Intubation, Induction and the Hunger Games.
Clerkship Day 137: Anesthesiology
PS. I know I am supposed to publish the other “clerkship notes” during my past rotations last year (Surgery, OBGYN, Pedia, Family medicine, etc.) I’m working on them :) I just have to remind myself that I am doing
Assalamu Alaykum (Peace be upon you all!). It’s been 5 days since our classes resumed. Actually, I prefer calling it “training” than “classes” because we don’t have much “class sessions” compared to when we were on our first three years in medschool. We are spending more time in the hospital, shadowing our doctors, trying to learn as much as we can from them. So yeah, it should be “training”.
We are now training under the department of Anesthesiology and this will last for two weeks only. They told us that we are fortunate because there are only TWO medical schools in the whole country has clerkship trainings for Anesth. Cool! So it’s really best to make the most of our two weeks stay while we can.
We’ve been to Surgery last time, so we are not that “alien” to the world of the Operating Rooms. Only this time, we are not working on the OR table anymore, but at the Anesth “territory”: that small, ever-present area where the anesthesiologist hide from everyone’s view. Haha!
So what do clerks do during these two weeks? After the orientation and skills training on the first day of the training, we are immediately brought back to the OR and apply what we learned!
|The things to prepare during ET intubation,|
|"I can view the glottis now." -Future Dr. Molina|
|Taking turns. Practicing how to intubate while others fool around for awhile.|
|After the skills training, with Dr Castillo. Sorry for the poor quality of photo -_-|
First things first: The call time for Anesth clerks is 6:30AM! And believe me, their “time” is pretty way advanced than the usual clock so better sync your watch ahead of their time so that you won’t be late. It happened to me and 2 other classmates on the first day! The wisest way to do? Leave your place an hour before call time, and you’ll be safe, in sha Allah. They are pretty strict with coming on time and signing your attendance.
PS. Be sure to sign at the OFFICIAL CLERKS’ ATTENDANCE LOGBOOK at the ANESTHESIOLOGY LOUNGE (see photo) where “Mama Mary” is and not just the one in the SECRETARY OFFICE!
[photo anesth lounge, clock, mama mary]
The clerks share a single callroom with the Anesth Interns and ICCs. There's a separate dressing room as well. I am just glad that the callroom had a small space available that's enough for my sudjara.
|Happy me :) when I found out the direction of the Qibla is parallel to the long side of the call room :)|
The OR Services
Then we are assigned into our respective OR services (General Surgery, ENT1, OB-LAP, ORTHO, etc.). The assignment of OR Services for the whole two weeks will be sent to your group usually on the second day of training. Most of the blocks who went to Anesth before us had General Surgery cases, but January’s not the best time to be clerks in Anesthesiology. Why? Because first year residents will also start their training this time of the year. So technically, most of the hard cases, especially “spinal” are given to them. So our block were assigned at the subspecialty OR cases for now.
The AOD and the Daily Grinder
Each OR service have at least one AOD (Anesthesiologist on Duty) for each said room. There are cases lined up per day, the first case usually starting at 6AM (that’s why you should be there earlier than 6AM!). All cases for each day will also be posted in the “Daily Grinder” found posted on the bulletin board at the Anesth Department hallway. The Daily grinder will also give you the details of the operation including the service, case number, time of operation, the name of surgeons and the AOD. Look for the name of the AOD in charge in your service and better check the cases on deck. Not all cases can be given to you. Pay patients, pedia and complicated cases are never given to us clerks. After having all the data you need the fastest you can, go immediately to your OR service and look for your AOD.
REMEMBER! Never forget to introduce yourself! The worst thing you can do is loiter around in the OR while the rest of the team are wondering what you’re doing in there!
No Pre-ops, No procs. That’s one of the solid rules in Anesthesiology. After your AOD agreed to give you the case, you must accomplish your Anesthesiology Preoperative Record before the operation begins. Students have different strategies on this. The most diligent ones would do it the night before the surgery (meaning, they already talked to the AOD way ahead of time), others like me would wait for the patient to be brought to the holding area and complete the pre-ops. It’s a pretty straightforward list of questions that we usually do while charting patients, with a few emphasis on important things such as history of allergies, recent labs, etc. You can do it in 10-15 minutes. Although you can get most of the data from the patients’ charts, it is always good to repeat the questions for confirmation. This is another strong rule in Anesth: Be Vigilant!
So what are these procedures that we are seeking to “scavenge” they say in the OR? There are only two of them: 1) GETA (General Endotracheal Anesthesia?) or GA (General Anesthesia) and 2) Spinal Anesthesia. By the end of the two weeks training, we are supposed to get 7 GA cases and 3 Spinal cases. That’s a total of 10 procedures. I don’t think I can’t give much details on the two aside from: GAs are easier to find but is far harder to do than spinal. GAs are also the best time to learn how to intubate properly. Don’t worry! Your AOD will surely guide you, just be confident and do your best. It’s important to review what you learned during the skills training on the first day.
|During surgery, the clerk will do exactly what his/her anesthesiologist is doing: Monitoring vitals intraoperatively.|
Alhamdulillah (All praise is due to Allah), my first two GAs were both successful (i.e. I was able to intubate the patient properly). The next ones were pretty harder that the first two, but my Anesthesiologist helped me out generously. The Anesth residents are most of the time pretty lenient and generous to clerks on their first week. But they do ask questions once in a while, so reading your notes is a must. There are residents who are generous in giving grades (yes! You are graded per procs!) so long as you show interest and willingness to learn, but some residents are not that “generous” unless you prove them that you are really worth giving that high grade. It’s a performance-based rating so it is expected that you get lower grades in the first week than the second.
Most of the past batches who went into Anesth Clerkship consider this rotation as “scavenging” for procs, a “hunger games” of sort as to who gets to complete the procs first. Our block would beg to disagree on this. We realized that competing for the number of procs will not bring us any further than just that: competition. So we decided to help each other instead: We make sure that most of us will have almost equal number of procs as much as possible. How did we do it? We coordinate with each other. If one of us already had a case and his next case is the same (say, another GA) and the other one needs it, he will give him the case. At first, you would think that this is counter-productive… like how would you be able to finish your procs if you are giving it to your team-mate? But actually it’s not. As proof, by the end of our fifth day, most of us already got 5 procedures which is half the number we need!
So yeah, working together is indeed better than competing with each other. We stopped the “Hunger Games” mania.
So what now?
I think I have been talking too much now in this post haha! I still have a lot of things to do, so gotta end this here for now -_- Hopefully I could write about what we usually do intraoperatively (meaning “during operations”). Honestly, I kind of started liking Anesthesiology as a practice itself. We weren’t able to appreciate this field of study the past years because we were not exposed to it that much yet, especially during ORs. We only often see Anesthesiologists as just sitting in their “territory”, looking at those weird machines all the time. We didn’t realize until now how important their roles are! Anesthesiology is in fact a vital part of patient health care and management before, during and after surgery. It’s not just about keeping your patient asleep and feel no pain during surgery, but more of getting the patient ready for the surgery, reassuring them that they will be safe, keeping them alive while the surgeons are doing their thing in the OR table. :D
They say you just have to love these three “P”s and you’ll be good in Anesth: Pharmacology, Physiology and a bit of Physics :P And if you hate clinics. Haha.
Oh well, till our next post. Hope this one enlightened you with what we usually do.
Ahmad ibn Hajiri