Transcript Slide 1

How do I chart …
Spinal Block:
Insertion
and
Anesthetic Drugs
Subarachnoid Block
Pt sitting – skin prep + LA – site L3-4
#24 Sprotte – easy – free-flow CSF @ 6cm
No blood in CSF / no paresthesias
Bupiv 0.5% 15mg + Fent 15mcg + PF Morphine 150mcg
Good block – T9-10 level – no complications
Charting Regional - Spinal Events
If you are familiar with adding an Event, skip to Slide 8
Click Here
• You want to “bookmark” the time you start the Spinal
• Look for the Macro Bar in the upper right part of the screen
Regional
Anesthesia
Start
Monitored
Anesthesia Care
Start
General
Anesthesia
Start
• Clicking on one of these 3 Buttons will place a bookmark on
the Timeline
• For a Combined Regional – General Anesthetic:
– click Regional when starting Block
– then click General when Inducing the GA
Charting Regional - Spinal Events
• A “Tool Tip” appears when the cursor arrow hovers over a button
• In this case, the name of the Macro button is “Regional Start”
• This button has been configured to add :
- event #1: the time that you began the Regional Anesthetic
- a reminder: you need to select an “Anesthesia Type”
- event #2: Oxygen by nasal cannula or facemask
• when the button is left-clicked
a pop-up window appears
• you have two choices:
- accept the time shown
(button or hit [Enter] key)
- change the time
(if you were delayed or
forgot to click Regional Start)
Charting Regional - Spinal Events
After clicking the Regional Start button:
• The button has a “depressed” look to show
that it has been clicked (no need to repeat!)
• There is now a Blue Square on the TimeLine
(in the 13:45 time box but reads 13:46)
• Hovering over the Blue Square tells you what
Events have been logged
Now you can direct your full attention to
performing the Spinal.
Once the Case is well underway, you can
complete the documentation.
Charting Regional - Spinal Events
When Case is underway and you have time to document, the
TimeLine has moved along and the Regional Start bookmark has
disappeared
Scroll Back
1 TimeBox
at a time
Click Here
for larger
time scrolls
Once you see a blue box, identify it as the Regional bookmark
by hovering over it with the mouse pointer
Note: The TimeBox is 13:45 but the Bookmark is for 13:46
Yellow
TimeBox
is current time
Charting Regional - Spinal Events
To document the insertion of the Spinal,
You need to “Add Events”
There are a few ways to do this.
The “formal” way is to use the menu
“Insert/View” and select “Add Events”
OR - You could use the “F6” key
This is what happens:
A large pop-up box appears with the Current time entered as
the default time.
Since you wanted 13:46 or thereabouts, this will require the tedious
job of editing the time.
Charting Regional - Spinal Events
The SIMPLEST method is to Left-Click on the TimeLine
But the question is: Where Exactly?
If you click in the 13:45 TimeBox, the Add Events box time will
default to 13:45 but the Regional bookmark says 13:46.
This can be easily altered by clicking on the Minutes and
typing in the time you want.
OR – click on the 13:50 TimeBox!
You can use
these tiny
arrows, too.
Charting Regional - Spinal Events
This is the Left half of the
Add Events pop-up
First few
options are
Anesthesia
Types
The “Event Set” named
“A064-Regional-Spinal”
was left-clicked
The list of “Events” then
appeared in the right
panel
The idea is to select all
Events that you want to
use to document
Hold down the [Ctrl] key
while you left-click on
each desired event
To select an Anesthesia Type
some relevant choices are
available within this
Event Set. A full list is in
A001_Anesthesia Type.
Charting Regional - Epidural Events
In this view, the slider
for the right panel has
been used to view the
Events in the lower
part of the panel
More selections using
the [Ctrl]-click method
have been made
Left-Click
this arrow to use
the selections
Charting Regional - Spinal Events
The Selected Events
are listed
Click in “Comments”
boxes as needed to
complete the notes
Left-Click
this arrow to
move the
selections
to the right
When done,
click on OK
Charting Regional - Spinal Events
To review the selected Events, you open up the “Event Log”
You can click on the
Event Log button
OR
the Events menu
item in Insert/View
OR
press the F4 key
This is the Event Log that is shown:
Note: Anesthesia Type
If you want to change (edit) a Comment, double-click on the Event line
and an Edit Event box appears
Charting Regional - Spinal Events
If you need to change an Event (e.g. Approach was Paramedian),
you will have to Delete the “Midline” event and Add a new one
This screen capture shows “Midline” is gone
and “Paramedian” is added at the bottom
An “Audit Trail” is kept of every entry, change and deletion.
