Topic outline

  • Welcome to Internship in Anesthesiology!

    Anesthesiology 260 is a one-week rotation in the Post Anesthesia Care Unit (PACU) which provides the intern (LU VII student) supervised involvement in the monitoring and care of post-operative patients. It provides the intern the clinical experience for the care of patients recovering from general, regional and monitored anesthesia for all types of surgeries and procedures. There are many physiologic disorders which need to be diagnosed and managed in the PACU during emergence from the effects of anesthesia and surgery. Emphasis is given in the recognition and care of post-operative problems as well as learning the various methods of providing adequate postoperative analgesia. The course also provides the student with the opportunity to experience firsthand the principles and practices of Crisis Resource Management (CRM) in a simulated setting.

  • Course Orientation/Introduction to the PACU

    • Target Learning Outcomes
      • Student is familiar with the following aspects of the course:
        • Learning objectives
        • Course Requirements
        • Activities
        • Attendance
        • Course Evaluation
      • Give an overview of the Post Anesthesia Care Unit (PACU)
      • Enumerate the staffing requirements for the PACU
      • Enumerate PACU staff duties and responsibilities
      • Describe the ideal location of a PACU within a hospital
      • Describe the layout of a properly designed PACU
      • Enumerate the equipment needed at the PACU
    • Watch: 
      • Introduction to PACU Lecture (Asynchronous/UPMVLE)
      • PACU Walkthrough Video (Asynchronous/UPMVLE)
      • COVID OR Walkthrough (Asynchronous/UPMVLE)
    • Lecture: Introduction to PACU File 3MB Powerpoint 2007 presentation

      This lecture will introduce the student to the PACU, its staffing requirements and responsibilities, layout, and equipment needed.

    • Video: PACU Walkthrough URL

      This video shows the Post Anesthesia Care Unit and its different areas.

    • Video: COVID OR Walkthrough URL

      This Video shows the general layout of the COVID OR at the left central block.

    • Assignment: Ideal COVID PACU Setup
      • Task: Submit a written essay on the ideal PACU setup for a COVID positive patient.
      • Procedure: The student will submit an essay detailing the PACU setup needed for a patient who is COVID positive, This essay should include all details of the PACU discussed in the instructional materials (e.g. location, staffing, etc.). This is submitted via email to the course coordinators/resident monitors on the due date.
      • DUE DATE: Day 5 of the rotation

  • Monitoring the Postoperative Patient

    • Target Learning Outcome
      • Student must be able to interpret data from standard monitors in a patient recovering from anesthesia
      • Student must be able to correlate the data with the clinical picture of the patient
    • Watch: Monitoring the Postoperative Patient Lecture Video
    • Video: Monitoring the Postoperative Patient URL

      In this video, Dr. Corsiga takes the students through the basics of monitoring patients at the PACU; what to watch out for, and how to assess and discharge patients.

    • Clinical Vignette: Monitoring the Postoperative Patient URL
      • Task: Interpretation of monitor data in the postoperative patient
      • Procedure: Students are given a clinical vignette showing abnormalities in the standard parameters that are monitored in the PACU. Students are expected to go through the entire clinical vignette and provide feedback after the activity. The feedback will serve as proof of fulfillment of this requirement.
      • DUE DATE: Day 3 of the rotation

  • Management of Postoperative Complications

    • Target Learning Outcomes
      • Student must be able to diagnose and manage the most common PACU complications
    • Read: Heitz, James W. Post-Anesthesia Care: Symptoms, Diagnosis, and Management. Cambridge University Press, 2016.
    • Watch: Management of Postoperative Complications Video Lecture 
    • Video: Management of Postoperative Complications URL

      In this lecture Dr. Antonio Mangubat discusses the most common postoperative complications encountered in the PACU, and their initial management.

    • Lecture: Postoperative Complications File 3.3MB Powerpoint 2007 presentation

      This lecture lists the most common post-operative complications in the PACU and their management.

    • SGD: Management of Post Operative Complications Assignment
      • Task: Participate in a small group discussion about the management of a specific postoperative complication during the course of the rotation.
      • Procedure: The SGD will be conducted during the week of the rotation by the consultant in charge for the week. Students will coordinate with either the consultant- or the resident-in-charge for the schedule and topic of the SGD. This will be held via a Zoom session and the students, as a group,  will present an index patient and the case discussion. Slides and other materials used in the SGD will be uploaded through this site for grading.

