1. CHEO Residents Manual Amy Rodgers 2008

2. Anesthesia Lounge Your file folder Coffee machine! Microwave In this chair at 7:30am for pain rounds! APS papers APS binder and folder APS board on this wall

3. Main OR organization board (entrance to main OR) Parental presence induction volunteer Anesthesia resident on-call Anesthesia staff on call Anesthesia staff in charge Nurse in charge

4. Interview Room (entrance to main OR)

5. OR booking Patient’s charts kept on this ledge after they arrive If schedule not printed for following day, it is organized at this desk, you can take a peek if you ask nicely!

6. Main OR hallway These are the doors just past the main OR entrance Anesthesia assistants office Anesthesia resident call room Conference room for teaching and grand rounds Entrance to anesthesia offices and lounge-code needed to unlock door

7. Pre-Anesthetic Assessment This part usually filled out in PAU by anesthesiologist in clinic Usually difficult to assess in young children Signed a.m. of OR by anesthetist, verify if any changes since PAU and fasting status Filled out by nurses in day care

8. Anesthesia Record

10. Physician Orders Fill out the admission recovery score in PACU

11. APS Order Sheet Currently no dilaudid PCA APS order sheet, it should go in patient’s chart

12. Follow-up record Place this sheet in the APS binder in anesthesia lounge Write patient info on APS board in lounge Be sure to write time and date of each visit. Mark if patient was in ICU

13. APS/PCA Place in APS billing folder in anesthesia lounge

14. Anesthesia Bill A bill is required for every case, every APS patient, every PAU Patient, every trauma, every post-op ICU patient that we are following (only if not ventilated) and every consult Place bill in APS folder for Carrie along with a copy of the consult. Patient’s hospital card info here Write anesthesia staff If a trauma code or a case, mark the duration Mark the date Write the surgical procedure here Patient’s surgical diagnosis Anesthesia staff will calculate codes

15. Anesthesia Supplies in Sterile Corridor

16. Anesthesia Supplies

19. Anesthesia Supply Drawers Use supplies with white clip first. When the slot is empty, remove the white clip and place it on the board to show it needs to be ordered. Then start using the slots with the red clips at the back of the drawer.

20. Anesthesia Supply Drawers Use the slots with the white clips first, remove this clip when drawer empty.

21. Anesthesia Supply Drawers Use supplies from this part of the drawer after finishing the supplies from the drawer with white clip. Place the red clip on the board to be ordered when this part of the drawer is empty.

22. To Be Ordered Board Place the clips from empty drawers on this board.

23. Drug Cart in Sterile Corridor

24. Pentaspan and Voluven

25. Blood Gas Machine in Sterile Corridor

26. Anesthesia Carts Handy reference guide ECG stickers Tape Ventolin

27. Medication labels on top of anesthesia cart

28. Handy Reference Card on all Carts

29. Handy Reference Guide ETT sizes, blades, vitals for all ages

30. Anesthesia Cart Organization This sheet is attached to every cart

31. Anesthesia Cart Top Drawer Emergency drugs Lip smackers for face masks NS flush bags Blunt needles

32. Second drawer Tegaderm Tourniquets Alcohol swabs needles Angiocaths

33. Third drawer-syringes Infusion tubing stopcocks

34. Fourth drawer Calculator Neuromuscular twitch monitor Steri-strips Caps for stopcocks Arterial catheters IV arm boards

35. Arm boards (to protect IV) Nurses will generally secure the IV on the board while anesthesia is securing the airway

36. Fifth drawer Blood set IV tubing T-pieces for IV

37. Sixth drawer Bags to cover neonates head to prevent heat loss Volatiles NS 500cc bags RL and 1L bags are kept in corridor. PS and Voluven are kept on the anesthesia drug cart. NG tubes NS flushes (10cc)

38. Top drawer of ventilator Stylets Laryngoscope Blades: each room has a specific colour of tape around it, to be kept in that room

39. Stylets small medium

40. Oral Airways

41. 3cm-pink 4cm-orange 5cm-blue 6cm-purple 7cm-white 8cm-green 9cm-yellow 10cm-red

42. Second drawer

43. Breathing bags 500ml bag 2L bag 1L bag

44. Third drawer

45. Face Masks Neonate Infant Toddler Small adult/child Medium adult

46. Fourth drawer- ETT

47. Head rests for patients (donuts) Usually kept on top of the anesthesia machine

48. Lip Smackers Apply sparingly to the face mask prior to inhalational induction. Kept in the top drawer of anesthesia cart.

