ANESTHESIA GOALS: Emergency medicine residents on anaethesia rotations should focus on the following main areas: 1. Development of airway management skills. 2. Learn how to monitor various patient parameters with invasive and non-invasive techniques. 3. Become familiar with fluid resuscitation and pharmacological agents used in anesthesia 4. Learn relevant pre-operative historical and physical exam considerations including evaluation of airway difficulty. 5. Learn principles of pain management including use of sedation techniques, local nerve blocks, epidural and spinal anesthesia. 6. Appreciate the unique characteristics of anaesthesia practice and the operating room environment, OBJECTIVES: Upon completion of the rotation, residents should be able to: Medical Expert 1. Describe the anatomy of the upper airway. 2. List the differences between the adult and pediatric airway, related head and neck anatomy and innervation of the airway. 3. List the indications for, and demonstrate appropriate judgement with respect to invasive airway management. 4. Recognize and manage an obstructed airway. 5. List the contraindications and complications of various airway management techniques including oral and nasal airway insertion, bag-valve-mask ventilation, blind nasal intubation, oral intubation, cricothyrotomy and tracheostomy. 6. State the dosages, mechanism of action, indications, contraindications and potential complications of inhalation anesthetic agents, intravenous analgesic and anesthetics, induction agents and neuromuscular blocking agents. 7. Demonstrate familiarity with advanced airway techniques including fibreoptic (bronchoscopic) intubation, retrograde intubation, the use of the lighted stylet, and laryngeal mask airway. 8. Demonstrate correct use of the bag-valve-mask device, nasal and oral airways in both the adult and child. 9. Demonstrate skill in nasotracheal and endotracheal intubation as well as management of complications 10. Demonstrate skill in the use of anesthetics and neuromuscular blocking agents including procedural sedation and rapid sequence intubation. 11. Demonstrate the ability to perform percutaneous transtracheal jet ventilation. 12. Demonstrate the ability to perform a surgical airway including both open and percutaneous cricothyrotomy. 13. Demonstrate the ability to use standard non-invasive monitoring techniques including heart monitors, blood pressure monitors, oxygen saturation monitor, end tidal CO2 monitors. 14. Demonstrate the ability to manage a patient on a ventilator and discuss the advantage and disadvantages of different ventilation techniques. 15. Coordinate the ongoing assessment and management of the intubated patient. 16. Demonstrate the ability to administer local anesthetics and be familiar with agents, dosing, side effects, and techniques to monitor pain. 17. Perform procedural sedation under faculty supervision and then independently. 18. Demonstrate knowledge of the principles of regional anesthesia and successfully perform metacarpal, digital, radial, median, ulnar, tibial, supraorbital, infraorbital, mental, auricular and sural nerve blocks. Communicator 1. 2. 3. 4. Converse effectively and sensitively with seriously ill patients and their families. Discuss relevant issues around surgical procedures and the risks of anesthetics Demonstrate knowledge of the health care consent act. Communicate effectively to all members of the operating room team. Collaborator 1. Work effectively as part of a health care team. 2. Describe the role, expertise and limitations of all members of the operating room team required to achieve optimal patient care. 3. Contribute to healthy team functioning, respecting the opinions and roles of team members and contribute his/her own expertise to the team's task. 4. Assume team leadership. 5. Demonstrate an understanding of the unique interaction of peri-operative care with every component of the hospital, especially the emergency department and acute care units. Manager 1. Demonstrate an appreciation of the efficient and responsible use of operating room resources. 2. Demonstrate proper documentation of the patient undergoing an anesthetic procedure.. 3. Manage time efficiently. 4. Identify medico-legal risks and take steps to address them. Health Advocate 1. Demonstrate an understanding of the determinants of health affecting patients and their families. 2. Act as an advocate for the individual patient and affected populations. 3. Demonstrate an understanding of "Do not resuscitate" orders, advance directives, living wills, competency, power of attorney and brain death criteria. Scholar 1. Critically evaluate the literature as it pertains to airway management and the practice of anaesthesia. 2. Demonstrate inquisitiveness around clinical cases. 3. Apply the principles of evidence-based medicine. Professional 1. 2. 3. 4. 5. Adhere to the code of ethics of the CMA and the institution. Treat patients and colleagues with respect. Self-evaluate, including insight into strengths and weaknesses. Demonstrate commitment to life-long learning. Be responsible, reliable and accountable for one’s actions. Evaluation Resident performance is evaluated by the attending Anesthetist and/or Service Chief. An ITER (In Training Evaluation Report) will be completed at the conclusion of the one month training period. The ITER should be reviewed and signed by the resident and returned to the office of the Residency Program Director with a completed Procedures Record and Rotation Evaluation Form.