AnesthesiologyResidentHandbook

An unofficial nuts&bolts guidefor residents by residents

USC

September 2009

Table of Contents

LAC Phone Numbers: 4

University Phone Numbers: 7

Norris Phone Numbers: 8

CHLA Phone Numbers: 8

Cedars Phone Numbers: 9

Doheny Phone Number: 9

How to pre-op: 10

The Mallampati (MP) Classification: 12

Atlanto-Occipital Joint Extension: 12

ASA Physical Status Classification 13

Fasting Recommendations: 15

Complications of Anesthesia: 16

How to prepare the meds we commonly use: 19

EPINEPHRINE 22

Endotracheal and Laryngeal Mask Airway Tube Sizes: 23

Local Anesthetics - Toxicity and Maximum Doses: 24

2

Fluid Management: 25

How to set up for an RB (red blanket): 30

3

LAC Phone Numbers: Generic: 323 409 xxxx In-House: 9 xxxx Outside Line: 8 1 xxx xxx xxxx

OR Front Desk 4591Pre-Op Clinic Front Desk 5143Pre-Op Clinic Nursing Station 5144Pre-Op Clinic Resident/Dr. Ali / Dr. Stafford 4976Outpatient Pre-Op (A5C) 7895Inpatient Pre-Op 4603Anesthesia Workroom 8944PACU 4602ORs (xx=OR #) 42xx Call Rooms, 5th Floor B5C 109 8941 B5C 110 8940 B5C 111 (Attending) 8942 B5C 112 8943Dr. Amaya VoIP 1840NancyCurtiss 7748Renee Meadows 6856Tim Vale 7869Anesthesiology Office Fax 323 441 8085Socorro Chavez 2212Dr. Rajesh Patel 2213Dr. Lumb 4597Anesthesia TechVoIP 1846OB Anesthesia Workroom 8945

4

Core Lab 7039ABG Lab 7024OR Pharmacy 5973OR Pharmacy Tech Pager 213 919 8908Main Pharmacy 7641Pharmacist Pager 213 919 1180Pyxis Hotline 4251Resident Workroom 2547GME, Old Hospital 323 226 6931Bed Control 5321Blood Bank 7134IT Help Desk 2100Dental Clinic 5013ED 5000ENT 5070Hospital Administration 2800Hospital Information 1000Patient Information 5800Jail 5266Labor & Delivery 3302Information Operator 2345Medical Administration 6734Medical Library 7006Medical Photography 7911Morgue/Autopsy 7062Nursing Administration 7519OB Attending Call Room 3386OB Resident Call Room 3325Ophthalmology Clinic 5227Pager Operator 4906

5

County Police 3333Employee Assistance Program (EAP) 213 738 4200Employee Health Services 323 226 5236Facilities Management 323 226 6873General Info 323-226-2345Medical Records 323 226 6911HR On-Site Satellite 323 226 8207County Benefits 323 890 8337Locksmith 323 226 6439

Hotlines Adverse Drug Reaction (ADR) 323 226 2246 Child Abuse 800 540 4000 DHS Compliance/HIPAA 800 711 5366 Domestic Violence/Intimate Partner 800 978 3600 Elder Abuse /Adult Abuse 877 477 3646 Fraud Hotline 800 544 6861 One Legacy 562 608 4100Patient Safety Hotline 323 226 SAFE Poison Center 800 411 8080 Safely Surrender Baby (SSB) 877 222 9723 Suicide Prevention 877 727 4747Incident Paging 111 Fire Code Red Disaster Code Triage Hazardous Spill/Radiation Code Orange Infant/Child Abduction Code Pink

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University Phone Numbers: Generic: 323 442 xxxx In-House: 2 xxxx Outside Line: 9 1 xxx xxx xxxx

Main Operator 8500University Hosp. OR, 4th Floor 8900 UUH, Anesthesia Office 8823 UUH, Resident Call Rm. (Operator+ext) 67367 UUH, Dr. Strums Office 8843FAX, Dr. Strums Office 8627 UUH, Dr. Kaufmans Office 5321 Anesthesiology Tech 8854 Priscilla Aldrete HCC2 Site 3451 7400 Dr. Lumb HCC 7420 Nelly Rueda HCC 7421 Doug Miller HCC 7422 Pain Management HCC2 Suite 3450 6202 Pain Back Line 6906Pain Mgmt., FAX 6255 Pain Pager 213 919 2158Dr. Richeimer Norris, Suite 1402 323 865 3761 Medical Records 8786Information Systems 8440Computer Accounts 1968

