A chronological listing of changes and updates to this site

Hint: If you DON"T SEE these changes when you open one of these pages, refresh the page (CTRL-R, CMD-R) as your browser may be reading from its cache)

18 March 2012

*Bivalirudin for anticoagulation in the presence of HIT for both Cardiac and  Non-Cardiac Cases is on the Drugs Page.

*Guidelines for after-hours management of Peripheral Nerve Catheters (now starting at Mercy) is on the Mercy Hospital page, one of the Off-Campus Practice Sites

*ACLS Adult algorithms (link to outside website) in a more readable format are now on the Home Page

1 March 2012

* Paula McKinley updates the helpful Table of AntiCoagulants and the implications for neuraxial catheters. On the Regionals & Anticoagulants Page.

22 November 2011

* a CRITICAL EVENTS page from the University of Michigan website has been linked to the Home Page. It details management for a number of scenarios: ACLS, PALS, MH, Air Embolism, etc. Well done. Thanks to Rob Hubbs for contributing this.

16 October 2011

* Updates to the Anesthesia Drugs Page, including ketamine, dexmetotomedine, and methylene blue

* The Printable Forms Page has been updated with revised Corneal (Ocular Surface) Injury and Epidural Blood Patch Handouts.

*Video links to taping of Epidural and Spinal Drainage Catheters have been restored. on the Pain Management Page.

4 July 2011

* Periop Management of Blood Sugar for Vascular Patients, including ASU , in the Operating Room, and PACU, is now on the Cardiac and Vascular Page. Thank you Chase Boyd.

7 May 2011

* Frank Altman has developed a simplified regimen for Insulin / Glucose management for insulin-dependent diabetics admitted overnight. It has been successfully and safely used for several years at the Mercy Hospital. It's on the Mercy Hospital off-campus site.

* a minor update to the Mercy Corneal Injury downloadable form. on the Forms Page.

* if you need interpretation of a Radiologic Study (xray, CT, MRI) after hours or on weekends, call the radiology resident on call with these guidelines, on the On-Call Admin Page.

17 April 2011

* Pain Management Page is updated, with new header and Table of Contents, and links to Ketamine Protocol.

* Massive Transfusion Guidelines have been updated, thanks to Jim Saloum.

* ECT Guidelines for Patient Selection and Therapy are added. Thanks to Nancy Boulanger for this helpful info.

* Video Instructions on programming the Symbiq pump: two short videos put together by several CRNAs at MMC make it easy to understand and use these pumps. On the Equipment Catalog. Thanks Rae Geren!

* How to Manage a Neurologic Injury after Regional Block or Positioning has been added to a New Page summarizing Complications, or, what to do when things don't go as expected or desired.

* Christine Sheetz has added a number of helpful points when doing NeuroRadiology cases with Dr. Ecker. Thank you, Chris.

28 January 2011

* TEE Diagnostic Codes (pdf): on the Cardiac & Vascular Page. Thank you Chris Connors.

* Update on the Regionals & Anticoagulants Table to include Dabigatran (Pradaxa). Also a drug fact sheet from the pharmacy on the Drugs & Agents Page. Thanks Robyn.

*AccessMedicine website gives access to 60 medical texts and online journals, as well as drug info. Write to Tom VerLee for your username/password.

*If you need an Interpreter, live or on the phone, follow the guidelines in the MMC Foreign Language Policy, on the Miscellaneous Page.

*Suggested Antibiotic Redosing in the OR for long cases is listed. From the University of Michigan Anesthesia Website, on the Miscellaneous Page.

14 December  2010

* Equipment Pages update: New Defibrillator at Ortho Associates.

2 December  2010

* Tony Miller has made a number of updates to the Mercy Hospital Admin Site, including Surgeon Preferences for Ortho Surgery, a customized Difficult Airway Form to print out and give to patients, and updated Preop Testing Guidelines.
* Robyn Dixon has created two videos on Taping the Connectors for Epidural and Spinal Drainage Catheters. Links to these YouTube videos are embedded on the Pain Management Page.

