Transcript Principles of Monitoring and Maintenance

Manage a Patient Under General
Parenteral Anesthesia
081-833-4549
INSTRUCTOR
SFC HILL
Joint Special Operations Medical Training Center
OBJECTIVE
As a Special Forces Medic given a
patient under general parenteral
anesthesia, continually monitor the
patients vital signs, apply corrective
treatment to any life threatening
changes in the patients vital signs,
and maintain the patient at stage
three of general anesthesia in
accordance with JSOMTC student
manual of anesthesia.
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REASON
• As a Special Forces Medic performing
general parenteral anesthesia, you will be
responsible for maintaining the patient at
stage three of general anesthesia and
maintaining the life of the patient through
surgery and recovery from anesthesia.
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PROCEDURES
• Review the principles of monitoring and
maintenance
• Review the components, clinical signs,
and depth of anesthesia
• Apply the principles of monitoring and
maintenance (Circle of Awareness)
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Review the Principles of
Monitoring and Maintenance
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Monitoring
Tasks
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•
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Level of Anesthesia
A
B
C
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Monitoring
Level of Anesthesia
• Unresponsive to pain stimuli
• Eyes fixed and pupils constricted
• Muscles relaxed
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Monitoring
Airway
• Must maintain positive control over the
patients airway (to include the tongue)
• Monitor the airway at all time while the patient
is under general anesthesia.
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Monitoring
Airway
• Oxygenation
pre-oxygenate for Intubation
100% O2 - 6 L/min
resuscitation 100% O2 - 15+ L/min
• Ventilation
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Monitoring
Breathing
• The lungs and breathing must be
continuously monitored.
• Rate and depth of respirations
• Dry versus wet lungs?
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Monitoring
Breathing
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•
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I
A
P
P
Inspection
Auscultation
Palpation
Percussion
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Monitoring
Circulation
• Heart rate, character, and rhythm = 68
strong and regular
• Tissue perfusion
• Body temperature
• Renal Function
Output = >25 to 50cc/hr
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Components of General
Anesthesia
Muscle Relaxation
Unconsciousness
Analgesia
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Components of General
Anesthesia
Muscle Relaxation
 Amount of skeletal muscle relaxation
requirements depend on the type of
operation.
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Components of General
Anesthesia
Analgesia/ Areflexia
 Pain reflexes are subdued.
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Components of General
Anesthesia
Unconsciousness/Hypnosis
 The patient is oblivious to all sensation
but pain reflexes can occur.
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Depth of Anesthesia
• Stages and Planes of Ether Anesthesia
Stage I
Amnesia
Stage II Excitement
Stage III Surgical Anesthesia
 Plane 1
 Plane 2 The Surgical Plane
 Plane 3
 Plane 4
Stage IV Impending Death
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Stages and Planes of Ether
Anesthesia
• STAGE I
Amnesia
From the onset of drowsiness to the loss of
the eyelash reflex.
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Stages and Planes of Ether
Anesthesia
• STAGE II
Excitatory Stage
Agitation, delirium, irregular respiration and
breath holding .
Pupils dilate, eyes diverge.
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Stages and Planes of Ether
Anesthesia
• STAGE III
Surgical Anesthesia
 Plane 1
From the return of regular respirations to the
cessation of REM.
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Stages and Planes of Ether
Anesthesia
• STAGE III
Plane 2 The Surgical Plane
From the cessation of REM to the onset of
paresis of the intercostal muscles.
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Stages and Planes of Ether
Anesthesia
• STAGE III
 Plane 3
From the onset to the complete paralysis of
the intercostal muscles.
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Stages and Planes of Ether
Anesthesia
• STAGE III
Plane 4
From the paralysis of the intercostal muscles
to the paralysis of the diaphragm - at the end
of this plane the patient will be apneic.
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Stages and Planes of Ether
Anesthesia
• STAGE IV
Impending Death
From the onset of apnea to circulatory failure.
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The Circle of Awareness is the
anesthetist monitoring
management tool.
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The circle helps the anesthetist
to monitor and manage:
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Vital signs
Stage of general anesthesia
Airway, respiratory and cardiac systems
Input and output of all fluids and drugs
Time
Recording
Communications
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The circle of awareness should
begin a few moments after the
patient is placed on anesthesia
maintenance.
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PATIENT
• Patient should be unresponsive to painful stimuli
• Eye’s should be: Fixed, pupils constricted (dilated =
caprine specific) and non-reactive to light
• Mandible and tongue: Relaxed
• Limbs: Relaxed, non-withdrawal to pain
• If being assisted by personnel within the OR,
request a temperature and blood pressure be taken
at this time
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AIRWAY
• Inspect Oxygen Tubing: From the wall to the
patient
• Inspect Endotracheal Tube: Secured, bulb
inflated, bite block present, and suction PRN
• Inspect Patients Respiratory Effort: Note rate
and rhythm, one deep ventilation
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BREATHING
• Inspect Trachea: Look for Tracheal deviation
or jugular vein distention (JVD)
• Inspect Chest: Rise and fall
• Auscultate Chest: Clear breath sounds, note
rate and rhythm (again)
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CIRCULATION
• Auscultate Heart: Note rate and rhythm
• Inspect All IV’s : Read labels and check fluid
levels, check drip rate, inspect tubing to
catheter, inspect IV site for infiltration
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RECORD
• Record on the SF 517: Time, drug input,
suction, oxygenation, ventilation, level of
consciousness, vitals signs, fluid input/output,
all complications throughout surgery in other
remarks
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REPORT
• Communicate: Communication the patients
status and vitals to surgical team.
• Insure you receive a response from the
surgeon
• At this point, make improvements,
adjustments and corrections to any
deficiencies that you discovered during the
circle
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SUMMARY OF
PROCEDURES
• Review the principles of monitoring and
maintenance
• Review the components, clinical signs,
and depth of anesthesia
• Apply the principles of monitoring and
maintenance (Circle of Awareness)
Joint Special Operations Medical Training Center
RESTATED
OBJECTIVE
As a Special Forces Medic given a
patient under general parenteral
anesthesia, continually monitor the
patients vital signs, apply corrective
treatment to any life threatening changes
in the patients vital signs, and maintain
the patient at stage three of general
anesthesia in accordance with JSOMTC
student manual of anesthesia.
Joint Special Operations Medical Training Center