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AVA ASA Low Electronic European

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43 views

AVA ASA Low Electronic European

Uploaded by

monicaza77
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Date:

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Anaesthesia record
Name: History: Temperament: ASA classification

Owner: HR: RR: I No organic disease


II Mild systemic disease
Breed: Pulse quality: Severe systemic disease
III
(not incapacitating)
Age: Sex: Clinical findings/results/medications: MM: CRT: Severe disease
IV
(constant threat to life)
Weight: Thoracic auscultation: Moribund
V
(life expectancy < 24 h)
Anaesthetist: Add ‘E’ for emergencies

Clinician: Temperature: °C ASA Grade:

Procedure(s): Anticipated problems:

Pre-GA medication Dose Route Time Induction agent(s) Dose Route Time
Anaesthetic
…………………………………………. ……………….. ……….. ………... Safety ……………………………………….… ……………….. ………... ………...
Checklist
……………………………………….… ……………….. ……….. ………... completed ……………………………………….… ……………….. ……….. ………...
(see overleaf)
……………………………………….… ……………….. ……….. ………... IV catheter Position: Size:

ET tube / LMA / Mask Cuffed / Uncuffed Size: Breathing system: Eye(s) lubricated
Time

Fluids/Drugs/Monitoring

Notes 220
Patient 210
200
position 190
180
Patient 170
160
warming 150
140
Throat Placed 130
120
pack Removed 110
100
In: Out:
90
80
70
Swabs 60
50
40
30
20
In: Out:
10

Sharps Iso / Sevo %

O2 / N2O / Air L/min

● HR SpO2 %
Symbols

o RR ø IPPV Jaw tone -/+/++

˅ SAP – MAP ˄ DAP Palpebral -/+

Doppler Eye position ↓/→


Recovery instructions: T+0 T+15 T+30 T+45
Time
Heart rate
Resp. rate
MM & CRT
Temp.
IV catheter care: Remove once recovered Maintain & flush Pain score
Anaesthetic Safety Checklist

Pre-Induction
Patient NAME, owner CONSENT & PROCEDURE confirmed
IV CANNULA placed & patent
AIRWAY EQUIPMENT available & functioning
Endotracheal tube CUFFS checked
ANAESTHETIC MACHINE checked today
Adequate OXYGEN for proposed procedure
BREATHING SYSTEM connected, leak free & APL VALVE OPEN
Person assigned to MONITOR patient
RISKS identified & COMMUNICATED
EMERGENCY INTERVENTIONS available

Pre-Procedure — Time Out


Patient NAME & PROCEDURE confirmed
DEPTH of anaesthesia appropriate
SAFETY CONCERNS COMMUNICATED

Recovery
SAFETY CONCERNS COMMUNICATED
Airway, Breathing, Circulation (fluid balance), Body Temperature, Pain
ASSESSMENT & INTERVENTION PLAN confirmed
ANALGESIC PLAN confirmed
Person assigned to MONITOR patient

This checklist was written by the AVA with design and distribution support from and distributor partner

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