CHEO Residents Manual Amy Rodgers 2008. Anesthesia Lounge Your file folder Coffee machine! Microwave...
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Transcript of CHEO Residents Manual Amy Rodgers 2008. Anesthesia Lounge Your file folder Coffee machine! Microwave...
CHEO Residents CHEO Residents ManualManual
CHEO Residents CHEO Residents ManualManual
Amy Rodgers 2008Amy Rodgers 2008
Anesthesia Lounge
Your file folder
Coffee machine!
Microwave
In this chair at 7:30am for
pain rounds!
APS papers
APS binder and folder
APS board on this wall
Main OR organization board (entrance to main
OR)
Parental presence induction volunteer
Anesthesia resident on-call
Anesthesia staff on call
Anesthesia staff in charge
Nurse in charge
Interview Room(entrance to main OR)
OR booking
Patient’s charts kept on this
ledge after they arrive
If schedule not printed for following day, it is organized at this desk, you can take a peek if
you ask nicely!
Main OR hallway
These are the doors just past the main OR entrance
Anesthesia assistants
office
Anesthesia resident call room
Conference room for teaching and grand
rounds
Entrance to anesthesia offices and lounge-code needed to unlock door
Pre-Anesthetic Assessment
This part usually filled out in PAU by anesthesiologist in
clinic
Usually difficult to assess in young
children
Signed a.m. of OR by anesthetist, verify if any changes since
PAU and fasting status
Filled out by nurses in day care
Filled out by nurses
in day care
Anesthesia Record
Anesthesia Record
Physician OrdersFill out the admission
recovery score in PACU
APS Order Sheet
Currently no
dilaudid PCA
APS order sheet, it should go in patient’s chart
Follow-up
record
Place this sheet in the APS binder in anesthesia loungeWrite patient info on APS board in lounge
Be sure to write time and date of each visit.Mark if patient was in
ICU
APS/PCA
Place in APS billing folder in anesthesia lounge
Anesthesia Bill
A bill is required for every case, every APS patient, every PAU Patient, every trauma, every post-op ICU patient that we are following (only if not ventilated) and every consultPlace bill in APS folder for Carrie along with a copy of the consult.
Patient’s hospital card
info here
Write anesthesia
staff
If a trauma code or a case, mark
the duration
Mark the date
Write the surgical
procedure here
Patient’s surgical diagnosi
s
Anesthesia staff will calculate
codes
Anesthesia Supplies in Sterile Corridor
Anesthesia Supplies
Anesthesia Supplies
Anesthesia Supplies
Anesthesia Supply Drawers
Use supplies with white clip first. When the slot is empty, remove the white clip and place it on the board to show it needs to be ordered. Then start using the slots with the red clipsat the back of the drawer.
Anesthesia Supply Drawers
Use the slots with the white clips first, remove this clip whendrawer empty.
Anesthesia Supply Drawers
Use supplies from this part of the drawer after finishing thesupplies from the drawer with white clip. Place the red clip on the board to be ordered when this part of the drawer is empty.
To Be Ordered Board
Place the clips from empty drawers on this board.
Drug Cart in Sterile Corridor
Drug Cart in Sterile Corridor
Pentaspan and Voluven
Blood Gas Machine in Sterile Corridor
Anesthesia Carts
Handy reference
guide
ECG stickers
Tape
Ventolin
Medication labels on top of anesthesia cart
Handy Reference Card on all Carts
Handy Reference Guide
ETT sizes, blades, vitals for all ages
Anesthesia Cart Organization
This sheet is attached to every cart
Anesthesia Cart Top Drawer
Emergency drugs
Lip smackers for face masks
NS flush bags
Blunt needles
Second drawer
TegadermTourniquets
Alcohol swabs
needles
Angiocaths
Third drawer-syringes
Infusion tubing
stopcocks
Fourth drawer
Calculator
Neuromuscular twitch monitor
Steri-strips
Caps for stopcocks
Arterial catheters
IV arm boards
Arm boards (to protect IV)
Nurses will generally secure the IV on the boardwhile anesthesia is securing the airway
Fifth drawer
Blood set
IV tubing T-pieces for IV
Sixth drawer
Bags to cover neonates head to
prevent heat loss
Volatiles
NS 500cc bags
RL and 1L bags are kept in corridor.PS and Voluven are kept on the anesthesia drug cart.
NG tubesNS
flushes (10cc)
Top drawer of ventilator
Stylets
Laryngoscope Blades: each room
has a specific colour of tape
around it, to be kept in that room
Stylets
small
medium
Oral Airways
Oral Airways• 3cm-pink• 4cm-orange• 5cm-blue• 6cm-purple• 7cm-white• 8cm-green• 9cm-yellow• 10cm-red
Second drawer
Breathing bags
500ml bag
2L bag
1L bag
Third drawer
Face Masks
Neonate
Infant
Toddler
Small adult/chil
d
Medium adult
Fourth drawer- ETT
Head rests for patients (donuts)
Usually kept on top of the anesthesia machine
Lip Smackers
Apply sparingly to the face mask prior to inhalational induction.Kept in the top drawer of anesthesia cart.
