Anaes Cases · Breathing systems & circuits
The accidentally closed APL valve — barotrauma
The hot barotrauma case — the recognition (the tense bag, the high pressure, the falling BP from the reduced venous return), the immediate action (the open the APL valve, the release the pressure), and the prevention.
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ANZCAFRCAABAEDAIC
Prompt
During emergence from anaesthesia, the APL valve is accidentally left fully closed. The reservoir bag becomes tense, the airway pressure exceeds 60 cmH2O, and the patient's blood pressure falls. Manage.
Presentation
During the emergence from a general anaesthetic, the anaesthetist has turned off the ventilator and switched to the manual mode. The APL valve is accidentally left fully closed. The fresh gas is still flowing at 6 L/min. The reservoir bag becomes tense and distended, the airway pressure alarm sounds at 65 cmH2O, the patient's blood pressure falls from 120 to 70, and the heart rate rises.[22563958]
References2ShowHide
- [3]AAGBI. Checking anaesthetic equipment 2012. Anaesthesia, 2012.PMID 22563957
- [22563958]Bersten AD, Soni N (eds) Oh's Intensive Care Manual. 8th edition, Elsevier, 2018.