Anaesthetists Handbook PDF
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Department of Anaesthesia Anaesthetists Handbook Twenty-fourth Edition January 2015 For review by February 2016 www.anaesthetics.uk.com Contents Department of Anaesthesia Anaesthetists Handbook Dr Ramesh Sadasivan, consultant anaesthetist Email: [email protected] Internal email: Sadasivan Ramesh (RKB) The Department of Anaesthesia and the clinical director for anaesthesia have approved this handbook. My thanks are due to those of my colleagues who have advised on or provided content or appraised sections. Further copies are available from the Anaesthesia Office at the University Hospital, Coventry. Email: [email protected]; internal email: Anaesthesia (RKB) The guidelines within are presented in good faith and are believed to be accurate. The responsibility for actions and drug administration remains with the clinician concerned. Dr Mark Porter has written all sections except where otherwise indicated, with amendments by appraisers. All sections have been appraised by me except where otherwise indicated, and reviewed by Dr Falguni Choksey. Edition history First edition February 1999 … … Twenty-second edition January 2013 Twenty-third edition January 2014 Twenty-fourth edition January 2015 Anaesthetists Handbook 2 Document control for approved clinical guidelines Guideline title Anaesthetists Handbook Guideline type Revised guideline Division Diagnostics and service division e-Library source folder Anaesthesia Dr Ramesh Sadasivan, consultant Author name anaesthetist Author email address Sadasivan Ramesh (RKB) Dr Falguni Choksey, consultant Reviewer name anaesthetist Reviewer email Choksey Falguni (RKB) address Expected date of next Before February 2016 revision Expiry date February 2016 Version number Twenty-fourth edition Anaesthetists Handbook January 2015 3 Contents Contents Contents 4 Introduction and scope of guidelines 11 Advice on personal issues 12 Further advice 12 Information and clinical guidelines in UHCW 12 Induction in the department of anaesthesia 13 What this handbook contains 14 Managing difficult airways 15 Known previous, or anticipated, difficult intubation 15 Airway assessment 16 Difficult airway trolley 17 Algorithm for management 18 Training 19 Awake Fibreoptic Intubation 20 Record keeping 25 Resuscitation – advanced life support 27 Duties of the on call anaesthetists 33 Important notice 33 Introduction 33 Shift times 34 What we circulate to the rest of the hospital 36 Bleeps 37 Transfers 38 Senior resident anaesthetist 38 Labour ward anaesthetist 44 Anaesthetists Handbook January 2015 4 Contents Resident anaesthetist 44 Trauma list anaesthetist (trauma) 45 General emergency teams and starred registrars 46 Conduct of general emergency lists 47 Consultants on call 47 Deferring urgent cases and advising against anaesthesia 49 Consultant advice for subspecialty interests 49 Getting senior help 52 Clinical alarm system 52 ‘Anaesthesia emergency’ group call 52 Mobile communications 53 On call cases 53 Routine cases 54 Documentation 55 Referral to the senior resident anaesthetist 55 Supervision for sick patients 55 Calling the senior resident anaesthetist 57 Role of the SAS anaesthetist and on call at Rugby 60 Perianaesthesia Care Unit (PACU) 61 Points to remember 62 PACU admission policy 62 PACU discharge policy 63 Integration with the critical care unit 66 Ventilated patients outside ICU 67 Inter-hospital transfers 69 Administrative issues 72 Anaesthetists Handbook January 2015 5 Contents The Anaesthesia Office 72 Signing on 73 Communications 73 Identity badges 75 Standard working day for trainees 75 Car parking 75 Weekly rotas 75 List cancellations and changes 76 On call rotas 76 Applying for leave and your entitlements 77 Expenses 78 Absence and sickness 78 Family planning claims 79 Department of anaesthesia 79 CLWrota processes 80 Data security 82 Education and training 85 ALS training 85 Records of supervised training 85 Obstetric anaesthesia assessments 86 Modular training 86 Anaesthesia specialty modules in Birmingham 88 Local teaching and courses 90 Quality improvement and patient safety 92 Study leave 93 Junior doctors forum 94 Anaesthesia junior doctors' forum 94 Anaesthetists Handbook January 2015 6 Contents Location of duties – study sessions 95 Role of the college tutors 95 Role of the educational supervisors 95 Role of the lead assessors 96 Serious Untoward Incidents 96 Escalation of concerns 96 Presenting at seminars 97 Logistic support and network computers 97 How to avoid a truly awful presentation 98 Clinical adverse event reporting 101 Quality improvement and patient safety (QIPS) 103 Getting help 103 Guidelines for undertaking clinical audit 104 Pain management service 107 Allergies and adverse drug reactions 108 Latex allergy 109 Suxamethonium problems in the family history 110 Awareness during anaesthesia 113 Preoperative assessment and investigations 115 Operational policy 115 Indications for investigations 118 Obesity 120 Hypertension and the surgical patient 120 ECG and echocardiography pathway 123 Respiratory function test pathway for pre-screening 124 Anaesthetists Handbook January 2015 7 Contents Sevoflurane 125 Clinical pharmacology 125 Clinical indications 125 Acceptable use policy 126 Blood and blood products 128 The bleeding patient 128 Blood availability 129 Crossmatch sample validity 130 Indications for transfusion 131 Ordering blood 133 Crossmatch samples 135 Checking blood availability 135 Blood storage 136 Other blood products and techniques 138 Administration of blood 138 Refusal of consent for transfusion 139 Blood transfusion contact details 141 Intraoperative Cell Salvage 142 Day case anaesthesia 143 Criteria for day case anaesthesia 143 Spinal anaesthesia in day surgical patients 145 Miscellaneous issues 146 Airway devices 146 Antibiotics: on the drug chart 147 ‘Bare below the elbows’ 147 Cardioversions 148 Central line insertion 149 Anaesthetists Handbook January 2015 8 Contents Clock policy 151 Dental damage during anaesthesia 151 Drugs and prescribing 152 Electroconvulsive therapy 154 Emergency calls while you are anaesthetising 155 Infection control policies 155 Inotrope infusions 157 Intravenous cannulae 157 Low flow anaesthesia 157 Managing Massive Haemorrhage in Trauma 158 MRI scans 163 Nerve blocks – postoperative care 165 Neuraxial opioids 165 Neuroradiological coiling procedures 166 Obstetric anaesthesia – new registrars and locums 167 Operating Department Practitioners (ODPs) and anaesthetic nurses 168 Ophthalmic anaesthesia 169 Oxygen prescription 170 Paracetamol loading doses 172 Patient monitoring in and out of theatres 173 Preoperative fasting times 175 Preoperative patient assessment and time keeping 176 Records 177 Recovery and patient handover 179 Safer surgery checklists 179 Sedation requests for diagnostic imaging 179 Sharps injury (exposure to potential contamination) 180 Anaesthetists Handbook January 2015 9 Contents Stop before you block 181 Syringe drivers, valves and TIVA 182 Theatre wear 183 Trauma lists 183 Guideline for anaesthetic management of hip fracture 186 Cement Curfew 189 Ultrasound guided nerve blocks 192 Waiting list initiatives 193 Working with other clinicians 193 Major Incident Procedure 194 Locations 194 General consultant on call (action card 23) 196 Senior resident anaesthetist (action card 24) 197 Consultant intensivist on call (action card 25) 197 Finding your way round the University Hospitals 199 Anaesthesia department lead clinicians 202 Telephone numbers 207 Index 211 Anaesthetists Handbook January 2015 10
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