Transcript The Checklists

The Checklists
Dr. Sanjay Gupte
MD, DGO, FICOG, FRCOG
President FOGSI 2010
National Convener "Save the Mother & Newborn National Initiative"
Secretary General World Gestosis Organization
Member Central Supervisory Board of PCPNDT Act
Member Ethics Committee, Medical Council India
Chairman Ethics Committee of Maharashtra Medical Council
Pre-anesthesia Questionnaire
• Is this the 1st surgery you are
undergoing?
• Any previous hospitalization?
• Do you use contact lenses,
dentures, pacemaker?
• Have you recently suffered
from influenza, cold, cough,
fever, sore throat?
• Have you recently suffering
from chest pain, cough,
breathlessness, vomiting,
ankle edema ?
• Any medicines at present?
• Any known allergies?
• Any BT received in the
past?
• Any anesthesia in the past/
any complication?
• Have you suffered from
heart disease/ HT/
asthma/convulsions/DM/
cancer/jaundice?
DR. SANJAY GUPTE, MD DGO FICOG FRCOG
Pre op check list : do & confirm
• Name, diagnosis, procedure
• Pre op instructions followed – NBM, medicines to be
taken (inhalers, Betnesol, anti hypertensive, thyroid
medicine. misoprost), medicines to be withheld (ASA,
Hypoglycemics, Heparin)
• Pre op investigations, imaging reports
• Pre op check by Physician, anaesthetist
• Consent – informed/high risk/tubal ligation/NICU/stem
cell
• X match & blood group – blood kept ready
• Risk factors social/medical/allergies
DR. SANJAY GUPTE, MD DGO FICOG FRCOG
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Pre op antibiotics amoxicillin / cefotaxime /
metronidazole
Usual drugs which are contraindicate
NSAIDS/Scoline/Prostaglandins
Additional equipment drains, epidural catheter
Trolley check Mop/ instrument count
Baby preparation trolley/ baby label/ baby paper/
pediatrician call/ NICU call/ warmer
DR. SANJAY GUPTE, MD DGO FICOG FRCOG
Pre-anesthesia
information to be
given by the
patient
Check list for anesthetist
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Name, diagnosis, procedure
Pre op instructions followed – NBM, medicines to be taken
(inhalers, Betnesol, anti hypertensives, thyroid medicine.
misoprost), medicines to be withheld (ASA, Hypoglycemics,
Heparin)
Pre op investigations, imaging reports
Preop check by Physician, anaesthetist
Consent – informed/high risk/tubal ligation/NICU/stem cell
Difficult airway/ aspiration risk
X match & blood group – blood kept ready
Premedication
DR. SANJAY GUPTE, MD DGO FICOG FRCOG
Check list for anesthetist
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Ambu bag
LMA
Anaesthetic drugs – Atropine/ Mephentin
Emergency drugs
Cardiac monitor/Pulse
Boyle’s/O2/Nitrous/Vapouriser
Laryngoscope with light
Bain’s circuit with mask
Endotracheal tube No 7
Airway - Green color
GA preparedness
DR. SANJAY GUPTE, MD DGO FICOG FRCOG
Post Op check list for doctors:
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Sponge & instrument count check
Pulse/BP/PPH/O2 saturation
Urine output/Colour
Lab sent – HPE/cord blood
Baby – warmer/label
Anesthetist permission for shifting the patient out of
the OT
• Reminder to sister about any instrument review
DR. SANJAY GUPTE, MD DGO FICOG FRCOG
Labour room safety starts with
Antenatal counseling
DR. SANJAY GUPTE, MD DGO FICOG FRCOG
Antenatal high risk tagging
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B.O.H.
Treated Infertility
Previous C.S.
IUGR
Incomp os
Hydramnios
RH Incompatibility
PIH
TH Abortion
Prematurity
Diabetics
Anaemia
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APH / PP
PPH
Elderly Primi
Previous Abortions
Post Dalism
Previous Bl. Transfusion
Hepatitis
Thyroid Dysfn
Oligohydramnios
Short Strature
Obesity
CPD
DR. SANJAY GUPTE, MD DGO FICOG FRCOG
Pre labour check-list
• Detailed history considered
• No contraindication to labour to proceedpelvic assessment.
• Previous scar
– Myomectomy
– Hysterotomy
– LSCS
• Allergies if anycontraindicated drugs
DR. SANJAY GUPTE, MD DGO FICOG FRCOG
• Blood group- whether to X match
• Rh typing
• Any need for modified protocol – augmentation,
only short trial
• Readiness & availability of staff & labour room
• Inform pediatrician & anesthetists
• Presence & discussion with relatives
• Consent for instrumentation
DR. SANJAY GUPTE, MD DGO FICOG FRCOG
Delivery check list
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Pre delivery check list- SOS anesthesia
Investigations reviewed
Allergies checked – contraindicated drugs
Relatives informed- SOS informed consent
Blood X matched
Stem cells or other samples considered
Labour room equipment checked
Trolley laid out & checked
Emergency medicines available
Baby’s preparation
DR. SANJAY GUPTE, MD DGO FICOG FRCOG
Post delivery check list
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Patient’s condition
Uterus palpation – PPH checked
Episiotomy wound checked
Baby’s condition & cord
Baby labeled & breast fed
DR. SANJAY GUPTE, MD DGO FICOG FRCOG
DR. SANJAY GUPTE, MD DGO FICOG FRCOG