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Anaphylaxis during OT
09/19/2026

Anaphylaxis during OT

❓ “The EtCO₂ Suddenly Drops to ZERO — IS IT THE PATIENT OR THE MACHINE?”This is a great next Anaesthesia Encounter poste...
09/11/2026

❓ “The EtCO₂ Suddenly Drops to ZERO — IS IT THE PATIENT OR THE MACHINE?”

This is a great next Anaesthesia Encounter poster because it teaches one of the most important intraoperative troubleshooting skills: never assume a flat capnogram means cardiac arrest.

The will cover:

📉 Sudden loss/marked fall of EtCO₂

🧠 DOPE approach — Displacement, Obstruction, Pneumothorax, Equipment

❤️ Pulmonary embolism / sudden fall in cardiac output

🫁 Circuit disconnection and oxygen supply problems

🔌 Capnography sampling-line problems

⚠️ Esophageal intubation and ETT displacement

🚨 Immediate ABC response

🔄 Patient vs airway vs circuit vs machine troubleshooting

❤️ Cardiac arrest recognition and CPR

🧠 A rapid bedside algorithm

❌ Common troubleshooting mistakes

> “EtCO₂ = 0. The monitor is flat. WHAT WILL YOU CHECK FIRST?”

Malignant Hyperthermia
09/09/2026

Malignant Hyperthermia

🚨 YOUR PATIENT DEVELOPS TINNITUS, SEIZURES & ARRHYTHMIA AFTER A NERVE BLOCK — WHAT WILL YOU DO?🧠 DESCRIPTIONLocal Anaes...
09/04/2026

🚨 YOUR PATIENT DEVELOPS TINNITUS, SEIZURES & ARRHYTHMIA AFTER A NERVE BLOCK — WHAT WILL YOU DO?

🧠 DESCRIPTION

Local Anaesthetic Systemic Toxicity (LAST) is rare—but potentially life-threatening. Early recognition can make the difference.

The presentation may begin with subtle neurological symptoms such as circumoral numbness, tinnitus, metallic taste, dizziness, agitation, or altered speech. However, cardiovascular toxicity—including conduction disturbances, hypotension and ventricular arrhythmias—may occur and can sometimes be the first manifestation.

🚨 THINK LAST. ACT FAST.

STOP → CALL → OXYGENATE → CONTROL SEIZURES → LIPID → SUPPORT CIRCULATION

🔴 Stop injecting the local anaesthetic immediately.
📞 Call for help and activate the LAST response system/rescue kit.
🫁 Prioritize airway management and oxygenation—avoid hypoxia and acidosis.
⚡ Treat seizures promptly, with benzodiazepines generally preferred.
💉 Consider 20% lipid emulsion early according to an established LAST protocol.
❤️ Remember that resuscitation in LAST differs from standard ACLS in important ways.

⚠️ During LAST resuscitation, drug choices and doses may need modification. Follow a recognized institutional or professional-society checklist rather than relying on memory alone.

🛡️ PREVENTION MATTERS

✔️ Use appropriate dosing
✔️ Inject incrementally when appropriate
✔️ Aspirate when appropriate—but remember aspiration is not completely reliable
✔️ Use ultrasound guidance where suitable
✔️ Maintain appropriate monitoring
✔️ Keep a LAST rescue kit and 20% lipid emulsion immediately available

🧠 KEY TAKE-HOME MESSAGE:

«Tinnitus is not “just a symptom.” It may be an early warning.»

Recognize early. Stop the injection. Oxygenate. Treat seizures. Start appropriate lipid therapy. Support the circulation.

📌 Save this post—because LAST is rare, and rare emergencies are exactly the ones we need to be prepared for.

This educational post is based on established LAST guidance, including the ASRA LAST checklist. The current ASRA checklist notes that it is under review, with a further update anticipated; always use the latest locally approved protocol during clinical care.

🔖 HASHTAGS

❓ HYPOTENSION AFTER INDUCTION — WHAT WILL YOU DO FIRST?A sudden drop in blood pressure after induction is common—but it ...
08/29/2026

❓ HYPOTENSION AFTER INDUCTION — WHAT WILL YOU DO FIRST?

A sudden drop in blood pressure after induction is common—but it should never be ignored.

The key is to recognize early, identify the cause, treat the physiology, and reassess continuously.

🩺 FIRST, RECOGNIZE

Look for:

• Sudden fall in BP
• Reduced perfusion
• Tachycardia or bradycardia
• Falling SpO₂ or abnormal EtCO₂
• Poor urine output in significant/prolonged hypotension

🧠 THEN ASK: WHY?