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Norris Phone Numbers: Generic: 323 865 xxxx In-House: 5 xxxx Outside Line: 9 1 xxx xxx xxxx

Norris OR 2nd Floor 3250 Norris Operator 3000 Norris Tech Dolores Pager 888 786 2067Norris Anesthesia Room 3233Norris ICU 3464Dr. Thangas Office 3441Resident Call Room 3456

CHLA Phone Numbers: Department of Anesthesiology & Critical Care 323 669 2262Employee Health Services 323 669 2533EHS Fax 323 913 3111OR Control Desk 323 669 25718th Floor Pediatric Pavilion 3625Tivi Ortiz, Coordinator 323 669 2262Tivi Ortiz Fax 323 660-8983

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Cedars Phone Numbers: Generic: 310 423 xxxx In-House: 3 xxxx Outside Line: 9 1 xxx xxx xxxx

Graduate Medical Education 4611GME Fax 0311Attending Call Room 4381Roberta in Anesthesia Office, 8th Floor 5841L&D, North 3rd Floor (North A elevator) 3601OR 1 8132OR 2 7994OR 3 8130Attending Pager (in-house #) (103) 0211Resident Floor Pager (in-house #) (103) 1314Resident C/S Pager (in-house #) (103) 7689

Doheny Phone Number: Doheny OR 323 442-8896

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How to pre-op:

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The Mallampati (MP) Classification:

The patient is sitting upright, with the head in neutral position, the mouth open as wide as possible, and the tongue protruded maximally. DO NOT have the patient say ah.

Class I Pillars visibleClass II Uvula visible, no pillarsClass III Only soft palate visibleClass IV Only hard palate visible

Atlanto-Occipital Joint Extension:

Have the patient extend his neck (normal is 35 degrees). This is important to achieve the sniffing position during intubation

Thyromental Distance:

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Have the patient fully extend the neck. Measure the distance from the mandible to the thyroid notch. If the distance is less than 3-4 finger breadths (less than 6 cm), there may be difficulty visualizing the glottis during laryngoscopy. A desirable value of greater than 6 cm will usually correlate with the ability to move the tongue out of the way during direct laryngoscopy to visualize the glottis.

ASA Physical Status Classification I No organic, physiologic, biochemical, or psychiatric diseaseII Mild to moderate disease; (essential htn, anemia, extremes of age, chronic bronchitis, morbid obesity)III Severe disease; (poorly controlled htn, DM vascular complications, COPD limiting activity, HD limiting activity, history of MI, angina pectorisIV Severe disease that is life threatening with or without surgery; (CHF, advanced pulmonary, renal or hepatic dysfunction)V Moribound patient with little chance of survival but submitted to surgery as a last resort-- resuscitative effort; (hemorrhage, cerebral trauma, pulmonary embolus)VI A declared brain-dead patient whose organs are being removed for donor purposes E Any case that is an emergency (added to ASA classification---ex: Class IIE)

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Other criteria which signal danger: Buck, missing, decaying, chipped, or loose teeth Mouth opening < 2.5cm Short Neck Macroglossia Large breasts or barrel chest Prominent thyroid cartilage/anterior airway Tracheostomy scar/history of tracheal stenosis

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Fasting Recommendations:

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Complications of Anesthesia: These lists are included so that you can explain to your patient in plain language the risks of anesthesia during your pre-operative evaluation. They need to understand these risks prior to signing the consent form. Some patients may not want to hear the risks, if so, then document this. Basic complications of General Anesthesia: Nausea and vomiting Hoarseness/vocal cord dysfunction Myalgias Dental Injury Peripheral Neuropathy of extremities Cardiac Dysrhythmias Myocardial Infarction Atelectasis/barotrauma Aspiration Stroke Allergic Drug Reactions Recall Death

Basic complications of Spinal Anesthetics: Hypotension Bradycardia, asystole, cardiac arrest Postspinal headache secondary to dural puncture Inadequate duration of block Patchy block or no block Total spinal (high/complete) Nausea

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Urinary retention/bowel incontinence Backache Transient radicular irritation Hypoventilation

Nerve damage, loss of sensation, motor weakness (not necessarily due to the spinal but more likely due to positioning).

Basic complications of Epidural Anesthetics: Same as Spinal and: Dural puncture Intrathecal Injection Subdural Injection Intravascular injection Epidural hematoma

The following is an example of how one of our faculty presents the risks of anesthesia to the patient::

"There is nothing doctors do that does not have some element of risk. Anesthesia can have a number of complications. Some of these are common and usually more of a discomfort than a threat to life. For example, you may become nauseated or have a headache. (Fill in your own list for the type of anesthesia you are proposing.) Life threatening complications can also happen. These are very rare, we will watch you carefully, and do our best to treat any complication.Do you have any questions?"

