Anaesthetists Handbook - MEDICAL EDUCATION at University ...

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Pain management and postoperative careIf the patient requires analgesia for further advice contact the PainTeam on bleep 2492 or 2493 or ward pharmacist.Discharge medicationMethadone or buprenorphine will not be supplied at discharge.Exceptions to this will be on the instruction of the CDT only and amaximum of 24 to 48 hours supply can be provided.The CDT should be contacted by the medical or nursing team toensure that the community supply and follow-up is resumed atdischarge.If the CDT is unavailable then contact the hospital pharmacydepartment for further advice.Guidelines for the management of opiate withdrawal symptoms inhospital patients who are opiate usersWithdrawal syndromes differ according to the particular drugsinvolved, the daily amounts taken, the duration of use and individualsensitivity. Withdrawal from opiates is associated with a specificwithdrawal syndrome. Assessment of withdrawal should be based onobservable signs rather than subjective symptom reporting. Theseverity and management of withdrawal is greatly influenced bypatient anxiety so informing patients about how their symptoms arelikely to vary over time can help to reduce this.The following treatments are recommended dependent upon thesigns and symptoms.Signs and symptomsNausea and vomitingDiarrhoeaStomach crampsTreatmentProchlorperazine orally 5mg 8-hourly or12.5 mg IM 8-hourly or cyclizine orally50 mg 8-hourlyOral loperamide 4 mg stat followed by2 mg after each loose stool for up to 5days. Max 16 mg daily dose.Mebeverine 135 mg tds (oral).120 Anaesthetists Handbook January 2010
Signs and symptomsAgitation, anxiety,tremorsSleeplessnessGeneralised aches andpainsPain management and postoperative careTreatmentDiazepam up to 5 - 10 mg orally QDS asrequired. Short course only (not to beprescribed at discharge).In severe cases of anxiety or agitationcontact the on-call psychiatrist.Zopiclone 7.5mg orally nocte. Shortcourse only (not to be prescribed atdischarge).Oral paracetamol 1 g QDS and• oral ibuprofen 1.2 g – 1.8 gdaily in 3 or 4 divided doses or• oral diclofenac 50 mg tds.Topical muscle rubefacients.Untreated heroin withdrawal typically reaches it peak 36 to 72 hoursafter the last dose. Symptoms of withdrawal will usually havesubsided significantly after five days.For further information or advice contact Pharmacy or the Pain Teamon bleep 2492 or 2493.Coventry Community Drugs team can be contacted on024 7655 3845 during normal office hours for advice.Anaesthetists Handbook January 2010 121
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Department of AnaesthesiaAnaestheti
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Document control for approved clini
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ContentsTrauma list anaesthetist (t
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ContentsStudy leave 81Junior doctor
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ContentsIndications for investigati
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ContentsRenal patients - clinical g
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Introduction and scope of guideline
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Introduction and scope of guideline
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Airway assessmentManaging difficult
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Managing difficult airways• Flexi
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Managing difficult airways• Manuj
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Resuscitation - advanced life suppo
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Resuscitation - advanced life suppo
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Duties of the on call anaesthetists
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Getting senior helpGetting senior h
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On call casesGetting senior helpYou
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Supervision for sick patientsGettin
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Calling the senior resident anaesth
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Perianaesthesia Care Unit (PACU)PAC
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PACUThe surgical team responsible f
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PACU6. Oxygen and intravenous thera
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Integration with the critical care
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Inter-hospital transfersInter-hospi
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Inter-hospital transfersConsultant
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Signing onAdministrative issuesYour
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Administrative issuesMobile phones
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Administrative issuesobstetrics, we
Page 69 and 70: Administrative issuesMain theatre r
Page 71 and 72: CLWrota processes• To complete ca
Page 73 and 74: Security rules:• Do not put confi
Page 75 and 76: Education and trainingthe Royal Col
Page 77 and 78: Education and trainingthe necessary
Page 79 and 80: Education and trainingarrive in the
Page 81 and 82: Education and traininginformation c
Page 83 and 84: Education and trainingexamination i
Page 85 and 86: Education and trainingAll consultan
Page 87 and 88: Presenting at seminars• Bring har
Page 89 and 90: Presenting at seminarsDOI advise yo
Page 91 and 92: Clinical adverse event reportingCli
Page 93 and 94: Clinical auditClinical audit[Apprai
Page 95 and 96: Clinical auditYour presentation sho
Page 97 and 98: Pain management and postoperative c
Page 119: Pain management and postoperative c
Page 123 and 124: Epidural anaesthesia and analgesiaP
Page 125 and 126: Epidural anaesthesia and analgesiai
Page 127 and 128: Epidural anaesthesia and analgesiaS
Page 129 and 130: IndicationsEpidural anaesthesia and
Page 131 and 132: Epidural anaesthesia and analgesiaH
Page 133 and 134: Assessment and treatment optionsEpi
Page 135 and 136: Epidural anaesthesia and analgesia3
Page 137 and 138: Epidural anaesthesia and analgesia
Page 139 and 140: Epidural anaesthesia and analgesiaA
Page 141 and 142: Epidural anaesthesia and analgesiaG
Page 143 and 144: Allergies and adverse drug reaction
Page 149 and 150: Awareness during anaesthesiaPrevent
Page 151 and 152: Fractured neck of femur:management
Page 153 and 154: Fractured neck of femurGuidelines f
Page 155 and 156: Management of patients with diabete
Page 157 and 158: Patients who take insulinManagement
Page 163 and 164: Preoperative assessment and investi
Page 167 and 168: Indications for investigationsFull
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SevofluraneSevoflurane[Dr Mark Port
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Sevofluranemust be considered on it
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Gabapentin in acute painSide-effect
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Blood and blood productsBlood and b
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Blood and blood productsWhen the un
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Blood and blood productsCross match
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Blood and blood productsBlood Cool
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Blood and blood productsHaematology
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Blood and blood products25322 so th
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Blood and blood productsfactors, ha
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Day case anaesthesia6. Social crite
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ENT anaesthesiaENT anaesthesia{Dr C
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ENT anaesthesiaIntraoperative• In
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Miscellaneous issuesMiscellaneous i
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Miscellaneous issuesideally be cont
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Miscellaneous issuesinstruction man
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Miscellaneous issuesRemifentanilRem
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Miscellaneous issuesCentral neuraxi
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Miscellaneous issuesAnalgesia Fenta
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Miscellaneous issues• Diclofenac
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Miscellaneous issues• Associated
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Miscellaneous issues• Everyone wi
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Miscellaneous issues• If fasting
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Miscellaneous issueslabour ward ana
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Miscellaneous issuesThere is no cli
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Patient monitoring in and out of th
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Miscellaneous issuessuch as Hartman
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Miscellaneous issues• Abdominal a
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Miscellaneous issuesPrevention of p
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Miscellaneous issuesDifferent clini
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Recovery and patient handoverMiscel
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For afternoon list (pm)Diabetic Pat
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Miscellaneous issuestake part in th
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Miscellaneous issuesSee page 37 for
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Waiting list initiatives[Appraised
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Major Incident ProcedureStaff assem
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Major Incident Procedure• In coop
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Finding your way round theUniversit
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• Coffee room.• Quiet room (fiv
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Anaesthesia department lead clinici
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Trust organisational structureTrust
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Telephone numbersLabour ward……
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IndexIndexAabsence, 68adenotonsille
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Indexemergency department, 222emerg
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Indexmortality review, 93MRI scansa
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Indexstudy leave, 81applications, 6
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NotesAnaesthetists Handbook January
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NotesAnaesthetists Handbook January
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