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Imagine this scenario: You’ve just finished anesthetizing a patient in a hospital setting, and the patient now requires transport from the operating room (OR) to the post-anesthesiacare unit (PACU). This is a reasonable policy, but what if anesthesia patient transport to the PACU lasts 4 minutes and 59 seconds (i.e.
To aid you in visualizing yourself in the hospital, I’m substituting the pronoun “you” instead of “I” in the narrative below. You complete your morning bathroom and breakfast routines, and leave your residence at 0630 hours for the hospital. Your hospital contains multiple operating rooms, and today you are in room #10.
The anesthesiologist and the operating room nurse transport the patient to the PACU (PostAnesthesiaCare Unit), where the patient is connected to the standard monitors of pulse oximetry, ECG, blood pressure, and temperature. This is every anesthesia provider’s nightmare. Can this scenario occur?
An anesthesia machine, with the vitalsigns monitor screen on the left, and the electronic medical records computer screen on the right. His vitalsigns are heart rate = 100, BP = 150/80, respiratory rate = 20 breaths/minute, oxygen saturation 95% on room air, and temperature 100.2 The BP is 100/50.
This includes basic qualifications like taking blood pressure, vitalsigns, measuring heart rate, and listening with a stethoscope. Specifically, you will want to ensure that you have ann active certification in Advanced Cardiac Life Support, a certification that is required for all critical care roles.
The Barnes Jewish Hospital, Washington University, St. Louis Imagine this: You’re an anesthesiologist in the operating room at a busy hospital. Anesthesiologists at Barnes Jewish Hospital at Washington University in St. Louis, Missouri are studying a novel system they call the Anesthesia Control Tower (ACT).
An anesthesia emergency occurs without warning. Your patient’s vitalsigns are dropping. You need the ultimate anesthesia emergency guidebook. That ultimate guidebook is the S tanford Emergency Manual of Cognitive Aids for Perioperative Critical Events S , written by the Stanford Anesthesia Cognitive Aid Group.
Imagine you’re two months out of anesthesia training, working at a community hospital, and at 2 a.m. you need to induce emergency anesthesia for a 300-pound man who just ate a full meal of pizza and beer two hours earlier. You’re working alone without that anesthesia attending who stood next to you during residency training.
Tell the surgeon that the patient needs to have cardiac clearance prior to any general anesthetic, and that the case needs to be done in a hospital setting rather than at a freestanding surgery center. Just do MAC (Monitored AnesthesiaCare) anesthesia for this case, but make sure he’s asleep.
Additional IV narcotics can be added post-extubation if the patient complains of significant pain. Anesthesia providers typically judge anesthetic dosing depending on: a) patient weight, b) patient age, and c) the patient’s vitalsigns (i.e. A patient’s weight can be misleading.
You learn to inject propofol and intubate a patient in the first few months, but its a lifetime journey to master the medical aspects of evaluating and treating the heart, lungs, brain, kidneys and vitalsigns during anesthesiacare. The endotracheal tube is your friend.
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