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Where to get our medications:

COUNTY: We currently utilize a Pyxis machine for drug distribution. You will receive a user id (SID) and a password (initially 12345 or 123456) for this system. To access controlled medications you will need to log in and further select a patient to pull meds for. Patients on the surgery schedule will be loaded and can be searched for by last name or patient id number. For RB patients you can add a temporary patient if the information hasnt been loaded yet. Once you choose your patient you will choose medications by name and select how many you want

NORRIS: Pick up box in OR entryway at about 0715 from pharmacist; if arrive later pick up box in nurses station on 3rd floor---pharmacy inside; return box to same location on 3rd floor when done for the day;

UNIVERSITY: Pick up box in OR Pharmacy and drop off in same location; other drug trays picked up by RN in your room;

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How to prepare the meds we commonly use:

*NOTE: All drugs must be labeled. Please write in the date, the concentration, and your initials.

Succinylcholine:-Vial concentration is 20mg/mL, draw up straight-Usual intubating dose 1-1.5mg/kg Rocuronium:-Vial concentration is 10mg/mL, draw up straight-Usual intubating dose 0.6-1.2mg/kg Fentanyl-Vial concentration is 50mcg/mL, draw up straight-Usual dose at intubation is 1.5-2mcg/kg Morphine:-Vial has 8mg in 1 mL.-Draw 7mL of NS into a 10cc syringe then add 1mL of morphine-Concentration is now 1mg/mLMerperidine (DEMEROL):-Vial has 100mg in 2mL-Draw 8mL of NS into a 10cc syringe then add 2mL of meperidine-Concentration is now 10mg/mL-Most often used for post-op shivering at 12.5 to 25 mg IVP Midazolam (VERSED):-Vial concentration 1mg/mL, draw up straight-Usual dose is 0.1-0.2mg/kgNeostigmine:

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-Vial concentration is 1mg/mL, draw up straight-Usual dose 0.03 0.06 mg/kg up to 5 mg maximum Glycopyrolate:-Vial concentration is 0.2mg/mL, draw up straight-Usual dose 0.008mg/kgPhenylepherine:-Premixed syringes with 40mcg/mlEphedrine:-Premixed syringes with 5mg/ml

MAC concentration of Inhalation Anesthetics: Halothane: 0.74 Isoflurane: 1.15 Desflurane: 6.0 Sevoflurane: 2.05 Nitrous Oxide: 104

Calculation of Drips: -Add X mg of medication to a 250 ml bag NS-Concentration becomes X mcg/min @ 15ml/hr(i.e.) Phenylephrine 1mg added to 250 ml bag NSconcentration becomes 1 mcg/min at 15 ml/hr. For a 70 kg person this is 0.14mcg/kg/min at 15ml/hr

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PEDS Only guidelines: See also product inserts. Note that provided concentrations may differ. Ultimate responsibility is that of the anesthesia provider. (02/07) AGE PRE 0 1M 3M 6M 9M 1Y 2 3 4 5 6 7 8 9 10 11 12 14 WT (kg) = AGE X 2 +9 2yr old) = AGE/4 + 4

2.5-3 3.5 4 4.5 5 5.5 6 + cuff

6.5 7

ETT LENGTH 10+AGE/2 or 3 X SIZE

8-9 10 11 12 13 14 15 16 17 18 20

LMA 1 1.5 2 2.5 3 ORAL AIRWAY (Varies) 00 0=50 60 70 80 BLADE 0 0 0-1 1 1.5 2 3 MIDAZ IV 0.1 PO 0.5mg/kg

mg mg

0.3 1.5

0.4 2

0.5 2.5

0.7 3.5

0.8 4

1 5

1.2 6

1.5 2.2

1.7 8.5

2 10

TYLENOL PO 10mg/kg, PR 40mg/kg one time

mg mg

30 120

40 160

50 200

70 280

80 320

100 400

120 150 600

170 200 800

250 300 400 500

PROPOFOL 2.5-3.5mg/kg [10mg/mL]

mg 8-10 10- 14

12- 18

18- 25

20- 30

25-35

30-40

35-50

40-60

50-70

60-90

75-100

100

STP 3-5 mg/kg (4 shown) mg 12 16 20 25 30 40 50 60 70 80 90 100 125 150 175 200 KETAMINE IV 1-3 IM 5-10, PO 6 mg/kg (Sedation= 1/2 dose)

IV(3) IM(5) PO(6)