See Epidural slides for illustration.
Charting Regional - Spinal Drugs
When Anesthesia Manager
is first opened, there is a
default list of drugs listed
under “Medications (All)”
The option “Show Headings”
is very useful to organize
how the drugs are displayed
and how to add new drugs
to a specific category.
Since no Local Anesthetics
are listed, we will have to
add the ones we want.
Charting Regional - Spinal Drugs
The “generic” method to add
drugs is to right-click on one
of the drug family headings.
In this case, since there is no
heading for Local Anesthetics,
right-click on the Medications
Bar and select “Add Item”.
You would select the drug
family for Local Anesthetics
and then the individual drug
wanted.
Warning! There are many options.
There is an easier way!
Click on the “deck of cards” icon called
Protocols. This will display a library of
groups of drugs and fluids from which
to choose.
Charting Regional - Spinal Drugs
This is the Protocols window that pops up after clicking the button.
This protocol
has been
selected
These drugs are
members of this
protocol
Charting Regional - Epidural Drugs
The way drugs are listed outside of Protocols can be confusing.
A drug may be a Bolus, an Infusion, or a part of a Combination.
Fortunately, we can list them all together in one Protocol!
Included for convenience, the Lido
test dose can be charted either as a
DRUG or as an Epidural EVENT
This is an
INFUSION combo
Bupiv + Fent
N.B. mL/h
This is a
BOLUS combo
Bupiv + Fent
N.B. mL only
Select the drugs you want by clicking on them, one at a time.
Charting Regional - Spinal Drugs
When you have selected the drugs you want, click on the Add button
and when prompted, click OK
The listing selected includes Bupiv 0.5%, Fent and Morph PF.
Each drug has a dose of zero mL’s or mcg’s.
Charting Regional - Spinal Drugs
Don’t get confused when the Protocol window remains,
but the previous Bupiv protocol has disappeared!
The program assumes you don't want any further drugs from
the Bupiv protocol but that you might want to look at other
protocols.
Click on the Cancel button to finish. The next time you open
the Protocols window, the Bupiv protocol will be there.
Charting Regional - Spinal Drugs
When you return to the Medication listing there is now a
new category called “Regional Block Anesthetics”
New Drug
Family
Horizontal Lines highlight
The less-than
symbols mark the
start of the case
Hover the pointer
to highlight a drug
line
To enter a drug dose, click in the TimeBox in the desired
time column.
In this case, we want to document all 3 drugs in one go.
It doesn’t matter which of the 3 TimeBoxes you click;
just stay within the horizontal highlighting lines.
Charting Regional - Epidural Drugs
This is the
standard drug
dose entry
pop-up window.
The time is from the
TimeBox you clicked
Focus is here when
the window opens
– no need to click you can type directly
the dose
It has been
customized for
this drug to
speed entry.
The default route
is EPID
Bolus drug –
so Infusion greyed out
Confirm and close –
either mouse click
or hit [Enter] key (faster)
Charting Regional - Epidural Drugs
Sometimes when you return to the Medication listing, only the drug with
the new dose shows on the screen.
Click on the Refresh/Restore
button to show the complete
drug list.
Charting Regional - Epidural Drugs
Now we want to enter the initial bolus dose of the Bupiv-Fent mixture,
in the next 5 minute TimeBox:
mL only = Bolus
Click within the highlighted 2 lines
to enter the drug doses.
As a 2-drug combo,
2 lines are
highlighted
Charting Regional - Epidural Drugs
This is a Combination Medication drug entry window:
With 2 drugs, you need to click
in a dose box to start
The defaults show
what 1 mL contains
You need to do
the math yourself:
6 mL = 30 mcg of Fent
Charting Regional - Epidural Drugs
We now want to enter the Infusion dose settings.
You can select Bupiv and Fentanyl separately to chart as
Infusions but Anesthesia Manager will chart these infusions
in the Medication Infusions & Fluids section.
To keep everything together in the Medications section,
it is necessary to configure the 2 drugs as a Infusion Combination:
mL/h = Infusion
Charting Regional - Epidural Drugs
This is the Infusion Combo dose entry window:
When you enter the Bupiv
rate, the Fent rate is
automatically entered
Simply enter
a new Pump Rate
here to change
infusion rate
Charting Regional - Epidural Drugs
Here is the completed entry of the Epidural drugs:
Large arrow
shows start of
Infusion
Small arrow shows
continuing Infusion
With a rate change, there is
a new large arrow