[Music] foreign
[Music] is always the four Rams checklist and this is machine monitoring mabels that's m-a-b-e-l-s
mabels and that's Airway equipment and finally medications so those are some of the things
we're going to go through so let's start with the first M and this is machine so these fancy
machines are really great for example usually in the morning my nests are fantastic they already
go through the integrated checklist and the full machine test that is automated back in the old
days you'd have to do it this manually but these days on the new machines you can literally press
this button full test and then it goes through a full checklist I might do that in another video
what I do is I literally go to show log and make sure that all of these things have been passed
for example Bentley and gas passed on this date with a leak that's okay so it's less than 100
mils generally up to 250 mils is okay if it's greater than 250 mils you really want to talk
to your supervisor a circuit lease has been passed again the date is today's date and it's
less than 100 so that's fantastic and now the low pressure leaks are often done once a week
or so but again this is has all been passed and it's fine what I do then is I even though I know
that the machine check has been done I make sure that a few other things are also really good for
example I go around to the back of the machine to make sure that I have a self-inflating Liddell bag
or a bag Mass valve and this means that if this machine was to stuff up in any way it's a very
complicated device it's you know with a couple hundred thousand dollars at least you can still do
most of the essential functions which is positive pressure ventilation with a little deal back so
if something went really wrong with this machine the Liddell bag would be absolutely fine for this
so that's the first thing so I make sure that the machine has been checked and I have a Liddell bag
let's go on to Mabel's some mabels m-a-b-e-l-s stands for masks so I checked that I've got a
mask and it's and I've got also a range of sizes it's usually in one of the drawers and see here
I've got a range of sizes of masks that can fit pretty much any face a is the airway so
I'm just making sure that I have Goodell's Airways again we'll go through this in a later Airway talk
um that I'll upload soon and also an esophageal Airways finally lmas in a range of sizes and again
kept in the drawer usually there's a three four and five LMA B is for Boost you know this you can
get these really fancy bougie's that look like this or you can just get the normal ones which
look like this and this this bougie or a stilette is fantastic when it comes to you know managing
difficult Airways so that's all sorted e is for ett again I look in the draw to make sure I've
got a range of etts in sizes six seven eight size tube is usually what I need L is for laryngoscope
and this device is absolutely essential obviously for incubating to getting that Airway exposure to
put the tube down into the trick here I make sure I have two laryngoscope blades a size three and
four Mac blade and just make sure without touching the blade that this is working you know that the
light is working which you might be able to see through there that it's working just fine foreign
both of these because you definitely want this to work when you need it and having the light out or
the battery blown or the bulb blown is you know just a really difficult situation to deal with
finally suction so I make sure that my suction is on maximum and then I just check through here
that it's working you can hear that sound and if I was to put my hand on the end of that it
would show me that this suction was working because you feel some traction on the skin
put that safely away so that's mabeled m-a-b-e-l-s next I go to monitoring so monitoring this machine
hears so many different measurements that it takes especially with ventilator alarms and pressure
alarms apnea alarms but really the essential things I need in any situation are a SATs probe
a blood pressure cuff an ECG and n-title CO2 so if I look over here in this particular machine
here I've got a SATs probe here I've got the blood pressure tubing and a cuff will be present
and then I've got the ECG leads here and finally entitled CO2 is already attached to my mask and
that then leads up this wire through some sidearm sampling all the way to this connection over here
and as soon as I've got that on the patient you'll receive a signal which shows that I've
got entitled CO2 just along this Trace here so that's my monitoring the absolute Essentials
I need is saturation probe blood pressure cuff ECG dots for you know ECG monitoring
of the heart rhythm and then end tile CO2 and I can go into those in another video
finally go over to my trolley now medications these are absolutely vital obviously now the
way I think about this is there's obviously a lot of medications I need in anesthesia but the ones I
need in an emergency are my spa drugs SP Triple A so first of all I need a fast acting relaxant and
here it is suction methodium or even high-dose Rock uranium at 1.2 milligrams per kilogram
I need propofol which is here and then I need atropin adrenaline and aramine and ephedrine
so just to go through those here's atropine make sure I've got that again every draw is different
depending on which hospital you work at I've got aramy which is the trade name for metroraminal
which is just here and there's another type of aramine in that's concentrated in a vial and
adrenaline over here in different concentrations I always think of ephedrine as well because that
is like adrenaline but just not as potent and much easier to use in more most anesthetic
circumstances now those medications obviously really important for a number of reasons now
the reason I chose my spa drugs or sucks propofol atropine adrenaline aramine versus all the other
drugs is because these drugs are so vital in the most emergent situations for example if a patient
has laryngospasm or is fighting the ventilator or something serious happens a rapid acting muscle
relaxant can really help and it needs to solve those problems again these drugs are not to be
given by a junior junior practitioners or ones who are not experienced and should always be done
with supervision so it must relax an absolutely vital to solve a lot of your problems P is for
profile again propofol deepens the anesthetic make sure that your patient is asleep and can
treat all things like a patient moving as well as hypertension and again you'll see one of our
medications videos which goes into that in a bit more detail now often with anesthetics especially
in kids hypoxemia can cause bradycardia and atropin's a solution for that and there's a
lot of different vagal type stimuluses that can happen during an operation bezel gyrus
reflexes Bagel reflexes and these can cause very severe bradycardism even even asystole
so having atropin ready to go is absolutely vital adrenaline is probably the most common
sense emergency drug you need because any time a patient is close to rest paria arrest or even a
rest you need to give that dose it's a treatment for a rest it's a treatment for peri-rest it's a
treatment for being a dilation vasodilation as well as poor contractility and adrenaline is a
fantastic treatment for anaphylaxis increasing its Central blood volume distribution through
vasoconstriction but also inhibiting mast cells that degranulate all that histamine everywhere
finally aramine and ephedrine these are the most common medications that you use on a day-to-day
basis after the induction of anesthesia because as we know giving propofolo another drug for
induction causes Vino dilation invasive dilation and the easiest thing to do there is give it a
small dose of aramine or metaminal and that just tightens the veins and the arteries to
improve your perfusion likewise occasionally sometimes your patient just doesn't have great
contractility maybe you've given some medications some beta blockers or maybe the induction itself
has caused the heart just not just not to function as well now there's some occasions
where you need to use ephedrine now ephedrine has more you know inotropy and beta effects than
Alpha effects whereas araminoamanol does Vino and vasoconstriction ephedrine does a bit of
Vino constriction and vasoconstriction but also is a positive ionotrope and that's absolutely
fantastic when you have a patient who might not have a very good heart maybe they've got poor
contractility or poor injection fraction or you've given a bit too much anesthetic and you just need
to improve the heart function so aramine and ephedrine really really commonly used and very
important drugs in this situation so obviously there's a lot of other medications that you need
for an acid but these are the absolute vital ones that you need so hopefully that's helped
we've gone through your overall preparation which is your 4ms and that's mabels machine medications
and monitoring so I hope you enjoyed this video if you have any questions please ask them in
the comments below and I'll see you guys next time thanks very much [Music] foreign [Music]