9 15 18

12 20 24

15 25 30

20 35 40

25 40 50

30 50 60

35 60 70

45 75 90

50 85 100

60 100 120

75 125 150

90 150 180

100 175 200

120 200 250

150 250 300

SUX IV 1-2 mg/kg, IM 4mg/kg (2 shown)

mg mL

6 0.3

8 0.4

10 0.5

14 0.7

16 00.8

20 1

24 1.2

30 1.5

34 1.7

40 2

42 2.1

46 2.3

50 2.5

54 2.7

60 3

70 3.5

80 4

100 5

ATROPINE [0.4mg/mL] IV 10-20mcg/kg (20shown) IM 20 mcg/kg

mg mL

0.1 .25

.12 .3

.15

.4 0.2

0.5 .25 0.6

0.3 .7

.34

.8 0.4 1

0.5 1.2

0.6 1.5

0.7 1.8

0.8 2

1 2.5

EPI 10mcg/kg(1:10,000) mL 0.3 0.4 0.5 0.7 0.8 1 1.2 1.5 1.7 2 2.1 2.3 2.5 2.7 3 3.5 4 5 MIV 0.2mg/kg [2mg/mL]

mg mL

0.6 0.3

0.8 0.4

1 0.5

1.4 0.7

1.6 0.8

2 1

2.4 1.2

3 1.5

4 2

5 2.5

6 3

8 4

10 5

VEC 0.1mg/kg mL 0.3 0.4 0.5 0.7 0.8 1 1.2 1.5 2 2.5 3 4 5 ROC 0.6mg/kg 1.2mg/kg

mL mL

0.2 0.4

.25 0.5

0.3 0.6

0.4 0.8

0.5 1

0.6 1.2

0.7 1.4

0.9 1.8

1.2 2.4

1.5 3

1.8 3.6

2.5 5

3.5 7

CIS 0.1mg/kg [2mg/mL]

mg mL

0.3 .15

0.4 0.2

0.5 .25

0.7 0.3

0.8 0.4

1 0.5

1.2 0.6

1.5 0.8

2 1

2.5 1.2

3 1.5

4 2

5 2.5

GLYCO 7-10mcg/kg (7 shown) [0.2mg/mL]

mcg mL

20 0.1

30 .15

35 .17

50 .25

60 0.3

70 .35

80 0.4

100 0.5

120 0.6

140 0.7

0.8

180 0.9

200 1

1.2

280 1.4

350 1.8

NEOSTIG. 40-70mcg/kg (70shown) [1mg/mL] [CHLA:0.5mg/mL]

mg mL mL

0.2 0.2 0.4

0.3 0.3 0.6

.35 0.35 0.7

0.5 0.5 1

0.6 0.6 1.2

0.7 0.7 1.4

0.8 0.8 1.6

1 1 2

1.2 1.2 2.4

1.4 1.4 2.8

1.5 1.5 3

1.6 1.6 3.2

1.8 1.8 3.6

1.9 1.9 3.8

2 2 4

2.5 2.5 5

3 3 6

3.5 3.5 7

FENTANYL 1-2mcg/kg [10mcg/mL] (postop 0.5mcg/kg)

mcg mcg

3- 6

4- 8

5- 10

7-14

8- 16

10-20

15-30

17-35

20-40

25-50

30-60

35-70

40-80

50-100

MS 0.1-0.2mg/kg [1mg/mL] (postop 0.05mg/kg)

mL mL

0.3-0.6

0.4-0.8

0.5-1

0.7-1.4

0.8-1.6

1-2 1.2-2.4

1.5-3

1.7-3.4

2-4 2-4 2.5-5

3-6

TORADOL 0.5 mg/kg mg mL

5 .16

6 0.2

10 0.3

12 0.4

15 0.5

20 0.6

25 0.8

DROPERIDOL (10 shown) 10-20mcg/kg. Dilute: 0.4mL/10mL=[100mcg/mL]

mcg mL diluted

30 0.3

40 0.4

50 0.5

70 0.7

80 0.8

100 1

120 1.2

150 1.5

170 1.7

200 2

250 2.5

300 3

400 4

500 5

REGLAN 0.1mg/kg mg 0.3 0.4 0.5 0.7 0.8 1 1.2 1.5 1.7 2 2.5 3 4 5 ZOFRAN 0.1- 0.15 mg/kg (0.15 shown)

mg mL

0.4 0.2

0.6 0.3

0.8 0.4

1 0.5

1.2 0.6

1.5 0.7

1.8 0.9

2.2 1.1

2.5 1.2

3 1.5

3.7 1.8

4 2

4 4 4

DECADRON 0.5 mg/kg [4mg/mL]