9 November  2010

* Lora Manning suggests that Battery Disposal and Recycling information be posted on this site. Here it is, on the Miscellaneous Page.

27 October  2010

* Equipment needed, and suggestions for placement of, a Tunneled Epidural Catheter or a Tunneled Spinal Drainage Catheter, are listed on the  Pain Management Page.

19 September  2010

* Patients taking Suboxone present unique challenges when facing the pain after surgery. Guidelines for the Management of Preop Patients on Suboxone Therapy are now listed on the Pain Management Page, as well as the Preop Guidelines Page.
* Rob Hubbs has the latest recommendations for PreOp Testing, including Labs, EKG, and Chest Xrays. also on the Preop Guidelines Page.

5 September  2010

* Occasionally a catheter intended to be inserted into the epidural space is discovered to be intrathecal. In some situations the decision is made to deliver analgesia via the intrathecal catheter. Guidelines for the Management of Inadvertent Intrathecal Catheters are now listed on the Pain Management Page.  

22 August  2010

* Nancy Boulanger has updated the data for Carotid Stent Placement in the Angio Suite, which includes a new Flowchart to aid in decision making and disposition. on the Special Situations Page.

* Transport of NICU patients and CCN Patients to/from the OR is outlined in a new document, on the Pediatrics Page. 

27 June  2010

* Massive Transfusion Protocol/Guidelines, as outlined by Tim Hayes MD in May, are now on the Transfusion Page. 

* Tim Hall MD, with guidance from John Makrides, has created the new Equipment Catalog, which details Anesthesia and Monitoring Equipment at each Spectrum Practice Site. If you're going to a site for the first time and want to know what equipment is available, and how to use it, it's all here. Thank you Tim!

25 April  2010

* Off-Campus Practice Site info has been updated for Portland Endoscopy Center and for Mercy Hospital. You'll find them both on the Off-Campus Page. 

12 April  2010

* Jeffrey Brown gives us some important points about Neurosurgical ICP and saturation monitoring equipment in use at Maine Med. On the NeuroAnesthesia Page. 

1 March  2010

* Kyle Steen has updated the Phone List for various rooms and sites around campus. Located on  the Miscellaneous Page. 

* Joanne Sullivan has put together a nice Instructional Manual on how to access the MMC Network with a Macintosh computer. Also on the  Miscellaneous Page.

* Common Forms used for Corneal Injury reporting, risk of Central Line Infection, patient handouts for Epidural Blood Patch and Epidural Catheter Site Infection are now available for viewing and printing. On the Home (Index) Page.

7 February 2010

*Rob Hubbs develops an evidence-based algorithm for management of Post-Op Nausea & Vomiting (PONV). on the Miscellaneous Page. Thanks, Rob!

18 January 2010

*A new NeuroAnesthesia Page, listed right on the Main Table of Contents. Now it's easier to go directly to Tips on Interventional NeuroRadiology (cerebral coilings) and Posterior Spinal Fusion tips. There's a new summary of Evoked Potential Monitoring summarized from a recent article in Anesthesia Clinics NA.

2 January 2010

*Finally! A place to put selected journal reprints and Grand Round Powerpoints, in the new Anesthesia Resources Library. You  can access this from the top link on PAGE 2 of the home screen. Suggestions for clinically relevant reprints are welcomed. 

20 December 2009

*Matt Green gives us a nice synopsis on the use of Dexmedetomidine (Precedex), on the Miscellaneous Info Page

*Nancy Boulanger & Chris Baker outline an updated Page on management of patients for Intracerebral Aneuryms, AVMs, and coilings. On the Special Situations Page. 

*Marge Humeniuk nicely organizes the processes and resources for the (rare) situation of 
Acute Unexpected Blood Loss at Scarborough Surgery Center. On the Off-Campus Page

20 October  2009

*Laura Mamchur & Matt Green update the Management of Endovascular AAA Stents, now done in Room 17, on the Special Situations Page

*Paul Lennon gives advice on management of various Procedures in the R8 Cath Lab. ICD placement, Bi-Ventricular Pacers, Ablations for a-flutter and a-fib, and others are linked to a page through the Cardiothoracic & Vascular Index.

