| Bedside Test | Procedure | Normal / Reassuring Value | Clinical Significance (Red Flag) |
|---|---|---|---|
| Clinical Assessment | Observe for signs of respiratory distress and bulbar weakness (speech, swallowing). | No accessory muscle use, effortless breathing, strong cough, clear voice. | Tachypnea, accessory muscle use, paradoxical breathing, weak “boggy” cough, slurred/fading voice. |
| Vital Capacity (VC) | Patient takes a maximal inhalation and exhales fully into a bedside spirometer. | > 20 mL/kg (ideal body weight) | < 15-20 mL/kg, or a declining trend during the breathing trial. |
| Negative Inspiratory Force (NIF) / MIP | Patient makes a maximal inspiratory effort against an occluded airway for ~20 seconds. | More negative than -30 cm H₂O | Less negative than -30 cm H₂O (e.g., -25, -20), or a worsening trend. |
| Single Breath Count | Patient takes a deep breath and counts aloud steadily (e.g., “1-one-thousand, 2-one-thousand…”). | > 25 | < 15-20. Indicates severely reduced vital capacity. |
| Head Lift Test | Patient lies supine and lifts their head off the bed, holding the position as long as possible. | > 30 seconds | < 20 seconds. Correlates with significant diaphragmatic weakness. |
| Breath-Holding Time | After a maximal inhalation, the patient holds their breath for as long as possible. | > 30 seconds | < 20 seconds. Suggests poor respiratory reserve. |
Category Archives: Anesthesia
Does intravenous alteplase administered 4.5 to 24 hours after acute ischemic stroke onset improve outcomes?
Anaesthesia Machine Checklist
✅ ASA Summary of Anesthesia Machine Checkout Recommendations
🔄 To Be Completed Daily
1. Verify that auxiliary oxygen cylinder and self-inflating manual ventilation device are available and functioning
👥 Provider and Technician
2. Verify that patient suction is adequate to clear the airway
👥 Provider and Technician
3. Turn on anesthesia delivery system and confirm that AC power is available
👤 Provider or Technician
4. Verify availability of required monitors, including alarms
👤 Provider or Technician
5. Verify that pressure is adequate on the spare oxygen cylinder mounted on the anesthesia machine
👥 Provider and Technician
6. Verify that the piped gas pressures are ≥ 50 psig
👥 Provider and Technician
7. Verify that vaporizers are filled and, if applicable, filler ports are tightly closed
👤 Provider or Technician
8. Verify that there are no leaks in gas supply lines between flowmeters and common gas outlet
👤 Provider or Technician
9. Test scavenging system function
👤 Provider or Technician
10. Calibrate or verify calibration of the oxygen monitor, and check the low oxygen alarm
👤 Provider or Technician
11. Verify that carbon dioxide absorbent is not exhausted
👤 Provider or Technician
12. Perform breathing system pressure and leak testing
👥 Provider and Technician
13. Verify that gas flows properly through the breathing circuit during both inspiration and exhalation
👥 Provider and Technician
14. Document completion of checkout procedures
👥 Provider and Technician
15. Confirm ventilator settings and evaluate readiness to deliver anesthesia care (anesthesia time out)
👤 Provider
🕒 To Be Completed Prior to Each Procedure
2. Verify that patient suction is adequate to clear the airway
👥 Provider and Technician
4. Verify availability of required monitors, including alarms
👤 Provider or Technician
7. Verify that vaporizers are filled and filler ports are closed
👤 Provider
11. Verify that carbon dioxide absorbent is not exhausted
👤 Provider or Technician
12. Perform breathing system pressure and leak testing
👥 Provider and Technician
13. Verify gas flows properly through breathing circuit (inspiration and exhalation)
👥 Provider and Technician
14. Document completion of checkout procedures
👥 Provider and Technician
15. Confirm ventilator settings and evaluate readiness to deliver anesthesia care (anesthesia time out)
👤 Provider
Legend:
👥 = Provider and Technician
👤 = Provider or Technician / Provider only
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