Anesthesia — Foundation of Discipline

F8 Diagnosing and managing common issues in the post-anesthesia care unit (PACU), or the surgical ward

Key Features:
- Examples of common issues include: pain, nausea and/or vomiting, hypotension,
hypertension, arrhythmias, cardiac ischemia, hypoxemia, respiratory depression, bronchospasm, pulmonary edema, deep venous thrombosis, delirium, slow awakening, decreased urine output.
- Management of conditions evolving into a life-threatening situation should not be considered part of this EPA. «Management of perioperative life-threatening complications» is a Core EPA.
- This EPA MUST include some observations of the management of non-complex patients with acute pain, either postoperative or traumatic, and managing common complications of acute pain.
- Options for managing acute pain should include at least IV PCA, multimodal analgesia and regional anesthesia.
- Observations of this EPA should be collected in both the PACU and on the surgical ward.
- This EPA may be observed by a senior resident.
Relation with other EPAs: In regards of pain management, this EPA is a step to the Core EPA on «comprehensive management of acute and acute on chronic pain conditions».

Form

F1: Observation

Milestones

• ME 1.3. Apply knowledge of the anatomy and physiology of acute pain

• ME 1.4. Perform focused clinical assessments

• ME 1.4. Recognize urgent problems that may need the involvement of more experienced colleagues and seek their assistance

• ME 2.4. Develop and implement management plans for common postoperative problems diagnosed in the post-anesthesia care unit or the surgical ward

• ME 1.3. Apply knowledge of the pharmacology of various groups of analgesics available for management of acute pain

• ME 2.4. Develop and implement initial management plans

• ME 3.3. Prioritize and advocate for the timely execution of a procedure or therapy,
  taking into account clinical urgency and available resources

• ME 3.4. Seek assistance as needed when unanticipated findings or changing clinical circumstances are encountered

• ME 4.1. Ensure follow-up on results of investigation and response to treatment

• ME 5.1. Prioritize the initial medical response to adverse events to mitigate further injury

• ME 2.2. Develop and prioritize differential diagnosis

• ME 5.1. Incorporate, as appropriate, into a differential diagnoses, harm from health
  care delivery

• ME 2.2. Establish the diagnosis of common complications in the post- anesthesia care unit or the surgical ward in a timely manner

• ME 2.2. Integrate the patient’s medical history, type of surgery and perioperative factors to anticipate which patients are at higher risk for postoperative surgical or medical complications

• ME 5.2. Apply strategies and ensure optimal specific monitoring to prevent complications

• COM 4.1. Explore the perspectives of the patient and others when developing care plans

• COM 5.1. Document clinical encounters to adequately convey clinical reasoning and the rationale for decisions

• COL 1.1. Receive and appropriately respond to input from other health care professionals

• COL 1.2. Negotiate overlapping and shared responsibilities with physicians and other colleagues in the health care professions in episodic and ongoing care

• COL 3.2. Communicate with the attending physician or other appropriate member of the health care team about the patient’s condition and care

• COL 3.2. Summarize the patient’s issues in the transfer summary, including plans to deal with ongoing issues

• L 1.1. Seek data to inform practice and engage in an iterative process of improvement

• L 4.1. Organize work using strategies that address strengths and identify areas to improve in personal effectiveness

• S 1.2. Identify, record, prioritize and answer learning needs that arise in daily work, scanning the literature or attending formal or informal education sessions

• HA 2.2. Improve clinical practice by identifying patients or populations that are not being optimally treated for pain

• P 2.2. Demonstrate a commitment to patient safety and quality improvement through adherence to institutional policies and procedures

• P 2.2. Monitor institutional and clinical environments and respond to issues that can harm patients or the impact the delivery of health care

Context Variables

• Location (single-choice)
  • ICU
  • PACU
  • surgical ward
  • other location
• Type of issue (single-choice)
  • pain
  • delirium
  • hypoxemia
  • arrhythmias
  • hypotension
  • other issue
  • bronchospasm
  • hypertension
  • slow awakening
  • pulmonary edema
  • cardiac ischemia
  • nausea and/or vomiting
  • decreased urine output
  • deep venous thrombosis
  • respiratory depression
• Type of observation (single-choice)
  • direct
  • indirect
• Type of surgical procedure (single-choice)
  • urology
  • gynecology
  • neurosurgery
  • ophthalmology
  • other surgery
  • otolaryngology
  • general surgery
  • plastic surgery
  • thoracic surgery
  • vascular surgery
  • orthopedic surgery

Requirements

• Collect a minimum of 8 observations (minimum 8)
• These observations should be performed in both the PACU and on the surgical ward
• At least 4 managing pain