29 August  2009

*Alison Drury  adds Guidelines for Total Hip Arthroplasty, on the Orthopedics Page. These Guidelines distinguish between the traditional Posterior Surgical Approach and the newer Anterolateral Surgical Approach ("minimally invasive") used by some surgeons.

11 May  2009

*Ted Rintel adds Guidelines for Awake Craniotomy, on the Special Situations Page.

*The MMC FloorWalker Manual is now on Page Two of the Dosdocs site.

3 April 2009

*Nice summary of Anticoagulants and Testing for Hemostasis (pdf format); 
on the Cardiovascular Page
*Guidelines for Organ Donation from Brain Dead Patient from NE Organ Bank, 
on the Transplant Page. Thank you, Nancy Quint.

7 February 2009

*Dantrolene & Malignant Hyperthermia Kit are now stocked in the Anesthesia Workroom. On the Malignant Hyperthermia Page

1 February 2009

*Guidelines for upkeep of the APMS Roundsheet, on the Pain Management Page

29 January 2009

*Protocol/Guidelines for Scoliosis Surgery (Posterior Spinal Fusion). Link is on the Pediatric Page
Thanks to James Flowerdew.

14 January 2009

*Charlie Higgins adds a second recipe for Spinals with the TVT procedure. On the Obstetrics/GYN Page.

24 November  2008

*Table for Management of Neuraxial Analgesia/Anesthesia & Anticoagulants. On the Regionals & Anticoagulants Page

29 October  2008

*Management of indwelling continuous Paravertebral Catheters,  on the Pain Management Page
*Guidelines for Anesthetic Management of Pyloric Stenosis, on the Pediatric Page

24 July 2008

*Update of Outpatient Epidural Blood Patch Guidelines,  on the Pain Management Page

5 May 2008

*Programming the GEMSTAR Epidural Pump; on the Pain Management Page

22 March 2008

*Hints on the use of Remifentanil. Link is on the Miscellaneous Page

16 March 2008

*Guidelines for Spinals with the TVT procedure. On the Obstetrics/GYN Page.

31 December 2007

*New Guidelines for antibiotic prophylaxis in Infective Endocarditis, courtesy of Barry Gleason. Link to this is on the Cardiac Page.

16 December 2007

*New Guidelines for Management of Motor Block with Epidural Analgesia. On the Pain Management Page.

31 May 2007

*Revision of Laparoscopic Donor Nephrectomy Guidelines, by Jim Whiting. On the Transplant Page.

25 May 2007

*Guidelines for Using Labor Epidural for C/S. On the Obstetrics Page.

4 May 2007

*Anesthesia for Carotid Artery Stents in Angio. On the Special Situations Page.

22 February 2007

*Total Knee Replacement management update. Femoral Nerve Block.. Under Orthopedics on the Special Situations Page.

20 February 2007

*Malignant Hyperthermia management update. Drager Primus machines require extended washout to prepare for use with MH-susceptible patients. On the MH page.

5 October 2006

*Total Knee Replacement management update. Simplified post-op management. On the Special Situations Page.

5 July  2006

*Dental Damage Policy update. Includes a new Flowchart to summarize process. On the Miscellaneous Page

31 May  2006

*Monitoring Neonates for Apnea/ Bradycardia after Anesthesia (PACU Stays). Link from the Pediatrics Page

4 May  2006

*Maine Center for Reproductive Health guidance manual. On the  Off-Campus Page.

12 March  2006

*Patient Exclusion Criteria for Plastic & Hand Outpatient Center. On the Off-Campus Page.

30 January 2006

*Updated Guidelines for Management of Implantable Cardio-defibrillator Devices (ICDs). Accessed from the Cardiovascular-Thoracic Page

15 January 2006

*CT-Guided Liver Ablation in Radiology Guidelines, on the Special Situations Page.

