CHEO Residents Manual Amy Rodgers 2008
Anesthesia Lounge Your file folder Coffee machine! Microwave APS binder and folder APS papers In this chair at 7:30am for pain rounds! APS board on this wall
Main OR organization board (entrance to main OR) Nurse in charge Anesthesia staff in charge Anesthesia staff on call Anesthesia resident on-call Parental presence induction volunteer
OR booking If schedule not printed for following day, it is organized at this desk, you can take a peek if you ask nicely! Patient’s charts kept on this ledge after they arrive
Main OR hallway Conference room for teaching and grand rounds Anesthesia assistants office Entrance to anesthesia offices and lounge-code needed to unlock door Anesthesia resident call room These are the doors just past the main OR entrance
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
Physician Orders Fill 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 Be sure to write time and date of each visit. Mark if patient was in ICU Place this sheet in the APS binder in anesthesia lounge Write patient info on APS board in lounge
APS/PCA Place in APS billing folder in anesthesia lounge
Anesthesia Bill Write anesthesia staff Patient’s hospital card info here Write the surgical procedure here Mark the date Anesthesia staff will calculate codes If a trauma code or a case, mark the duration Patient’s surgical diagnosis 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 consult Place bill in APS folder for Carrie along with a copy of the consult.
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 clips at the back of the drawer.
Anesthesia Supply Drawers Use the slots with the white clips first, remove this clip when drawer empty.
Anesthesia Supply Drawers Use supplies from this part of the drawer after finishing the supplies 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 Pentaspan and Voluven
Anesthesia Carts Handy reference guide Ventolin Tape ECG stickers
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 NS flush bags Blunt needles Lip smackers for face masks
Second drawer Tourniquets Tegaderm Angiocaths Alcohol swabs needles
Third drawer-syringes Infusion tubing stopcocks
Fourth drawer Steri-strips Arterial catheters Calculator Neuromuscular twitch monitor IV arm boards Caps for stopcocks
Arm boards (to protect IV) Nurses will generally secure the IV on the board while anesthesia is securing the airway
Fifth drawer Blood set IV tubing T-pieces for IV
Sixth drawer NG tubes NS flushes (10cc) Volatiles Bags to cover neonates head to prevent heat loss NS 500cc bags RL and 1L bags are kept in corridor. PS and Voluven are kept on the anesthesia drug cart.
Top drawer of ventilator Laryngoscope Blades: each room has a specific colour of tape around it, to be kept in that room Stylets
Stylets small medium
Oral Airways • 3cm-pink • 4cm-orange • 5cm-blue • 6cm-purple • 7cm-white • 8cm-green • 9cm-yellow • 10cm-red
Breathing bags 2L bag 500ml bag 1L bag
Face Masks Small adult/child Infant Neonate Medium adult Toddler
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 Buretrol NS 500cc bags unless teen T-piece 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