mg mL

1.5 0.4

2 0.5

2.5 0.6

3.5 0.9

4 1

6 1.5

8 2

10 2.5

10 10 10 10

SOLUMEDROL 1.5-2mg/kg (2mg shown)

mg mL

6 0.1

8 .13

10 .16

14 0.2

16 .25

20 0.3

25 0.4

30 0.5

40 0.6

45 0.7

50 0.8

60 1

70 1.1

80 1.3

100 1.6

BENADRYL 0.5-1mg/kg mg 3 4 5 7 8 10 12 15 17 20 25 30 35 40 50 CaCl 20 mg/kg mg 60 80 100 140 160 200 240 300 340 400 500 600 800 1gm NaHCO3 1mEq/kg then 0.5 mEq / kg or 0.3 X kg X base def- icit SBE: AMP IV or AMOX PO 50mg/kg

mg 150 200 250 350 400 500 600 750 850 1gm 1.2 gm

1.3 gm

1.4 gm

1.5 gm

1.8 gm

2 gm

ANCEF 25 mg/kg mg 75 100 125 175 200 250 300 375 425 500 575 625 675 700 875 1gm GENT 2 mg/kg mg 6 8 10 14 16 20 24 30 34 40 50 60 80 VANCO 20 mg/kg mg 60 80 100 140 160 200 240 300 340 400 500 600 800 1gm CLINDA 10 mg/kg mg 30 40 50 70 80 100 120 150 170 200 250 300 400 500 CAUDAL 1mL/kg(20max) 0.25% MARCAINE+EPI

mL 3 4 5 7 8 10 12 15 17 20 20 20 20 20

HR 100 - 170

80 - 160

80 -130

80 -120

75-115

70-110

60-105

SBP mmHg 55 - 70

75-90

75-100

75-110

80-115

85-120

DBP mmHg 35-40

45-55

50-65

55-75

55-80

55-80

RR 40-60

30-40

25-30

20-25

18-25

18-22

BLOOD VOL mL/kg 90 80 75 70 4 ml PRBC / kg = 1 gm/dL Hb

mL 12 16 20 28 32 40 48 60 68 80 84 92 100 110 120 140 160 200

IV mL/h [ 4:2:1] mL/h 12 16 20 28 32 40 45 50 55 60 65 70 75 80 90

EPINEPHRINESUGGESTED MAXIMUM DOSAGE FOR INFANTS AND CHILDREN (SUB-Q) -1:100,000 0.4 ml/kg of body weight (limit 10 ml) -1:200,000 0.8 ml/kg of body weight (limit 20 ml)

MAXIMUM OF 4 UG/KG

Concentrations: 1 ml = 1:10 = 100 mg 1 ml = 1:100 = 10 mg 1 ml = 1:1000 = 1 mg = 1000ug 1 ml = 1:2000 = 0.5 mg = 500 ug 1 ml = 1:5,000 = 0.2 mg = 200ug 1 ml = 1:10,000 = 0.1 mg = 100 ug 1 ml = 1:50,000 = 0.02 mg = 20 ug 1 ml = 1:100,000 = 0.01 mg = 10 ug 1 ml = 1:200,000 = 0.005 mg = 5 ug SOLUTION PERCENTAGE = MG/CC (10) x % = MG/CC 0.1 % Solution = 1 mg/cc 0.5 % Solution = 5 mg/cc 1.0 % Solution = 10 mg/cc 5.0 % Solution = 50 mg/cc

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Endotracheal and Laryngeal Mask Airway Tube Sizes:

Endotracheal Tubes:Diameter selection: -Male adults usually take 7.5 - 8.0 mm ETT -Female adults usually take 7.0 - 7.5 mm ETT -Formula for children: 4 + (age / 4)Tube depth selection: -Male adults usually need 23 cm from the teeth. -Female adults usually need 21 cm from the teeth. -Formula for children: 12 + (age / 2 )

Laryngeal Mask Airways:Size selection: Patient size: Max cuff volume: 1 up to 5 kg up to 4mL 1.5 5 - 10 kg up to 7mL 2 10 - 20 kg up to 10mL 2.5 20 - 30 kg up to 14mL 3 30 - 50 kg up to 20mL 4 50- 70 kg up to 30mL 5 70 - 100 kg up to 40mL 6 over 100 kg up to 50 ml LMA Contraindications:1. Risk for aspiration 2. Patients with decreased pulmonary compliance3. Patients not fully unconscious

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Local Anesthetics - Toxicity and Maximum Doses:

Toxicity: Signs and symptoms of CNS toxicity include: tinnitus, metallic taste, visual disturbances, numbness of tongue or lips, muscle twitching and eventually loss of consciousness, seizures, and coma. Treatment of this begins with oxygen and anticonvulsant therapy with midazolam 1-2mg, or sodium thiopental 50-150mg.

