Building protocol…

Tailoring emergence steps to your patient

SRNA in the OR
DNP Scholarly Project
Anesthesia
Emergence Guide
A structured clinical decision-support tool for SRNAs, built to bridge the gap between what is taught in didactics and what is expected at the bedside during emergence.
Protocol
Generator
Crisis Cards
Practice
Scenarios
Drug
Reference
PACU
Handoff
About This Project
Why this tool exists and who built it
Anesthesia machine in the OR
Yordanos Zewde
Yordanos Zewde, SRNA
SRNA  ·  Nurse Anesthesia

Emergence is the most unpredictable phase of anesthesia. For SRNAs, it's often the one with the least structured guidance. Every time you rotate to a new site, the approach changes. Every preceptor does it differently. You're expected to manage hemodynamics, assess ventilation, time your reversal agents, prevent PONV, and make airway decisions: all simultaneously, all from memory.

I built this tool because that gap is real and it affects patient safety. This is my DNP project: a structured, evidence-based decision-support tool designed to give SRNAs a consistent framework they can carry into any OR, with any preceptor, at any stage of training.

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Built for the transition that matters most

Emergence doesn't follow a predictable script. Airways become reactive, hemodynamics shift, and consciousness returns unevenly: all in a narrow clinical window. This tool gives you a systematic framework to move through it confidently.

Anesthesia monitoring equipment
The moment between anesthesia and wakefulness. Where this tool lives.

A consistent framework across every rotation

Preceptors approach emergence differently. This tool isn't here to replace your preceptor. It's here to give you an objective anchor regardless of where you're training or whose style you're adapting to.

Evidence-based, not opinion-based

Every protocol, drug dose, and recommendation is drawn from Miller's Anesthesia, Nagelhout & Elisha, Barash Clinical Anesthesia, and current ASA guidelines: not one preceptor's preference.

What this tool gives you

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Patient-specific emergence protocols: generated from age, weight, agents, NMB, surgery type, and Apfel score
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11-phase emergence checklist: from surgical completion through PACU handoff
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Crisis Cards: rapid-reference for laryngospasm, bronchospasm, and delayed emergence
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Drug reference: weight-based dosing across 7 drug categories
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Clinical practice scenarios: with immediate feedback and key learning points
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PACU handoff note generator: structured documentation built from your case
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Modified Aldrete & Apfel scoring: point-of-care calculators
Educational use only. This tool supports SRNA training and clinical education. It is not a substitute for clinical judgment, institutional protocols, or attending supervision.
Session only  ·  No patient data stored  ·  Works offline after first load
Session only. No data stored.
My Cases
Patient-specific emergence protocols

No cases yet

Create a new case to generate a step-by-step emergence protocol.

New Emergence Case
Enter clinical details to generate a tailored, evidence-based emergence protocol
Patient Demographics
Surgical Position & Opioid Plan
Classification & Airway
General Anesthesia Type
Select all agents used: emergence applies to general anesthesia only
SevofluraneDesflurane IsofluranePropofol TIVA KetamineDexmedetomidine Nitrous OxideMidazolam FentanylRemifentanil SufentanilMorphine Remimazolam
Neuromuscular Blockade & PONV
Comorbidities (select all that apply)
OSA Obesity (BMI ≥35) Obesity Hypoventilation Syndrome COPD Asthma Pulmonary Hypertension Restrictive Lung Disease Coronary Artery Disease Heart Failure (HFrEF) Heart Failure (HFpEF) Hypertension Dysrhythmia / Pacemaker Diabetes (Type 1) Diabetes (Type 2) Chronic Kidney Disease ESRD / Dialysis Hepatic Disease / Cirrhosis Neurologic Disease Seizure Disorder GERD / Full Stomach Chronic Pain / Opioid Tolerance Malnutrition / Low Albumin Anemia / Coagulopathy Thyroid Disease Adrenal Insufficiency MH Susceptible Pediatric (<12 y) Elderly (≥75 y) Pregnancy / Postpartum
Additional Notes
Emergence Protocol
0 of 0 complete0%
Drug Reference
Patient-specific dose calculator
Point-of-Care Calculators
Scoring Tools
Modified Aldrete Scale and Apfel PONV Score
Scoring Tools
Modified Aldrete Score: PACU Discharge
Score 0–2 per category. Total ≥ 9/10 required for standard discharge.
Aldrete Total
Complete all categories
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Nagelhout Nagelhout JJ, Plaus KL. Nurse Anesthesia, 5th ed. Ch. 54: Post Anesthesia Care.
Apfel PONV Risk Score
Apfel Score
Select risk factors
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Barash Barash PG et al. Clinical Anesthesia, 8th ed. Ch. 55: PONV. Apfel simplified risk score.
TOF Ratio Interpretation
TOF RatioDepthClinical FindingAction
0.00–0.25DeepNo movement; apneicDo NOT extubate. Await deeper recovery or reverse.
0.25–0.70ModerateWeak movement; inadequate head liftReverse. Do NOT extubate.
0.70–0.89ResidualClinically silent: appears adequateClinically unreliable. Confirm ≥ 0.9 quantitatively.
≥ 0.90ReversedAdequate strength; safe protective reflexesMeets reversal criterion for extubation.
Miller Miller RD et al. Miller's Anesthesia, 8th ed. Ch. 34: TOFR ≥ 0.9 standard for extubation.
Approved References
All clinical guidance sourced exclusively from these approved textbooks
Quick Assessment
Answer three questions to identify the most likely emergence complication
Practice Scenarios
Clinical cases for SRNA self-assessment: select the best answer then review the explanation
Emergency Reference
Crisis Cards
Rapid decision support for emergence emergencies
Feedback & Contact
Your input directly shapes this DNP project: share your experience or reach out directly
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Your feedback has been received and will be reviewed to improve this DNP project.
Contact the Developer
Have a question, clinical suggestion, or want to collaborate on this DNP project? Send a direct message below.

This will open your email client with the message pre-filled. Alternatively, reach out directly at yordanos.zewde@emergenceguide.edu

Yordanos Zewde
Yordanos Zewde, SRNA
SRNA  ·  Nurse Anesthesia
This DNP project addresses the absence of a standardized decision-support tool for SRNAs during emergence: the most cognitively demanding and physiologically vulnerable phase of anesthesia care. Your feedback directly shapes the next version.