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record anesthesia sedation 2
record anesthesia sedation 2
ARRIVAL TIME:
AGENTS/DRUGS 0 5 10 15 20 25 30 35 40 45 50 55 60 TOTALS
FLUIDS NS LR mL
OXYGEN L/min %
ECG
SpO2 IV
200
MONITORS ❏ 22G Catheter
❏ AUTO BP R L 180 ❏ 20G Catheter
❏ ECG (Lead II) ❏ ___________
❏ PULSE OXIMETER 160
R ❏ Antecubital
SYMBOLS 140 L ❏ Radial
SBP V ❏ Dorsum hand
V 120 ❏ N/A
DBP
PULSE • 100 AIRWAY
RESP ❍
❏ Nasal Cannula
POSITION 80 ❏ Nasal Mask
❏ RECLINED ❏ Mask
60 ❏ Nasopharyngeal
❏ SUPINE ❏ Oral
40 ❏ LMA
❏ N/A
20
Discharge Criteria
❏ Normal depth/rate of respiration (2) ❏ Limited breathing/airway (1) ❏ Airway support needed (0)
❏ Moves 4 extremities at will (2) ❏ Able to sit, but not stand (1) ❏ Non-ambulatory (0)
❏ Alert and oriented x 3 (2) ❏ Aroused by verbal stimulus (1) ❏ Aroused by physical stimulus (0)
❏ BP +/- 20% preop (2) ❏ BP +/- 21-40% preop (1) ❏ BP > 40% preop (0)
❏ None or mild nausea w/ no vomiting (2) ❏ Transient vomiting or retching (1) ❏ Persistent nausea and vomiting (0)
Disposition
Verbal instructions given to ❏ Patient ❏ Escort Written instructions given to ❏ Patient ❏ Escort
Post-operative appointment ❏ PRN ❏ One week ❏ 10-14 days ❏ ___________________❏ Confirmed by scheduling staff
START TIME:
AGENTS/DRUGS 0 5 10 15 20 25 30 35 40 45 50 55 60 TOTALS
mg
mg
M mg
LIDOCAINE 2% 1:100K mg
ARTICAINE 4% 1:100K/200K mg
BUPIVACAINE .5% 1:200K mg
MEPIVACAINE 3% mg
PRILOCAINE 4% 1:200K mL
FLUIDS NS LR mL
NITROUS OXIDE L/min
OXYGEN L/min
ECG IV
SpO2
MONITORS ❏ 22G Catheter x___
mmHg
❏ 20G Catheter x___
❏ AUTO BP R L 200
❏ __________ x___
❏ ECG (Lead II)
180 ❏ ___G IO Tibia x___
❏ PULSE OXIMETER
R ❏ Antecubital x___
❏ STETHOSCOPE 160
❏ CAPNOGRAPH L ❏ Radial x___
❏ Dorsum hand x___
❏ AED 140