Maximum Doses: You will need to convert the percentile of local into mg/kg and give a max dose; Lidocaine 1.0% = 10mg/cc (move decimal over one when converting percentile to mg)

Drug Maximum DoseLidocaine 4mg/kgLidocaine with epi 6mg/kgBupivicaine 3mg/kgBupivicaine with epi 5mg/kgRopivacaine 3mg/kgProcaine 14mg/kgChloroprocaine 11mg/kgTetracaine 0.7mg/kg

Cocaine (topical) 3mg/kg

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Fluid Management:

Appropriate fluid management is always important, but even more essential in cardiac patients or in patients with large

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OR Hour Maintenance

Deficit EBL Insensible Loss

Total mL/hr

0-1 110 550 1/3 520 1330

1-2 110 275 1/3 520 1130

2-3 110 275 1/3 520 1055

3-4 110 0 1/3 520 930

Maintenance Deficit Insensible Loss Estimated Blood Loss

70 kg patient4x10 = 402x10 = 201x50 = 50 110 mL/hr

10 hrs of NPO110x10 hrs = 110 mL of 110 = 550 mLfor 1st hour of 1100 = 275 mLfor next 2 hours

Operation is total colectomy. Assume maximum insensible loss: 7-8 mL/kg/hr = 490-560 mL/hr ~ 520 mL/hr

Replace with 1:3 ratio crystalloid 1:1 ratio colloid

amounts of blood loss. Several factors must be calculated for appropriate fluid delivery.

Maintenance: -Calculate using the 4, 2, 1 rule and the patients weight in kg.

Take a 70 kg person for example: 4 x 1st 10 kg = 40 2 x 2nd 10 kg = 20 1 x remaining kg (50) = 50 Total = 110mL/hrDeficit:

-Take the maintenance x ____ hours of NPO status = deficit.-Give the 1st half in the first hour, and the second half over the next two hours.

Insensible losses: 3-4 mL/kg/hr for minimal trauma 5-6 mL/kg/hr for moderate trauma 7-8 mL/kg/hr for severe trauma

Estimated Blood Loss (EBL):-1 saturated lap sponge = 100mL blood-1 saturated raytech 4*4 = 15mL blood-Check suction canister and subtract amount of irrigation used

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-Replacement of blood with colloids (hespan, PRBCs, albumin) is done with a 1:1 ratio. -Replacement of blood with crystalloids (normal saline, lactated ringers) is done with a 1:3 ratio.

Example: EBL of 200cc can be replaced with 200cc of hespan or 600cc of normal saline.

Estimation of Blood Volume Premature Infants 100 ml/kg Term Newborn 95 ml/kg 1 year age 75 ml/kg 3 years age=adult 70 ml/kg

Blood Product Replacement 10 cc/kg packed RBC will raise HCT 3-4% 10-20 cc/kg FFP if bleeding is acute; 1 ml of FFP contains 1 unit of coagulation factor activity. 1 unit/kg of Factor VIII will raise plasma level by 2% 1 unit of platelets contains at least 5.5 x 10 platelets in 50 to 70 ml of plasma; 1 unit/10kg or 20 ml/kg

All of these fluids can be added up on an hourly basis to give you a total amount of fluid needed per hour. See below for an example of a Fluids Chart.

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28

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How to set up for an RB (red blanket):

Airway:-Endotracheal tubes sizes 7.0, 7.5 stylette & syringe, cuff checked-Oral Airways sizes adult sizes: 8. 9, 10-Laryngoscope & blades sizes Mac 3, Mac 4, Mil 2

Suction: attached and working

Drugs: in labeled syringes, fresh and datedSuccinylcholine 200 mg in 12 ml syringeRocuronium 100 mg in 12 ml syringeEphedrine premixed 5mg/ml syringePhenylepherine premixed 40mcg/ml syringePropofol bottle out with 20 ml syringeEtomidate bottle out with 20 ml syringe Atropine box out

Empty syringes labeled as:Midazolam 6 ml syringe (1mg/ml)Fentanyl 6 ml syringe (50mcg/ml)Ketamine 12 ml syringe (10mg/ml)

Tape: clear, paper, wide, and orange

IV Fluids:

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LR 1 liter (2 bags) NS 1 liter (2 bags) Hespan 500 ml (2 bags) Albumin 500 ml (1 bottle) Nitroglycerine Drip 1 bottle

Level One: setup with 1 liter NS, extension tubing, primed and record date and time with tape on fluid bag when spiked.