16 Dec 2005

*Updates on new Blood Collection tube(s), on Miscellaneous Page. New Total Knee Replacement (TKR) Management Protocol, under Special Situations

* Emergency C-Section Protocol: Who calls who, when. On the Obstetrics Page.

7 Oct 2005

*New Major Index for MMC /Spectrum Anesthesia Protocols. What to do if you're stuck with a needle; how to document and treat a corneal injury;the updated Beta Blockade Protocol; how to treat and document dental damage. Under Protocols on the Main (Home) Page

25 March 2005

*MH-Susceptible patients have shorter post-op monitoring period: on the MH Page

18 February 2005

*R Dixon reminds us to get a Platelet Count before pulling epidurals on patients that have had heparin running >4 days. On the Regionals & Anticoagulation Page

19 Dec 2004

*L. Rutstein MD presented a talk recently on Intraperitoneal Hyperthermic Chemotherapy, aka "Hot Chemo". Management guidelines are on the Special Situations Page.

16 Nov 2004

*Occasionally it becomes necessary to perform an Emergency Shut-Off of an Intrathecal Pump. Here's How: (Pain Management Page)

04 Nov 2004

*What to Document if a patient with an epidural is started on anticoagulation. See Regionals & Anticoagulation Page.

20 Sept 2004

*Guidelines for Thoracotomies and Epidural Placement, including post-op pain management. On the Cardio-Thoracic Page
*Ortho Associates Obesity Guidelines. On the OffCampus Page.

26 July 2004

*Renal Transplant Protocol modified to give solumedrol 60' before starting Thymoglobulin, presumably to attenuate any possible allergic reaction. on the Transplant Page.

17 July 2004

*PONV Prophylaxis Algorithm for Adults with General Anesthesia. Under the Preop/Postop Guidelines Page

3 June 2004

*Dental Damage Protocol updated. See Miscellaneous Info Page.

14 May 2004

*Renal Transplant Protocol modified to give solumedrol 30' before starting Thymoglobulin, presumably to attenuate any possible allergic reaction. on the Transplant Page.

25 April 2004

*At David Clement's suggestion, added the AHA Guidelines for Endocarditis Prophylaxis, under the Cardiac Page.

5 February 2004

*Pedi Epidural Guidelines, Epidurograms revised. Adding Glucose to Infant IVs. On Pedi Page (also link from Pain Management)
*PCEA Management Revisions. APMS Critical Events. Responsibilities of carrying APMS Pager. On Pain Management Page & Resident's Page
*Establishing Priorities for Emergency Cases, revised. On On-Call Admin Page
*A New Page for Off-Campus Sites like P&H, Ortho, MEC, with info specific to their policies and Q/A. Get to it from the Main Index

22 October 2003

*"Fastrack" criteria for admission to Phase II Recovery (ASU) directly from OR. On the Preop/Postop Guidelines Page

21 September 2003

*Revision of Epidural Blood Patch guidelines, to stop NSAIDS prior to EBP.

2 June 2003

*Memos re: Epidurals for Colon Surgery added to Pain Management Page.

15 January 2003

*Memos re: Outpatient Pediatric Fiberoptic Bronchscopies & Retinopathy of Prematurity added to Pediatric Page.

1 December 2002

*The internet host for this site has changed to www.spectrummedicalgroup.com/ps. For instructions on how to change your AvantGo settings to continue receiving this site on your Palm, click here.

25 October 2002

*Tweaks to the info on Thymoglobulin infusion, on the Transplants Page.
*Faulty hyperlinks on OB Page. I think these are all corrected. If you come across hyperlinks on other pages that don't take you where they should, please email me (tom@dosdocs.com) and let me know so I can correct them.

