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

2. 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.

3. 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

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

5. 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

6. 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

7. 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?

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

9. 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

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

11. 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

12. 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

13. 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

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

15. 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

16. 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

17. 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

18. Joint Special Operations Medical Training Center Prep for general parenteral anesthesia

19. Joint Special Operations Medical Training Center Review and Prep Review the patients SF517 Prepare the anesthetist cart and all equipment to be utilized during the procedure to include back-up and emergency equipment

20. 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

21. 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

22. Joint Special Operations Medical Training Center Administer Premedication Administer antisialagogue (Atropine,.4-.6mg deep IM 45 minutes prior to induction) Administer sedative (Promethazine, 25- 50mg PO 30 minutes prior to induction) Continue to monitor the patients vitals every 15 minutes until induction Move the patient to the OR

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

24. 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

25. 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

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

27. Joint Special Operations Medical Training Center Administer Premedication Administer antisialagogue (Atropine,.4-.6mg deep IM) Administer sedative (Promethazine, 25- 50mg slow IV)

28. 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

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

30. 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.