cheo residents manual

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)