WARNING: I find this system
useful, but it has NOT been validated by anyone else. Use it at your own risk.
Your feedback is most welcome.
When a patient is under an anesthetic it is necessary to monitor and deal with a variety of systems on a continuous basis. A systematic approach will help you to achieve this quickly , efficiently, and completely. This website offers one such system that you may incorporate in your day to day anesthetic care. It is rapid, easy to remember, and easy to do.
Why is scanning necessary?
Anesthetists and pilots have often being compared. Like anesthetists, pilots have to monitor and adjust many parameters. An anesthetists looks at factors such as circuit, ventilation ,circulation , depth , positioning etc, while pilots similarly have to deal with a variety of aspects such as height , speed, direction, fuel, and engine performance.
In both professions , there is a grave risk of focussing on some aspects and ignoring others. For an example , if a pilot concentrated only on the most obvious items such as height , speed and direction , he or she could easily miss monitoring fuel consumption which could lead to a disaster. Similarly an anesthetist might focus on occasional ventricular ectopics appearing on the screen and completely miss out that the vaporiser has run out. This is more likely with long cases, exhaustion , and / or when the case isn't going well.
Pilots get around this problem by using a scanning technique. This basically involves monitoring their instruments in a regular systematic way so that they don't miss out anything. Their eyes scan the instruments in a particular pattern and make adjustments to the flight accordingly. With regular practice it becomes effortless and quick.
Anesthetists can also get around this problem by developing a scanning technique to go over systems in an organised way so as to not miss anything of importance. When done regularly , it becomes effortless, quick and useful. "Rapid Anesthesia Scan" is one such scanning technique you can use.
If a scan technique is to move from paper (or computer screen !) to practical use in the operating room , it must be capable of being remembered easily. This scan tries to achieve this by using headings similar to ABC's that are familiar to all. It is also logically arranged to make it easy to remember and deal with .
Being a short scan , it can be mastered quickly and easily done routinely. However, like anything else , it too has a learning curve and you will have to persevere for at least half a morning before it yields its fruits.
Use this scan at your own risk. It is presented for your consideration with good intentions , but I do not in any way claim it to be a perfect, error free system. However , PLEASE provide your feedback by clicking on any of the "contact" links.
Enjoy your scanning !
Brief Description of Rapid Anesthesia Scan
Given below is a brief description of the scan. While the text may appear long, in reality the scan can be accomplished quite quickly ( e.g. less than two minutes ). The purpose of this section is to "talk you through" a scan. More details of individual components are available elsewhere in this website. When you read through, don't get disheartened if you cannot remember it all. Any scan will take a little practice before one becomes fluent in it !
The scan begins with the "Airway". In this scan, the "Airway" includes all the tubing from the common gas outlet up to the patient end. You start at the common gas outlet. Is it connected and secure? Then assess the breathing system. See for secure connections and valve positions. Then check the specific airway such as laryngeal mask or endotracheal tube. Is it secure?
From the airway , move onto the chest to assess "Breathing". Look for equal chest expansion. If not done recently , you might also want to auscultate.
Now assess gas exchange. Assess Oxygenation. Since your eyes are at the patient , check the surgical field. Is the blood red? You can also , at the same time , judge oozing / bleeding. Then move to your monitor. Look at FiO2 and Oxygen saturation. Then assess CO2. Look at the trace and end tidal CO2.
Now that you have an idea of the gas exchange, you can optimise the mechanics of ventilation. Remember Flow -- Pressure -- Volume -- Rate -- Muscle (diaphragm). "Flow" is to remind you to check the flow meters. Are they set correctly? Regarding ventilation, is the Pressure , Volume , and Rate appropriate. "Muscle" reminds you to check muscle relaxation. (You can think of the diaphram to help remember muscle relaxation). This completes "Breathing".
Now assess "Circulation".
Look at the output of the heart. Is the BP appropriate? You might want to palpate pulse volume ( you have already seen the pulse oximeter plethysmograph under "oxygenation" ).
Now look at the heart itself. Is the electrocardiogram okay?
Then assess the input to the heart. Asses the Fluid IN Vs. Fluid OUT. Assess CVP.
This completes "Circulation"
Now asses "Depth". Use clinical, MAC and other means to assess depth of anesthesia and analgesia. Check vaporizer level.
Then look at "Exposure". Look at position and pressure points. Check on anti DVT measures. Check temperature and warmers.