  • Crisis Resource Management in the PACU

    • Target Learning Outcomes
      • Know and apply the principles of Basic Life Support (BLS)
      • Know and apply the principles of Advanced Cardiac Life Support (ACLS)
      • Diagnose and treat the underlying complication of a patient recovering at the PACU
      • Apply the principles of CRM in a simulated clinical scenario
        • Know the environment
        • Anticipate and plan
        • Call for help early
        • Exercise leadership and followership
        • Distribute the workload
        • Use all available information
        • Communicate effectively
        • Use cognitive aids
        • Re-evaluate repeatedly
        • Use good teamwork
    • Video: Simulation and CRM in Anesthesiology URL

      In this lecture Dr. Luretta Tayao discusses the role of simulation in medical education and its application in crisis resource management.

    • Video: Crisis Resource Management URL

      Sample case scenario of a simulation and crisis resource management

    • Online CRM Activity Assignment
      • Task: In this TedEd activity you will go through a Crisis Resource Management (CRM) video and analyze and discuss it through the embedded URL below. (Crisis Resource Management Principles | TED-Ed)
      • During a critical event or crisis in medicine, the knowledge of medical principles is not enough to achieve favorable outcomes. 60-80% of medical errors primarily resulted from ineffective communication and teamwork. What other skills do you think doctors and other medical personnel should learn to help improve patient safety and outcomes during a crisis?
      • Procedure: Follow the embedded URL and go through the 5 activities in the TedEd, namely: Watch, Think, Dig Deeper, Discuss, And Finally.
      • Due Date: On the last day of the rotation
    • Online SIM Session: Crisis Resource Management Assignment
      • Online Simulation: An online simulation using the DARTSim Program and/or standardized patients will be conducted on the 5th-7th day of the rotation, to be conducted by the LUVII consultant coordinators. This will cover the diagnosis and management of one of the complications outlined above, application of BLS and/or ACLS guidelines, as well as Crisis Resource Management (CRM) skills. 
        • Date: TBD by LUVII Simulation Consultant for the week
        • Duration: Case simulation - 10-15 minutes, Debriefing - 20 - 30 minutes, total duration for one block approximately 1 hour 30 minutes
        • Medium: DARTSim through Zoom
        • Procedure: Students will be given the zoom link for the simulation at least a day in advance of the actual activity. The block should be divided into two groups, and each group will undergo the simulation activity one after the other. The group not participating will be passive observers for that session, and roles will be reversed afterwards. Debriefing sessions will follow immediately after the simulation.

  • Management of Postoperative Pain

    • Target Learning Outcomes
      • Know the definition of acute postoperative pain
      • Learn how to assess acute postoperative pain using different grading systems
      • Apply the WHO reverse step-ladder approach for acute postoperative pain
      • Commonly used analgesics
    • Read: Barash, P.G. et al. (2015). Management of Acute and Chronic Pain. In Clinical Anesthesia Fundamentals (pp. 699-720). Philadelphia, PA: Wolters Kluwer Health.
    • Deep Dive: Australian and New Zealand College of Anaesthetists and Faculty of Pain Medicine. (2015). Acute Pain Management: Scientific Evidence (4th ed.). Retrieved from: ACUTE PAIN MANAGEMENT: SCIENTIFIC EVIDENCE
    • Watch: Pain Assessment Video 
    • Lecture on Acute Postoperative Pain Management Lesson
      • This is a synchronous lecture on the management of acute postoperative pain at the PACU.
      • Procedure: Coordinate with the resident-in-charge regarding the schedule of the lecture. Lecture will be conducted synchronously via Zoom.
    • Video: Pain Assessment in Pediatric Patients Using the FLACC Scale URL

      This video teaches the student how to assess pediatric pain using the FLACC scoring system.

    • Assignment: Management of Acute Postoperative Pain at the PACU
      • Task: Submit a comprehensive postoperative pain management plan for a patient with acute pain at the PACU
      • Procedure: Students will be given a case scenario of a patient with acute postoperative pain. They are required to submit a written case discussion on the pain management of the patient. The discussion should contain these elements:
        • History/PE (what other questions would the student like to ask the patient)
        • Laboratory Examinations (what other laboratory examinations can be done)
        • Pain assessment
        • Pain physiology and pathophysiology
        • Pain management
      • DUE DATE: First Tuesday after the end of the rotation 

  • Recovery from Anesthesia and Discharge from the PACU

    • Target Learning Outcomes:
      • Familiarize oneself with the handover procedure for patients coming into the PACU from the operating room
      • Familiarize oneself with the discharge criteria from PACU
      • Assess adequacy of recovery from anesthesia and suitability of discharge from PACU
    • Read: Longnecker, D.E et al. (2017) Postoperative Care of the Anesthesia Patient. In Anesthesiology, 3rd Edition, McGraw-Hill Education, pp 1212-1222
    • Watch: 
      • Effect of Anesthesia on Recovery Video
      • PACU Handover Video
      • Bromage Score Assessment Video 
      • Aldrete Scoring Video