Prepare a Patient for General Anesthesia 081 833

Prepare a Patient for General Anesthesia 081 -833 -4522 INSTRUCTOR SFC HILL Joint Special Operations Medical Training Center

OBJECTIVE As a Special Forces Medic, prepare a patient for general parenteral anesthesia, in accordance with JSOMTC student manual of anesthesia. Joint Special Operations Medical Training Center

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 Joint Special Operations Medical Training Center

PROCEDURES • The Preanesthetic Visit • Prep for general parenteral anesthesia • Emergency prep for general parenteral anesthesia Joint Special Operations Medical Training Center

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 Joint Special Operations Medical Training Center

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 Joint Special Operations Medical Training Center

Preanesthetic Visit • What are some possible problems or complication that can be identified prior to the administration of anesthesia? Joint Special Operations Medical Training Center

Preanesthetic Visit • • • Tracheal Intubation Problems Allergies Drug interactions Previous Exposure to Anesthesia Concurrent Illnesses Classification of Physical Status Joint Special Operations Medical Training Center

Tracheal Intubation Problems • • • Short Thick Neck Disease of Pharynx or Larynx Tracheal Deviation Small Mouth Stiff Temporomandibular Joint Prominent Upper Incisors Joint Special Operations Medical Training Center

Tracheal Intubation Problems • • Chipped or Cracked Enamel Caries Loose Teeth Dentures, Crowns Joint Special Operations Medical Training Center

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 Joint Special Operations Medical Training Center

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 Joint Special Operations Medical Training Center

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 Joint Special Operations Medical Training Center

Concurrent Illnesses • • Common Cold Liver Disease Diabetes Mellitus Anemia COPD Heart Disease Essential Hypertension Joint Special Operations Medical Training Center

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 Joint Special Operations Medical Training Center

Record information • Record all the information from the preanesthetic visit into the preanesthetic summary of the patient’s SF 517 Joint Special Operations Medical Training Center

Patient Instructions • Review the upcoming procedure with the patient • Ensure the patient understands his/her responsibilities prior to the planned procedure Joint Special Operations Medical Training Center

Prep for general parenteral anesthesia Joint Special Operations Medical Training Center

Review and Prep • Review the patients SF 517 • Prepare the anesthetist cart and all equipment to be utilized during the procedure to include back-up and emergency equipment Joint Special Operations Medical Training Center

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 Joint Special Operations Medical Training Center

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 Joint Special Operations Medical Training Center

Administer Premedication • Administer antisialagogue (Atropine, . 4. 6 mg deep IM 45 minutes prior to induction) • Administer sedative (Promethazine, 2550 mg PO 30 minutes prior to induction) • Continue to monitor the patients vitals every 15 minutes until induction • Move the patient to the OR Joint Special Operations Medical Training Center

Emergency prep for general parenteral anesthesia Joint Special Operations Medical Training Center

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 Joint Special Operations Medical Training Center

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 Joint Special Operations Medical Training Center

Prepare the patient • Draw blood for grouping and crossmatching • Establish large bore IV access and prepare for fluid resuscitation and possible transfusion • Establish patient on monitors • Establish nasogastric tube Joint Special Operations Medical Training Center

Administer Premedication • Administer antisialagogue (Atropine, . 4. 6 mg deep IM) • Administer sedative (Promethazine, 2550 mg slow IV) Joint Special Operations Medical Training Center

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 Joint Special Operations Medical Training Center

SUMMARY OF PROCEDURES • The Preanesthetic Visit • Prep for general parenteral anesthesia • Emergency prep for general parenteral anesthesia Joint Special Operations Medical Training Center

RESTATED OBJECTIVE As a Special Forces Medic, prepare a patient for general parenteral anesthesia, in accordance with JSOMTC student manual of anesthesia. Joint Special Operations Medical Training Center