Joint Special Operations Medical Training Center Prepare a Patient for General Anesthesia...

Joint Special Operations Medical Training Center

Prepare a Patient for General Anesthesia

081-833-4522

INSTRUCTOR

SFC HILL


OBJECTIVE

As a Special Forces Medic, prepare a patient for general

parenteral anesthesia, in accordance with JSOMTC student

manual of anesthesia.


REASON

• As a Special Forces Medic preparation of the patient and yourself will be a critical task in the successful performance of general parenteral anesthesia


PROCEDURES

• The Preanesthetic Visit

• Prep for general parenteral anesthesia

• Emergency prep for general parenteral anesthesia


The Preanesthetic Visit

• The preanesthetic visit is conducted so the anesthetist can meet with the patient for the purpose of identifying any possible complications prior to the anesthetic procedure and alleviating the patients possible anxiety or fear of anesthesia/surgery


Preanesthetic Visit

• Should take place at least 24 hours prior to the scheduled procedure

• If possible, it should be conducted prior to emergency administration of anesthesia


Preanesthetic Visit

• What are some possible problems or complication that can be identified prior to the administration of anesthesia?


Preanesthetic Visit

• Tracheal Intubation Problems• Allergies• Drug interactions• Previous Exposure to Anesthesia• Concurrent Illnesses• Classification of Physical Status


Tracheal Intubation Problems

• Short Thick Neck

• Disease of Pharynx or Larynx

• Tracheal Deviation

• Small Mouth

• Stiff Temporomandibular Joint

• Prominent Upper Incisors


Tracheal Intubation Problems

• Chipped or Cracked Enamel

• Caries

• Loose Teeth

• Dentures, Crowns


Allergies

• All Pharmacological Agents are potential allergens

• Emergency drugs for anaphylactic shock must be on hand prior to administration of any drug

• Take detailed History to differentiate between side effects and allergic reaction


DRUG INTERACTIONS

• Note present drug therapy

• Research any present drug therapies verses the anesthetic therapy plan for this procedure

• Many drugs will not interact well with anesthetic agents


Previous Exposure to Anesthesia

• Repeat use of certain anesthetic agents may cause hepatic damage or stress

• Take a detailed History of previous use of anesthesia

• Agents that caused problems in the past should not be repeated

• Take a detailed History of any previous difficulties


Concurrent Illnesses

• Common Cold

• Liver Disease

• Diabetes Mellitus

• Anemia

• COPD

• Heart Disease

• Essential Hypertension


Classification of Physical Illnesses

• Class I- fit and healthy

• Class II- Mild systemic illness

• Class III- Severe systemic illness that is not incapacitating

• Class IV- Incapacitating, systemic, life threatening illness

• Class V- Expectant, with or without surgery

• “E”- Emergency


Record information

• Record all the information from the preanesthetic visit into the preanesthetic summary of the patient’s SF 517


Patient Instructions

• Review the upcoming procedure with the patient

• Ensure the patient understands his/her responsibilities prior to the planned procedure


Prep for general parenteral anesthesia


Review and Prep

• Review the patients SF517

• Prepare the anesthetist cart and all equipment to be utilized during the procedure to include back-up and emergency equipment


Receive the patient

• Identify patient and reconfirm type and location of procedure

• Converse with the patient to establish his or her mental status

• Establish the patients compliance with his or her preanesthetic orders

• Review the procedure once again with the patient

• Calm and reassure the patient


Prepare the patient

• Establish baseline set of vitals for the patient

• Establish the patient on 2 liters a minute, humidified oxygen

• Establish patient on monitors

• Establish IV access, Normal Saline, TKO


Administer Premedication

• Administer antisialagogue (Atropine, .4-.6mg deep IM 45 minutes prior to induction)

• Administer sedative (Promethazine, 25-50mg PO 30 minutes prior to induction)

• Continue to monitor the patients vitals every 15 minutes until induction

• Move the patient to the OR


Emergency prep for general parenteral anesthesia


Receive the patient• Identify the patient and attempt to obtain a

brief but thorough history• Work with the surgical team to establish the

patients condition (A-B-C) and level of consciousness

• Perform life saving measures• If the patient is conscious and orientated X 3,

converse with the patient to establish his or her mental status

• If the patient is conscious and orientated X 3, attempt to calm and reassure the patient


Prepare the patient

• Obtain vitals of the patient

• Establish and maintain the patients airway

• Establish the patient on 6 - 15 liters a minute, humidified oxygen


Prepare the patient

• Draw blood for grouping and cross-matching

• Establish large bore IV access and prepare for fluid resuscitation and possible transfusion

• Establish patient on monitors

• Establish nasogastric tube


Administer Premedication

• Administer antisialagogue (Atropine, .4-.6mg deep IM)

• Administer sedative (Promethazine, 25-50mg slow IV)


Prepare for induction

• Prepare for induction of anesthesia• Emergency patients should be stabilized prior

to induction of anesthesia whenever possible.• With the unstable patient, induction should

proceed when only the immediate surgical intervention will save the patients life


SUMMARY OF PROCEDURES

• The Preanesthetic Visit

• Prep for general parenteral anesthesia

• Emergency prep for general parenteral anesthesia


RESTATEDOBJECTIVE

As a Special Forces Medic, prepare a patient for general

parenteral anesthesia, in accordance with JSOMTC student

manual of anesthesia.

Date post:	15-Dec-2015
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Joint Special Operations Medical Training Center Prepare a Patient for General Anesthesia...

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