Think systematically:

Drug effect → Hypovolaemia → Vasodilation → Myocardial depression → Bradycardia/vagal stimulation → Anaphylaxis → Other critical causes

Don't assume every post-induction hypotension is simply “too much propofol.”

🚨 ACT FAST

CALL → O₂ → CHECK → FLUIDS → VASOPRESSOR → TREAT CAUSE → REASSESS

✔️ Ensure adequate oxygenation and ventilation
✔️ Check airway, breathing and circulation
✔️ Review anaesthetic depth and recent medications
✔️ Establish reliable IV access
✔️ Give appropriate fluid therapy when indicated
✔️ Use a vasopressor appropriate to the clinical scenario
✔️ Treat the underlying cause
✔️ Reassess BP, HR, SpO₂ and EtCO₂ after every intervention

⚠️ DON'T FORGET

Persistent hypotension may be a sign of something much more serious:

Bleeding • Anaphylaxis • Severe myocardial dysfunction • Arrhythmia • Tension pneumothorax • Other causes of shock

🧠 KEY TAKE-HOME

«Don't just treat the number—find the cause.»

Early recognition + appropriate treatment + continuous reassessment can prevent progression from a manageable episode to a life-threatening perioperative crisis.

📌 Save this poster for your anaesthesia emergency revision.
📤 Share it with an anaesthesia trainee or colleague.

Educational content for healthcare professionals, trainees and medical students. Always follow local guidelines, institutional protocols, drug information and senior clinical judgment.

Difficulty in intubation. what you do?
08/27/2026

Difficulty in intubation. what you do?

❓ SUDDEN BRONCHOSPASM UNDER ANAESTHESIA — INCREASING AIRWAY PRESSURE & FALLING SpO₂: WHAT WILL YOU DO?POST DESCRIPTION🚨 ...
08/27/2026

❓ SUDDEN BRONCHOSPASM UNDER ANAESTHESIA — INCREASING AIRWAY PRESSURE & FALLING SpO₂: WHAT WILL YOU DO?

POST DESCRIPTION

🚨 A sudden rise in airway pressure with wheeze, prolonged expiration and falling SpO₂ during anaesthesia should make you think of bronchospasm — but don't forget the differential diagnosis.

Airway obstruction, kinked or blocked ETT, circuit problems, aspiration, anaphylaxis and pneumothorax can produce similar findings.

🫁 RECOGNIZE IT

Key clues include:

• ↑ Peak airway pressure
• Wheeze or reduced/absent air entry
• Prolonged expiration
• Falling SpO₂
• Rising EtCO₂ / hypercapnia
• Difficulty with ventilation
• Tachycardia, with bradycardia in severe hypoxaemia

🚨 MANAGEMENT — ACT FAST

CALL → O₂ → DEEPEN → CHECK → BRONCHODILATE → ESCALATE

1️⃣ Call for help and give 100% oxygen.
2️⃣ Ensure adequate anaesthesia depth and neuromuscular relaxation when appropriate.
3️⃣ Check the ETT, airway and breathing circuit — don't assume every high airway pressure is bronchospasm.
4️⃣ Give an inhaled β₂-agonist such as salbutamol.
5️⃣ If severe or persistent, consider additional bronchodilator therapy and other appropriate rescue treatments according to the clinical situation and local protocol.
6️⃣ Continue controlled ventilation and avoid excessive airway pressures and dynamic hyperinflation.

⚠️ DON'T MISS

High airway pressure ≠ always bronchospasm.

Think of:

DOPES + anaphylaxis + pneumothorax

And remember that severe bronchospasm can lead to hypoxaemia, hypercapnia, auto-PEEP, haemodynamic compromise and cardiac arrest.

🧠 KEY TAKE-HOME

«Treat the patient, not just the airway pressure.»

Recognize early, oxygenate, exclude mechanical causes, give appropriate bronchodilator therapy, and reassess continuously.

📌 Save this for your anaesthesia emergency revision.
📤 Share it with an anaesthesia trainee or colleague.

Educational content for healthcare professionals, trainees and medical students. Always follow local guidelines, institutional protocols, drug information and senior clinical judgment.

High Spinal or total spinal
08/26/2026

High Spinal or total spinal

What do you do if you suspect Malignant Hyperthermia?
08/26/2026

What do you do if you suspect Malignant Hyperthermia?

Do you know which block targeted these five nerves?
08/24/2026

Do you know which block targeted these five nerves?

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