscopy.
Consider potential causes:
Laryngospasm and stridor → 3-6
Bronchospasm → 3-4
Anaphylaxis → 3-1
Circulatory embolism → 3-5
Cardiac ischaemia (or infarction) → 3-12
Cardiac tamponade → 3-9
Sepsis → 3-14
Malignant hyperthermia crisis → 3-8
Aspiration, pulmonary oedema, congenital heart disease.