Providing peripartum anesthetic management for high-risk parturients including all complex cases of labour analgesia, caesarean section and other operative deliveries. This includes patient assessment, identification of contraindications, discussion of risks/benefits and consent, identification of required monitoring and execution of the management plan as well as resuscitation of the unstable parturient. Management includes parturients with complex medical conditions and medical conditions / complications of pregnancy.
CBD Stage For This Rotation
Core of Discipline - Anesthesia
EPA For This Rotation
COD 4 Managing patients presenting with a difficult airway, including developing plans for extubation. Target # of Entrustments (EEM): 4
COD 7 Providing peripartum anesthetic management for high-risk parturients. Target # of Entrustments (EEM): 6 + MSF
COD 8 Initiating resuscitation and providing anesthetic management for unstable parturients. Target # of Entrustments (EEM): 2
COD 24 Providing care for patients who have experienced a patient safety incident. Target # of Entrustments (EEM): 0 - 1
Key Objectives For This Rotation
By the end of the rotation, the resident should be able to:
Use complete, accurate assessments and anesthetics considerations for consultations of high risk parturients with, but not limited to, hypertensive disorders of pregnancy, respiratory disease, cardiac disease, morbid obesity, endocrine disease, hematologic and coagulation disorders. Role - Medical Expert
Demonstrate advanced breadth of knowledge, clinical application and appropriate procedural skills in the perioperative management of high risk parturients for the delivery of the newborn in emergent and non-emergent situations. Role - Medical Expert
Demonstrate advanced critical thinking, insight, judgement and management of the unwell parturients. Role - Medical Expert
Recognize and manage emergency conditions of unstable parturients resulting in prompt and appropriate treatment; diagnostic tests and therapeutic interventions are appropriate and consultative services are usually appropriately consulted. Remain calm, act in a timely manner and prioritize correctly. Role - Medical Expert / Professional
Demonstrate competence in intrapartum and postpartum neonatal resuscitation. Role - Medical Expert
Establish a therapeutic and effective relationship with patients and communicate well with family. Provide clear and thorough explanations of the perioperative anesthetic plan, including risk and potential complications, in a professional manner. Demonstrate empathy and sensitivity to racial, gender and cultural issues. Role - Communicaton
Work effectively and respectfully with multidisciplinary teams. Convey clinical reasoning and rationale for decision-making. Role - Collaborator
Demonstrate an understanding of prioritization of patients, carry out cases in a timely manner with available resources, and takes appropriate safety precautions for self and others. Role - Professional
Take appropriate actions to ensure patient safety and limitation of adverse events, including appropriate management of complications when they occur, all to the highest ethical standard. Role - Health Advocate / Professional
Other Goals, Objectives Or Activities:
Physiology
Physiologic changes of normal pregnancy and anaesthetic implications
Physiologic changes that accompany the onset of labour, delivery and postpartum
Pharmacology
Pharmacokinetic and pharmacodynamic changes in normal pregnancy and the anaesthetic implications
Commonly used drugs in labour and delivery
Potential drug interactions between obstetrical and anaesthetic drugs
The effects of pharmacologic agents and anaesthetic techniques on uterine blood flow and fetal development
Labour Analgesia
Physiology and anatomy of labour pain
Non-pharmacologic analgesia
Pharmacologic analgesia
Opioid analgesia (routes of administration, patient control)
Regional analgesia: epidural, spinal, combined
Goals of analgesia
Contraindications and complications of obstetrical analgesia
Consent issues concerning labour analgesia
Operative Delivery
Anesthetic options, contraindications and complications
Post-Op Analgesia
For elective, urgent and emergency caesarean section
Airway Management
Implications in parturients
Various options and their advantages / disadvantages
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