Pharmacological Patient Response Evaluation

Guidelines:

• Continuous assessment for medication reaction
  • Induction particularly
  • Vesiculation
  • Allergy
  • Iv site!
• Appropriate local selection
  • No epi on appendages
  • No epi for peds (typically)
  • NO lido with exparel!
    • Communicate with anesthesia! They love it for blocks
• Heparin before induction if ordered
  • Don’t administer on surgical site

Considerations:

• Epi local visible on admin
• Communicate totals of local given, calculate mix dosage
  • None extra on field!
  • Anesthesia involvement with calculation
• Label label label
• Routine reassess IV site/admin site
• Propofol burns, given quick
  • Quick = pressure = Iv blow
  • Beware rubbing

Nurse’s role:

• Police labeling and logistics
• Communication with pharmacy
• Provide last check before placing on field
• Advocate communication between anes and surgeon
• Exparel band!

Pitfalls:

• Dumping entire local onto field
  • More than max available
  • Several surgical teams each administering max
• Exparel block, lido from surgeon
• Epi on peds/appendages
• Iv site infiltration

Examples:

• Fasciculations visible at appropriate time (IV patent, confident adequate dosage delivered)
• Red blanching across chest, difficult mask (Allergy! Must identify, expose chest)

Linchpins (Key Points):

• Surgical process introduces many unique medications to patient and multiple teams administering potentially conflicting meds