And dare I say it:
- ultrasound for regional (this one may be necessary for younger docs these days).
The first 1/2 of my residency, I learned with the nerve stim. I got pretty good at it ... at least, as good as any CA2 can be at anything.
Call it proficient. Then they put an ultrasound in the preop area, and I did most of my remaining blocks in residency with that. Since then, I haven't always had u/s available, but when it's there, I use it. Likewise, I learned to put in IJ lines with landmarks, finder needle, poor man's CVP with some IV tubing. Got good at it, then u/s came along, and at least for IJs it's standard of care now.
I don't like u/s because it's new or cool. I think we have to be careful about adopting methods or techniques because they sound good, or are intuitive, because the history of medicine is littered with stuff that sounded right but just didn't pan out. However, I don't think ultrasound for blocks is just a fad, or a crutch. Any more than pulse oximetry or capnography.
I'm glad I learned to do IJs by landmarks, because every once in a while I've needed central access in a hurry and being able to just stick a line in under the drapes without waiting for someone to find the u/s machine is valuable. But blocks are never emergencies. These days, everywhere I work, there's always an u/s machine right there, so there's really no time lost. I don't sterile sleeve it for single shot blocks. It's instant, bedside, noninvasive, completely safe imaging that all but guarantees one stick, one needle pass. Good for patient comfort, good for avoiding other structures you don't want to poke ... what's not to like?
$40K for the machine, I guess.
Welcome back, hope you stay.