Central line: 8.5 french Cordis, Slick catheter and Triple Lumen Catheter. (in drawer on back boom)

Arterial cannula: 20 ga (long) +/- Arrow, wire, sterile gauze, alcohol swabs, tegaderm, wrist roll, plastic tape, sterile gloves, chloraprep

Anesthesia Machine: checked, long anesthesia circuit hooked up

Anesthesia Cart: supplies and drugs stocked

Monitors: Blood pressure cuff Pulse-oximeter Arterial line set-up, zeroed (500cc NS) EKG with leads Nerve stimulator with leads

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32

33

34

35

36

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All Residents/Fellows and Mike Garcia are One Way Text Pagers: to Text = area code + phone # @archwireless.net

July 1, 2009 DEPARTMENT OF ANESTHESIOLOGY

RESIDENT PAGER LIST

RESIDENTS PAGER # HOME/CELL PHONE ALEM, NAVID 213 919-0751 949 413-4950 ATOIAN, ANDRE 213 919-5125 310 951-8400 AUNG, ANDREW 213 919-0974 510 435-3215 BACK, NICHOLAS 213 919-8756 213 448-8282 BANG, JASON 213 919-0908 214 417-0300 CHAN, SANDY 213 919-0216 626 683-9508 COTTRELL, MIQUAEL 213 919-0476 310 592-3949 CUDEMUS, GASTON 213 919-0749 954 254 0247 DARJEAN, MELISSA 213 919-0765 832 215-9827 DUNLAP, NEKA 213 919-0232 323 423-4015 EHRESMANN, SONYA 213 919-0741 323 440-6642 EVAZYAN, TANDIK 213 919-0743 818 515-2411 FAZELI, BAHAR 213 919-8636 818 416-4111 FOX, CHRISTOPHER 213 919-3545 703 731-4349 HALUM, MARTIN 213 919-0263 908 208-5726 HSIEH, GRACE 213 919-0331 973 946-2380 IIDA, WANDA 213 919-8644 209 256-4037 JANIGIAN, DENA (Chief Resident) 213 919-0902 559 270-4713 KARANDIKAR, KALYANI 213 919-0734 310 614-5044 KARU, ANOUKI 213 919-0909 909 261-4380 KIM, CHARLES (Chief Resident) 213 919-0904 310 923-8864 KIM, PETER 213 919-0905 443 838-5712 LALANI, FAISAL 213 919-3102 619 993-4057 LAZAR, MICHAEL 213 919-0729 714 658-1034 LI, ERIC 213 919-0916 415 269-8533 MADARA, JONATHAN 213 919-0736 562 852-9206 MENOR, CHRISTINA 213 919-8613 602 573-7756 MUHTAR, DAN 213 919-1602 310 420-4791 NATARAJAN, SIVA 213 919-0118 310 422-6851 NGUYEN, BENJAMIN 213 919-0752 714 782-2760 NGUYEN, FRANCIS 213 919-0748 626 991-7742 NGUYEN, JOHN 213 919-0754 714 425-0936 NIU, DAVID 213 919-8935 909 553-1181 NOGAKI, VANESSA 213 919-0733 808 561-5985 OSHAUGHNESSY, TIMOTHY 213 919-8653 919 306-5721 PARK, ELLEN 213 919-0747 917 575-2755 PARK, HYUN (JONATHAN) 213 919-0914 323 829-9578 POFFENBERGER, KYLE 213 919-2057 717 979-6337 RAJARATNAM, CRISANJALI 213 919-0742 951 288-1073 ROBY, JAY 213 919-0913 303 641-7856 RUMJAHN, HOWARD (Chief Resident) 213 919-0912 626 872-0350 SAMIMI, NADIV 213 919-5073 310 903-8878 SHARMA, SHELLEY 213 919-3134 909 567-8834 TANG, CARA 213 919-0745 202 679-0827 THIO, WARREN 213 919-0746 310 372-5257 THOMAS, AMY 213 919-0744 562 627-8496 TRAN, JULIE 213 919-0901 310 990-3918 TRINH, THUAN-HAU 213 919-0911 714 876-3049 TSONG, CHERIE 213 919-0641 949 400-3233 UMSTOT, AMBER 213 919-8635 951 265-7746 VOSKANIAN, STEVEN 213 919-0735 619 200-6552 YANG, SUSIE 213 919-0910 310 936-6118 YEN, AUDREY 213 919-0569 714 335-8996 ZAIDI, ZAHEER 213 919-0915 201 407-9002

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Skytel Pagers beginning with 888 drop area code and use the 7-digits @skytel.com. Those beginning with 877 you must include area code + 7-digits @skytel.com.

