Sie sind auf Seite 1von 1

ANESTHESIA RECORD

PATIENT’S IDENTIFICATION PROCEDURE


START STOP
ASA PRIOR TO INDUCTION
1 2 3 4 5 6 E Anesthesia
□ UNCHANGED □ CHANGED

Procedure
Date OR No. Page of Surgeon(s)

PRE-PROCEDURE MONITORS AND EQUIPMENT ANESTHETIC TECHNIQUES AIRWAY MANAGEMENT RECOVERY


□ Identified □ ID Band □ Questioning □ Steth □ Esoph □ Precord □ Other Method: □ General □ Spinal Intubation □ Oral □ Nasal
Location Time
□ Chart Review □ Permit Signed □ Epidural □ Caudal □ Brachial
□ Non-Invasive BP □ Left □ Right □ Direct Vision □ Magill’s □ Blind
□ NPO Since □ Bier Block □ Ankle Block □ M.A.C.
BP O2 Sat.
Pre-anesthetic State: □ Continuous ECG □ V Lead ECG □ Diff. see Rmks □ Fiber Optic □ Stylet
General: □ Pre-02 □ L.T.A. P R T
□ Calm □ Pulse Oximeter □ Oxygen Analyzer □ Attempts X ___ □ Blade
□ Awake □ Asleep □ Rapid Sequence □ Cricoid Pressure □ Awake □ Stable □ Nasal Oxygen
□ Apprehensive □ Confused □ End Tidal C02 □ Gas Analyzer □ Intravenous □ Inhalation □ Tube size ____ □ Drowsy □ Unstable □ Mask Oxygen
□ Uncooperative □ Unresponsive □ Temp__________ □ Nerve Stimulator □ Regular □ RAE □ Armored □ Somnolent □Intubated □T-Piece Oxygen
□ Intramuscular □ Rectal
□ □ Unarousable □ Ventilator
□ Warming Blanket □ EEG □ Doppler Regional: □ Cuffed □ Min. occ. pres. □ Oral/Nasal Airway
PATIENT SAFETY □ Airway Humidifier □ Fluid Warmer □ Position_________________ □ Uncuffed, leaks at ___ cm H 20
□ Anes. Machine ______________Checked □ NG/OG Tube □ Foley Catheter □ Prep _______ □ Local______________ □ Secured at _____ □ ET CO2 Present CONTROLLED DRUGS
Drug Used Destroyed Returned
□ Safety Belt On □ Axillary Roll □ Art line__________________________ □ Needle__________________________ □ Breath Sounds _________________
□ Arm Restraints □ Arms Tucked □ CVC ____________________________ □ Drug(s)_________________________ □ LMA □ Size ____
□ Pressure points checked and padded □ PA Line__________________________ □ Dose ___________ □ Attempts x_____ Airway: □ Oral □ Nasal □ Natural
□ Eye Care: □ Ointment □ Saline □ IV(s)_______________________________ □ Site ____________ □ Level _________ □ Mask Case □ Via Tracheostomy Provider Witness

□ Taped □ Pads □ Goggles □_________________________________ □ Catheter ________ □ See Remarks □ Nasal Cannula □ Simple 02 Mask
TIME:

□ Enf □ Iso (%)


□ N2O □ Air (L/min)
TOTALS
Oxygen (L/min)
FLUIDS / AGENTS

( )
( )
( )

Urine (ml) SYMBOLS:


EBL (ml)

EKG X
ANESTHESIA
MONITORS

% 02 Inspired (FI02)
02 Saturation (Sa02)
End Tidal C02 ¤
Temp: □ °C □ °F
OPERATION



B/PCUFF
PRESSURE
Baseline

200
Values

180
T
ARTERIAL
160 LINE PRESSURE

Δ
VITAL SIGNS

140
MEAN ARTERIAL
BP 120 PRESSURE

100
=
PULSE
P 80
Ο
60
SPONTANEUS
RESP
40
Ø
R 20 ASSISTED
RESP

Tidal Vol. (ml) r ⊗


VENT

Resp. Rate CONTROLLED


Peak Pres, (cm H20) RESP

PEEP (cm H20) T


TOURNICQUET
Symbols for Remarks
Position

REMARKS / RECOMENDATIONS:

ANESTHESIA PROVIDER(S) _________________________________________________


signature

Das könnte Ihnen auch gefallen