1 October 2002

*Info on Autologous & Directed Blood Donation through the Red Cross. On the Transfusion Page.
*Faulty hyperlinks on Cardiac Page. I think these are all corrected. If you come across hyperlinks on other pages that don't take you where they should, please email me (tom@dosdocs.com) and let me know so I can correct them.

2 September 2002

*A description of the CIWA Protocol for management of Withdrawal to Alcohol, Sedatives, and Hypnotic Drugs. On the Miscellaneous Page.
*Elimination of the Spirited Gourmet Sandwich Menu.


27 July 2002

* Guidelines for Pancreas Transplants; revised guidelines for Kidney transplant recipients, both Live and Cadaveric, all on the Transplant Page


22 June 2002

* PCEA Update (new Dilaudid (hydromorphone) guidelines with new dose recommendations). On the Pain Management Page.
* Updated Precautions re: Implanted Pacers, AICDs, and Magnets: see Cardiac Page.


11 May  2002

* New protocols for Abdominal Aortic Surgery, including Perioperative Beta Blockade and Diabetes Management, as well as Am.College of Cardiology Clinical guidelines. Indexed through Cardiac & Vascular Page.


30 April 2002

* Indrit Reso MD has compiled a huge list of Pediatric Information: Anesthesia Drugs & Doses, Resuscitation drugs, antibiotic doses, airway equipment, and much more. Check it out via a link on the Pediatric Page to Pedi drugs & data. Thanks Indrit!
 

30 March 2002

* PCEA Update (changing from Fentanyl to Dilaudid (hydromorphone), with new dose recommendations). On the Pain Management Page.
* Premixed Epidural Marcaine for OB is changed to fentanyl  2 mcg/cc. See Obstetrics Page.

6 November 2001

* Revised guidelines for Continuous Caudals in kids <6 months. On the Pediatric Page.


20 October 2001

* ACLS Algorithms (for those of us taking the course November 3). On the Miscellaneous Page.

* Hemodynamic Parameters. A page of normal numbers and formulas, with some comments on interpretation. On the Resident's Page. 
 
6 October 2001

* Call Point Values for Weekdays and Weekends are updated as of this Summer. 

25 September 2001

* The Dental Damage Policy has been updated. Locate under Miscellaneous Page.
 
25 August 2001

* The WEB Host for this site has changed. Please logon to Avantgo and change the URL for this site to: http://www.dosdocs.com/ps
* Some additions to the Resident's Pages


8 August  2001

*Obstetrical Updates: OB Consults and Standby for Vaginal Delivery (esp. Twins)
 
19 July  2001

* Newly updated guidelines to ERCP in Xray, under the Special Situations Page.
* A new Resident's Page, which includes information especially appropriate for the Student of the specialty (perhaps that is ALL of us)


28 April  2001

*Additions to Opioid Equivalency Page, under Pain Management. For when you're asked to convert parenteral drugs to PO on the weekends when Robin isn't around.
* Pediatric Continuous Epidural guidelines, esp. for children <6 months of age. The drug of choice is now chloroprocaine. On  the Pediatric Page.

2 April  2001

*Treatment of Air Embolism  on Cardiopulmonary Bypass (Bob Groom), on the Cardiac Page.
*Anesthesia for Neuroradiology Cerebral Embolization Procedures, under Special Situations

17 February 2001

Some general cleanup, deletion of outdated information

1 January 2001

New Page: On-Call Administrative Guidelines; includes links to specific on-call issues, like the newly created Eye Surgery After Hours Directives, Pediatric & Pediatric Heart Call, and  Epidural Blood Patches & supervision


12 December 2000

* Anesthesia for Special Situations:  Endovascular Stents in Radiology
* Cardiac: Implantable Pacemakers: what do those letter codes mean?

2 November  2000

Anesthesia Math & Physics Page (a start; looking for suggestions and contributions)

27 October 2000

*Herbal Medicines & Drug Interactions (from the recently distributed ASA Handout)
*Pediatrics & Pedi Heart: Staff Call List
*Renal Transplants: new protocol for Laparoscopic Nephrectomy from Live Donor