49. IV Line Set-up T-piece Buretrol NS 500cc bags unless teen CHEO routine: place tegaderm over IV to secure prior to hooking up to the line -ensure no bubbles or air in ports especially in cardiac cases! -needle free system, attach syringe to port to inject drugs

50. IV line This clip needs to be closed to place in the IV pump

51. IV pumps

52. Choose accept

53. “Yes”

54. Primary Infusion

55. Setting IV rate VTBI: Volume to be infused, set amount smaller than size of bag so bag doesn’t run dry. VI: Volume infused, look her to record final volume infused at end of case

56. IV pump When changing options press the hold button first. Press the button either beside rate, VTBI or VI. When finished making changes press the run button. Press one of these buttons to change either the rate, VTBI or VI.

57. Oximeters -Neonatal (<3kg) on foot -Adult (>40kg) on finger Infant (3-20kg) on toe/finger Always keep oximeter on at end of case, will be reused in PACU

58. Oximeters

59. Disconnect oximeter here for transfer to PACU

60. Temperature probe Usually placed in axilla, however in longer cases may be placed in nasopharynx/esophagus for more accurate monitoring

61. Bair Hugger

62. Multi-use port

63. Multi-use port for medication vials Syringes will attach to port for withdrawal of drugs

64. Emergency drugs Sux and atropine should be drawn up with a 25G needle attached in case IM/SC injection required

65. Anesthesia Cupboard in corner of OR Anesthesia circuits-small and large Filters Oximeter probes Suction tubing and yaunkers

66. Room beside the changerooms Stores refrigerator for blood products, BIS monitor, Glidescope and ultrasound machine

67. BIS monitor

68. Portable ultrasound machine

69. Glidescope

70. Glidescope blades

71. Emergency Supplies Fluid warming set Arterial line boards Blood line sets Central line kits Arterial line kits Arterial pressure line kits

72. Neonatal Cart in Sterile Corridor Bring cart into OR when working on a neonate. Supplies should be quickly accessible.

73. Neonatal cart-1 st drawer Laryngoscope blades Magill forceps Baby Yaunker Oxyblades Robert Shaw blades size 0, 1 Miller blades size 00, 0, 1

74. Neonatal cart-1 st drawer Ett # 2.5, 3.0, 3.5 Oral airways 000, 00, 0 Nasal airways at front: 12, 14, 16Fr

75. Neonatal cart 2 nd drawer ETT connectors with Co2 ports- #2.5, 3.0, 3.5 Masks-neonatal and infant sizes

76. Neonatal cart-2 nd drawer Breathing bags 500mL Mastisol

77. Neonatal cart-3 rd drawer Infant tegaderms Infant sized tourniquets IV boards Caffeine Citrate Mini blood tubes Small gauge needles

78. Neonatal cart -3 rd drawer Guidewires Arterial line boards Short Insyte Jelco’s 24, 26G

79. Neonatal cart-4 th drawer Neonatal ECG electrodes Baby SpO2 probes NG tubes-5Fr, 8Fr Precordial stethoscope

80. Neonatal ECG package Includes small stickers and wires

81. Precordial stethoscope Ng Tube 14Fr Sticker to place on dome of stethoscope Precordial stethscope Remove bell from stethoscope and attach here Tape stethoscope to L axilla to rule out R endobronchial intubation intra-op

82. Neonatal cart-5 th drawer Bp Cuffs

83. BP cuffs Size #1 #2 #3 #4 #5

84. Neonatal cart -5 th drawer Hemacue Temp probe covers

85. Neonatal cart-6 th drawer Shoulder rolls Infant MIE Baby hats

86. Neonatal Cart-6 th drawer Infant nasal cannulae Infant donut D10W D5W Extension set small bore

87. Regional Cart in Sterile Corridor

88. Regional cart-top drawer Drugs: bupivacaine, lidocaine, tetracaine, ropivacaine -also available on drug cart in sterile corridor

89. Regional Cart-top drawer Emergency drugs

90. Regional Cart-2 nd drawer Spinal needles

91. Regional Cart-2 nd drawer Syringes, fluid

92. Regional cart-3 rd drawer Epidural kits

93. Epidural Kit Contents: 19G catheter, 17G Tuohy needle, 10cc loss of resistance syringe, filter

94. Epidural Kit Contents: 20G catheter, 18G needle, 10cc loss of resistance syringe, filter

95. Regional cart-3 rd drawer Steristrips, saline flushes, large tegaderms, drapes

96. Regional Cart-4 th drawer Nerve stimulator, Pajunk stimulating needles, Regional anesthesia textbook

97. Crash cart Located in the sterile corridor beside the Neurosurgery OR Difficult Airway cart beside it (not available when working on this presentation)