* Indicates an Arch Two-Way or One-Way Pager: to E-mail area code+phone # @archwireless.net

September 8, 2009 DEPARTMENT OF ANESTHESIOLOGY

ATTENDING STAFF - PAGER LIST PLEASE NOTE: TO USE PAGERS, DIAL THE NUMBER, WAIT FOR THE TONE, ENTER THE NUMBER YOU ARE CALLING FROM AND

HIT THE POUND (#) KEY.

NAME PAGER# PERSONAL PHONE# AFRASIABI, ANOUSH 213 919-2011 714 734-0679 AHMED, KABIR 213 919-8901 323 333-0642

ALEXANDER, RUSSEL 213 919-8808 * 626 254-9194 ALI, NASIM 213 919-0006 * 818 952-6399 AMAYA, RODOLFO 213 919-0249 * 323 656-8005 AMIRKHANIAN, SEBO 213 919-1571* 310 903-0188 ARNAUDOV, DIMITER 213 919-0493 *

323 571-8688

AYOUB, TAWFIK 888 602-9839 310 544-4119 AYRIAN, EUGENIA 213 203-0980 * 818 952-4027 AZAD, ARMIN 213 919-0139 * 310 454-4479 BAEK, ANDREW 213 919-1569* 310 780-9614

BAHMANI, MASMOUEH 213 717-6034 home 310 230-7757 cell 310 383-3317 BENBASSAT, MAXIM 213 919-0482 * 626 285-2702 BERGER, JACK 310 718-4637 310 558-3883 BLANCO, ADOLFO 213 919-1565* 786 553-4942 BOHORQUEZ, MARTIN 213 287-0077 * 310 641-4229

COHANIM, RANTIM 213 919-1563* 646 280-7181 DANIEL, JAMES 213 704-1476 818 506-5354 DARWISH, AHMED 888 270-9653 310 577-2175 DIX. DAVID 213 919-0781 * 310 503-0736 ELSPAS, SHLOMO 213 919-5061 310 838-2001

GASIOR, BARBARA 213 287-0168 * 626 793-2204 GUCEV, GLIGOR 213 919-0157 * 562 494-9429 GUNDAMRAJ, NARASIMHA 877 415-1278 626 422-2536 HADDY, STEVEN 888 602-1858* 818 422-5212 HUMPHREY, TARA 213 919-1567 248 207-1522 JOSEPH, MARY 213 717-0153 * 626 282-2315 KANDIL, SHERIF 213 919-1572* 818 241-7759 KAUFMAN, WAYNE 888 602-2149 818 243-9103

KHAN, RAFAT 213 919-5309 * 310 377-7418 LEE, JEFFREY 213 919-0490 323 497-3449 (cell phone use 1st) LEIPZIG, GREG 213 203-0836 415 722-7299 LUMB, PHILIP 888 602-1937* 626 449 7955 323 974-1968(cell phone) MCKEEVER, RODNEY 213 919-1094* 310 486-4827 MILLER, MARGARET 213 287-0006 * 626 794-6689 626-318-9364 cell MOGOS, MARIANA 213 287-0656 * 714 374-0329 MOVAHEDI, RANA 877 252-5675 310 413-9935

NEMAT, M. ALI 213 287-0177 310 559-1512 NGUYEN, CHUCK 213 919-1566* 213 944-9212 PATEL, JAYESHKUMAR 877 250-5358 818 957-4673 PATEL, RAJESH 877 427-1008 818 360-0428 RAHMAN, PARIZA 213 287-0113 * 626 683-8491 RAPHAEL, DAVID 213 919-0484 * 818 752-8643 REVER, LINDA 213 919-7729 626 683-9995 RICHEIMER, STEVEN 213 717-2781 323 935-0741

ROFFEY, PETER 213 919-0497 * RYAN, ANGELE 310 580-1776 310 378-3734 SEDRA, ASHRAF 888 602-1390 661 263-2323 310-433-5628 cell STAFFORD, NOVARRO 213 919-5069 818 788-2846 STRUM, EARL 888 602-7720* 818 763-0185 TAKLA, FAYEZ 213 919-5292 * 818 956-2234 THANGATHURAI, DURAI 213 919-0496 * 626 795-8101 TSE, HERMAN 213 919-1570 * 323 605-6009 VARNER, CHELSIA 877 421-1098 * 301 318-1045

WEINSTEIN, FAYE 213 717-6662 310 474-5064 ZELMAN, VLADIMIR 877 481-6634 310 393-5310

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