IV Line Set-up
T-piece
Buretrol
NS 500cc bags
unless teen
CHEO routine: place tegaderm over IV to secure prior to hooking up to the line-ensure no bubbles or air in ports especially in cardiac cases!-needle free system, attach syringe to port to inject drugs
IV line
This clip needs to be closed to place in the IV pump
IV pumps
Choose accept
“Yes”
Primary Infusion
Setting IV rate
VTBI: Volume to be infused, set amount smaller than size of bag so bag doesn’t
run dry.
VI: Volume infused, look her
to record final volume infused at end of case
IV pump
When changing options press the hold button first.Press the button either beside rate, VTBI or VI.When finished making changes press the run button.
Press one of these buttons to change either
the rate, VTBI or VI.
Oximeters
-Neonatal (<3kg) on foot-Adult (>40kg)
on fingerInfant (3-20kg) on toe/finger
Always keep oximeter on at end of case, will be reused in PACU
Oximeters
OximetersDisconnect
oximeter here for transfer to
PACU
Temperature probe
Usually placed in axilla, however in longer cases may be placed in nasopharynx/esophagus for more accurate monitoring
Bair Hugger
Multi-use port
Multi-use port for medication vials
Syringes will attach to port for withdrawal of drugs
Emergency drugs
Sux and atropine should be drawn up with a 25G needle attached in case IM/SC injection required
Anesthesia Cupboard in corner of OR
Anesthesia circuits-small
and large
Filters
Oximeter probes
Suction tubing and yaunkers
Room beside the changerooms
Stores refrigerator for blood products, BIS monitor, Glidescope and ultrasound machine
BIS monitor
Portable ultrasound machine
Glidescope
Glidescope blades
Emergency Supplies
Fluid warming setArterial line boards
Blood line sets
Central line kits
Arterial line kits
Arterial pressure line kits
Neonatal Cart in Sterile Corridor
Bring cart into OR when working on a neonate. Supplies should be quicklyaccessible.
Neonatal cart-1st drawer
Laryngoscope blades
Magill forceps
Baby Yaunker
Oxyblades
Robert Shaw blades size 0, 1
Miller blades size 00, 0, 1
Neonatal cart-1st drawer
Ett # 2.5, 3.0, 3.5
Oral airways
000, 00, 0
Nasal airways at front: 12, 14,
16Fr
Neonatal cart 2nd drawer
ETT connectors with Co2 ports-#2.5, 3.0, 3.5
Masks-neonatal and infant sizes
Neonatal cart-2nd drawer
Breathing bags 500mL
Mastisol
Neonatal cart-3rd drawer
Infant tegaderms
Infant sized tourniquets
IV boards
Caffeine Citrate
Mini blood tubes
Small gauge needles
Neonatal cart -3rd drawer
Guidewires
Arterial line boards
Short Insyte
Jelco’s 24, 26G
Neonatal cart-4th drawer
Neonatal ECG
electrodesBaby SpO2
probes
NG tubes-5Fr, 8Fr
Precordial stethoscope
Neonatal ECG package
Includes small stickers and wires
Precordial stethoscope
Ng Tube 14Fr
Sticker to place on dome of stethoscope
Precordial stethscope
Remove bell from stethoscope and
attach here
Tape stethoscope to L axilla to rule out R endobronchial intubation intra-op
Neonatal cart-5th drawer
Bp Cuffs
BP cuffs
Size #1
#2
#3
#4
#5
Neonatal cart -5th drawer
Hemacue
Temp probe covers
Neonatal cart-6th drawer
Shoulder rolls
Infant MIE
Baby hats
Neonatal Cart-6th drawer
Infant nasal cannulae
Infant donut
D10WD5
W
Extension set small bore
Regional Cart in Sterile Corridor
Regional cart-top drawer
Drugs: bupivacaine, lidocaine, tetracaine, ropivacaine-also available on drug cart in sterile corridor
Regional Cart-top drawer
Emergency drugs
Regional Cart-2nd drawer
Spinal needles
Regional Cart-2nd drawer
Syringes, fluid
Regional cart-3rd drawer
Epidural kits
Epidural Kit
Contents: 19G catheter, 17G Tuohy needle, 10cc loss of resistance syringe, filter
Epidural Kit
Contents: 20G catheter, 18G needle, 10cc loss of resistancesyringe, filter
Regional cart-3rd drawer
Steristrips, saline flushes, large tegaderms, drapes
Regional Cart-4th drawer
Nerve stimulator, Pajunk stimulating needles, Regional anesthesia textbook
Crash cart
Located in the sterile corridor beside the Neurosurgery ORDifficult Airway cart beside it (not available when workingon this presentation)