OB Rotation Notes
C-Section Room Setup:
full machine check
ancillary O2, nasal cannula, EKG pads
paperwork: anesthesia record, preop questionnaire, charge sheet, post-op sheet, order set.
ETT (7, 6.5, 6) with stylets and syringes
2 working laryngoscopes with 1 Mac, 1 miller blade + extras in drawer
emesis basin / working suction
LR bags x 2 (LUD IV)
empty syringes for emergency induction: 10cc sux, 20cc propofol
Drugs:
5cc syringe for oxytocin need 2 vials for 2cc (20units) total = 10units/cc final concentration
10cc syringe + TB for phenylephrine (neosynephrine) syringe draw up 0.1cc and add to 10cc of
NS = 100mcg/cc final concentration
5cc syringe for ephedrine, draw up 1cc (1 vial of 50mg/cc) ephedrine add to 4cc NS = 10mg/cc
final concentration
TB syringe, draw up 0.2cc of duramorph from 10cc vial, save for adding to spinal, draw up
remainder in a 10cc syringe, (save for pain management after baby out)
5cc syringe for zofran (1-2 vials) 2mg/cc final concentration
two empty 3TB syringes and 23g IM needle for Tordol (after cleared with surgeon)
one empty 10cc syringe for antibiotic
1 cup 30ml sodium citrate (bicitra) give to patient in room as soon as done interviewing when
ready to proceed
AMPLE history for Emergencies:
Allergies
Meds
Past illness/surgeries
Last meal
Events (leading up to emergency)
Epidural/spinal risks/benefits
RISKS
OB Rotation Notes
Back & Nerve pain, damage (back pain = most common)
Hematoma (blood clot)
Infection (we use sterile technique)
Not work/one-sided
Blood pressure drop/nausea
PDPHeadache (HOLD STILL)
Slow or speed labor time
BENEFITS
Makes labor tolerable (not pain & pressure free)
Goal: 4/10 pain scale
Allow relaxation/nap
NOTIFY US IF
Nausea
Unable to lift legs
SOB/tingly fingers
Pain 7/10
C-Section Room Documentation:
___: Interviewed and assessed.
__:Time to OR #__
patient safely to OR table with assist.
lower lumbar sterile prep and drape
__cc lidocaine skin wheel
Introducer inserted at L4-L5
20g needle – blood, - paresthesia, + CSF.
__cc bupovacaine 0.75% with 0.2mg duramorph injected. – paresthesia
___: T4 level noted
Foley with clear yellow urine.
MD notified.
__: uterine incision
__: baby out
__:oxytocin 20units added to IV fluid bag.
APGARS__\__
__: to room #__. VSS. Awake and talking. no distress. Report to RN.
Emergency / Failed block C-Section Documentation:
__: Interviewed and assessed. Anesthesia education. States no questions.
__: To CS#, transferred to OR table safely with assist.
Spinal per MDA/CRNA name. +CSF, marginal aspiration. Failed block. Patient elects to GA.
-or-
OB Rotation Notes
Multiple attempts at SAB by RRNA, CRNA, MDA without success. Patient elects to GA.
Standard O2 and monitors placed. Pre-oxygenated, surgical prep and draped. SIVI. Intubated per
CRNA. ETT secured # at lip. Detention as preop. Clear yellow urine in foley bag. MD notified.
__:Uterine Incision
__:Baby Out
__:APGARS
__: 20units oxytocin added to IV fluid bag.
__:Additional 20units oxytocin added to fluid bag per surgeon request (etc)
__: Awake. Follows commands. Good resp. effort. VSS. Suctioned and Extubated.
__:To room #. Report to RN. Awake and talking. VSS.
Epidural /Spinal Prep
get name and room number from nurse
take 8 patient stickers from chart
2 for epidural/spinal sheet + yellow copy
1 for patient questionnaire
3 for syringes
1 for blue card
1 for epidural bag
pull meds from pixis:
RRNA Kit:
100mcg/cc vial fentanyl
30cc vial Marcaine (0.25% bupivicaine)
epidural bag of marcaine + 3.6mcg/cc fentanyl from fridge
1cc vial of ephedrine (if not included in epidural kit) mix with 4cc NS
draw up 10 cc syringe labeled blue and gray with 100mcg fentanyl and 9cc Marcaine
draw up 10cc syringe x 2 gray labeled syringes with 10cc each Marcaine
draw up 5cc syringe labeled purple with 4cc NS to add ephedrine to
set on top of cart:
paperwork
OB Rotation Notes
o2 pulsoximeter
meds labeled with patient stickers
primed epidural bag with yellow tubing from bottom drawer
correct size sterile gloves
2-3 extra tegaderms
nurse will have epidural kit in room
insure fluid bolus (500-1000mL) received within last 30 min
check for platelet count (must be >150, >100 if approved by anesthesiologist)
Initial bolus: 10cc 0f 0.25% bupivicaine with 100mcg fentanyl
Maintenance: ____ cc/hr of 0.1% bupivicaine with 3.6mcg/cc fentanyl
OB Intrathecal Prep:
get name and room number from nurse
take 4 patient stickers from chart
2 for epidural/spinal sheet + yellow copy
1 for patient questionnaire
1 for blue card
pull meds from pixis:
0.3cc Demerol (15mg) in TB syringe
0.3cc of 0.75% Sensorcaine (often found in Spinal kit)
set on top of cart:
paperwork
o2 pulsoximeter
meds labeled with patient stickers
correct size sterile gloves
nurse will have spinal kit in room
insure fluid bolus (1-2L) received within last 30 min
check for platelet count (must be >150, >100 if approved by anesthesiologist)
OB Rotation Notes
Extra notes:
Spinal/Intrathecal based on concentration (patient position)
Epidural/caudal based on volume (1-2mL per dermatome)
0.75% bupivicaine w/ 8.25% dextrose = hyperbaric (sinks based on gravity)
Isobaric (stays where you inject it) {Tetracaine diluted w/ equal part CSF}
Tetracaine alone = hypobaric
ex: for hip fx (lateral position w/ broken hip in air), but make sure their head isn’t up! Or you
will end up doing a general anyway
Duration 2-ish hours
Tetracaine alone = 3hrs
Tetracaine w/ epi = 6hrs
Ester vs. amide matters
Epi or not matters
Epi doesn’t usually help prolong hyperbaric bupivicaine
