Deep breath...

[Random Anesthesiologist]

CA-1 starts tomorrow.

I've read, but haven't touched anything in an anesthesia context in over a year and a half (my electives were ICU and ER in the midst of gen surg last year). And I'm feeling the anxiety that makes you forget things you've read. I don't think I'm going to sleep well tonight. New program, new city, new everything.

Please tell me this is normal.

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[DreamLover]

CA-1 starts tomorrow.

I've read, but haven't touched anything in an anesthesia context in over a year and a half (my electives were ICU and ER in the midst of gen surg last year). And I'm feeling the anxiety that makes you forget things you've read. I don't think I'm going to sleep well tonight. New program, new city, new everything.

Please tell me this is normal.

Normal. My deal was the exact same. Zero Anesthesia intern year and then moved to new city for CA-1. I was nervous as hell. It all worked out fine in the end. Good luck!

 

[pgg]

Normal. New CA1s are assumed to know nothing. Welcome to the specialty.

 

[deleted9493]

I had trouble getting good sleep on several nights during residency--first day? first day of cardiac? First big case with a not so pleasant attending? There are so many 'firsts' you're bound to be stressed through training. Embrace it. If you're not being stressed, you're not going to grow as much.

Be as prepared as you can be for each day, keep your head about you, and be sponge-like in your readiness to learn. Forget the "well, on the ICU service or in the ER we didn't do it that way" bit. You are in residency to learn and reach your potential in training in anesthesiology and you'll do that much better if you see each day with a different attending as an opportunity. As a CA-1, a good program will assume that you know nothing and will treat you accordingly.

Best to you!

 

[deleted171991]

CA-1 starts tomorrow.

I've read, but haven't touched anything in an anesthesia context in over a year and a half (my electives were ICU and ER in the midst of gen surg last year). And I'm feeling the anxiety that makes you forget things you've read. I don't think I'm going to sleep well tonight. New program, new city, new everything.

Please tell me this is normal.

Relax. You're just a newborn. You're not supposed to know anything. Just suck on that maternal... knowledge and stop worrying for the next 18... months.

 

[deleted126335]

Don't worry. Your attendings know that you don't even know how to turn on the anesthesia machine. Everyone of them knew as little at some point as you know now.
The situation is critical but not serious.

 

[OB1🤙]

Congrats on making it to the first day of the rest of your life!

In addition to the usual bits of advice about sponges, I will add this:

Get to know the anesthesia machine. Start now while no question is a stupid question. Know it in and out, backwards and forwards. Ideally your program has a variety of machines, get to know them all.

Know it better than your techs. This will take a few months, but is a noble goal.

Of my many pet peeves, maybe the worst was seeing a CA-3 who couldn't troubleshoot their machine when it acted up on them.

 

[Arch Guillotti]

So how did it go?

Everything you are feeling is normal.

 

[sevoflurane]

Yep. That feeling is natural. Soon enough you'll be solo in a room with BP's in the 40's... and your HR will be 50 BPM.
Keep your eyes open, learn and give it time. Good choice.

 

[RK.md]

Newly minted CA-1 here - survived my first day!

 

[NightNight]

Tube in....turn the gas on.

 

[Yangkower]

My first day Solo in the OR the dinguses scheduled me for 5 short cases. Ha ha I was sweating like a "sex worker" in church.

 

[deleted171991]

Welcome to the real world, Neo!

 

[aneftp]

Don't worry. Your attendings know that you don't even know how to turn on the anesthesia machine. Everyone of them knew as little at some point as you know now.
The situation is critical but not serious.

Lol. Ha ha.

Don't think I have done a machine "check" at the beginning of the day in ages.

 

[pgg]

Lol. Ha ha.

Don't think I have done a machine "check" at the beginning of the day in ages.

Residents, please do your own equipment checks, despite posts like this.


I always do my own machine check at the start of the day. The anesthesia techs do it first. Some have been techs for longer than I've been a doctor. But I catch a real problem every month or two. Recent problems:
- backup O2 tank was empty
- suction manifold cracked ... it sucked, but too weak to be useful
- broken CO2 absorbant lock handle thingy, circuit wouldn't hold pressure
All on machines that were "checked out" by someone else.

If I change rooms mid-day I'll do a machine check. CRNAs and other anesthesiologists can be just as sloppy.

There are ninjas and assassins everywhere. Trust no one to check your equipment.

 

[DreamLover]

Residents, please do your own equipment checks, despite posts like this.

