Anaesthetists Handbook - MEDICAL EDUCATION at University ...

Miscellaneous issuesMiscellaneous issues‘Bare below the elbows’The dress code and uniform policy is being revised at presentfollowing change throughout the NHS. You should bear the followingin mind:• Do not wear wristwatches, long sleeves or long ties on clinicalduties.• No white coats.• Corporate and professional identity is important. Wear yourname badge at all times when working so that it is visible topatients, including on your theatre scrubs.Cardioversions[Appraised by Dr F Choksey, January 2010]Urgent cardioversions may be called for the emergency assessmentunit, coronary care unit, or cardiothoracic critical care or ward areas.If asked to anaesthetise for urgent cardioversion, treat it as a fullanaesthetic. Take an Operating Department Practitioner to assist andperform the anaesthetic with full AAGBI-standard monitoring. If thefacilities are not appropriate at the patient’s location, use ananaesthetic room in the cardiothoracic or general theatre suite.Speak to the nurse in charge of theatres (bleep 2597) to organise atechnician. Be aware that the doctor performing the cardioversionmay not be as capable as you at diagnosing and treating postcardioversioncomplications.These patients are often on warfarin and the INR is maintainedaround 2. Patients whose INR is higher than 4 are consideredunsuitable for cardioversion due to the potential for haemorrhage.Preoxygenation is essential and propofol is the induction agent ofAnaesthetists Handbook January 2010 197