I admit, I always do a machine check each morning too when I'm solo. I've caught many an empty E-cylinder. Granted, most of the machines I use now essentially check themselves, so it's crazy not to really.

I also check for an extra O2 tank, ambu bag and by beloved bougie before my cases too...I can't tell you how many times lately I'll ask one of my residents where their auxiliary O2 tank is and I get blank stares.

 

[OB1🤙]

Another PP daily machine checker here.

But it takes literally 10 seconds to do a cursory check- turn on suction, confirm o2 cylinder contents, make sure machine holds pressure. I have found MANY leaks the techs don't find. It's not hard and it matters I think.

Trust no one.

 

[Dwindlin]

Newly minted CA-1 here - survived my first day!

More importantly my patients survived my first day...


Sent from my iPhone using Tapatalk

 

[BobBarker]

1. Put the tube between the cords
2. Keep the patient asleep
3. Keep the vital signs WNL

It's really that simple.

 

[aneftp]

Residents, please do your own equipment checks, despite posts like this.


I always do my own machine check at the start of the day. The anesthesia techs do it first. Some have been techs for longer than I've been a doctor. But I catch a real problem every month or two. Recent problems:
- backup O2 tank was empty
- suction manifold cracked ... it sucked, but too weak to be useful
- broken CO2 absorbant lock handle thingy, circuit wouldn't hold pressure
All on machines that were "checked out" by someone else.

If I change rooms mid-day I'll do a machine check. CRNAs and other anesthesiologists can be just as sloppy.

There are ninjas and assassins everywhere. Trust no one to check your equipment.

I should have clarified my post a little more.

I haven't start my own room in almost 2 years at the beginning of the day. Always covering either resident or crna by the beginning of the day. They do the check out. That's what I should have stated.

If I do my own case at the middle of the day, it's so easy to check if machine has been checked at the beginning of the day with the history of the machine. I don't do a machine check if the machine has been checked in at the beginning of the day.

But my real pet peeve when starting cases has to do with suction always been available.

 

[Random Anesthesiologist]

So, follow up! First day was great. I felt so dumb, but very satisfied with my program choice and specialty choice. The first week was basically me learning the facility. Huge place, and I kept getting lost on the way to/from the cafeteria

I have officially finished 3 weeks of residency and I'm starting to do some cases without a senior resident, just my attending in the room for induction/intubation and emergence. So far I'm doing okay, but they have been stable pts. My art lines are ok, and my peripheral iv skills sucked bad in the beginning but starting to pick up. Central lines... No problems.

I'm pretty exhausted.. We have lecture at 6:15 so I have to check out my machine and get the room ready before that so very early mornings. But it's all good. The hours are still better than surgery.

I am constantly amazed at how well my attendings know physiology. Of everything. I am kind of excited to think I could be that good someday. I'm trying to get involved in some research - I kind of like it and think it's good if I want to do a fellowship.

There is so much info. I thought surgery had a lot of info to digest but it doesn't hold a candle to how much I have to read for anesthesia. Every morning lecture I come across half a dozen more things I find I know little about. Ugh.

But overall, it's a great start. I actually like going to work now.

 

[Random Anesthesiologist]

Oh, I forgot. I'm paranoid as heck. I check my machine thoroughly. I can count on two hands already how many times the suction has had tubing looking like it's readying to go but not turned on, or the CO2 cannister needs changing, etc.

Thankfully I'm in the same room all day usually so I trust it from case to case, but definitely a must do first thing in the am. I also do a cursory cart check. I was left without any 7.0 tubes and stylettes yesterday morning.

 

[partydoc]

Hey glad things are going well for you. Everyday when I leave the hospital I feel like I just got my a**kicked but can't wait to go back the next day and do it again. I'm still struggling with IV's, decent at a lines, no shots at any CVL's yet.

 

[okayplayer]

Oh, I forgot. I'm paranoid as heck. I check my machine thoroughly. I can count on two hands already how many times the suction has had tubing looking like it's readying to go but not turned on, or the CO2 cannister needs changing, etc.

Thankfully I'm in the same room all day usually so I trust it from case to case, but definitely a must do first thing in the am. I also do a cursory cart check. I was left without any 7.0 tubes and stylettes yesterday morning.

Keep that up. That will serve you well in the future.

Good luck. You picked a good field.

 

[Triple AAA]

Congrats guys. It's definitely a big transition, and certainly not easy. Just wait til your first day as an attending...