Anesthesia

[roja]

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What did/does your anesthesia rotation look like?

how many intubations? do you jump from room to room? do blocks? LMA's?



curious because there seems to be alot of variability out there.

 

[deleted109597]

I'll let you know in November.
Currently, the wording is that you go to the OR every Friday for a month, tube and run. LMAs if the MDA wants it based on the case. No blocks, but we do a fair number of those in the department.
The rest of that month is divided into orthopedics and ultrasound. Makes a hectic month.

 

[tkim]

Two weeks tubing adults - jumping around = attending-dependent. About 30. One week peds. Staked out the T&A room for quick room turnovers. About 20. Then one week vacation. I didn't do any blocks, but a couple of LMAs.

 

[DrMom]

What did/does your anesthesia rotation look like?

how many intubations? do you jump from room to room? do blocks? LMA's?



curious because there seems to be alot of variability out there.

I was at a site with multiple off-service residents/interns rotating there plus too many students, so there was no moving from room-to-room (sometimes we had more than one off-service person per case). I pulled rank as needed to get tubes and managed an average of 2 per day (the students, for example, got a handful during the whole month). Quite a few peds tubes. Did a number of LMAs. A few central lines/art lines. No blocks.

 

[lucky_deadman]

What did/does your anesthesia rotation look like?

how many intubations? do you jump from room to room? do blocks? LMA's?

curious because there seems to be alot of variability out there.

Probably 3-4 tubes per day. Mix of adults and peds OR days; in addition to SDS cases. Plenty of LMA's. No blocks. Can jump from room to room.

 

[deleted65604]

I think I had 45-50 intubations, only 3 of which were peds. Had 3 LMA, and several conscious sedations. No blocks, no lines.

 

[CommunityED]

Did approx 50-60 tubes, bunch of alines, a few central lines, a few lmas. Also spent one day doing sedations for ECT which was really good because it allowed a lot of practice at bagging.

 

[BADMD]

What did/does your anesthesia rotation look like?

how many intubations? do you jump from room to room? do blocks? LMA's?



curious because there seems to be alot of variability out there.

I did two weeks at what were basically surgi-centers. Lots of LMAs and 2-5 tubes a days. Mostly adults, but a few kids. Bounced from room to room with the anesthesiologist while a CRNA handled the case. Most of the blocks were beyond the scope of emergency medicine, but I got to do a few scalene and axillary blocks.

Got to do some post anesthesia care, which was interesting, but I'm glad that only lasted 2 weeks.

 

[VALSALVA]

2-3 tubes a day. Lots of fiberoptics, LMA's, video MAC, etc. Good mix of peds. Got to do several elective needle cryco's as well. 2-3 blocks. Great month.

 

[fakin' the funk]

Most of the blocks were beyond the scope of emergency medicine, but I got to do a few scalene and axillary blocks

Just curious - I'm an MS4 going into anesthesiology - what blocks do fall into the scope of EM? Hadn't heard of such a thing.

 

[SoCuteMD]

Just curious - I'm an MS4 going into anesthesiology - what blocks do fall into the scope of EM? Hadn't heard of such a thing.

We do digital and shoulder blocks all the time (digital more so). I've seen some long-lasting intercostal blocks with rib fractures to keep the patient from splinting. I've seen a penile block in a patient with priapism who they were going drain.

 

[BADMD]

Just curious - I'm an MS4 going into anesthesiology - what blocks do fall into the scope of EM? Hadn't heard of such a thing.

I do plenty of digital and wrist blocks. Other blocks I'll do: ankle, femoral nerve, superior orbital, maxillary, and lingual. I know some docs who will go after a few of the forearm blocks with ultrasound. And I almost forgot the ring block.

 

[theCamel]

What did/does your anesthesia rotation look like?

how many intubations? do you jump from room to room? do blocks? LMA's?



curious because there seems to be alot of variability out there.

in my internship (i'm doing a 1+3 as you know) i just did an anesthesia rotation. basically 7:30 am, when cases started, i'd try to do as many intubations and LMA's as possible before our noon conference. then i'd come back and do as many of the pm cases as possible. 60+ tubes plus maybe a dozen lma's, got comfortable with miller and mac, and got to play with the mcgrath and glidescopes a couple of times.

in between tubes, i added my pager to the code pager, which the cRNA on call responds to when the ED or another area can't succesfully intubate a difficult patient, those were pretty useful.

also, once comfortable, they allowed me to put in as many lines as i could (usually had to go to pre-op b/c they generally came to the PACU lined) - and i did get to put in some a-lines and central lines. scalene blocks maybe once a day. and they let me do a handful of peri-bulbar blocks (they didn't allow me to do retro bulbars).

pretty disorganized, but it worked out for the best for me, because i could tailor the month to my interests. especially cool was the practice with airways, and once the tube was in they told me to go try to find the next one, instead of hanging in the OR doing nothing.

*

 

[Mighty Mouse]

my place we bounce room to room. goal is 100 tubes for the month. we do LMA's too. and they really make us concentrate on good BVM technique. can't adequately bag and they won't let you tube. first week or two is getting comfortable with technique. last 2 weeks you try out whatever blade you're less comfortable with, do some peds cases, and learn the glidescope.

 

[NateintheED]

Basically a month of adult anesthesia. Bounce from room to room depending on who the provider is - anesthesia resident vs CRNA vs attending. In between, practiced peripheral IV's in pre-op (which we as residents do very few of). A few LMA's in the ortho room. 1 or 2 a-lines, no central lines. Didn't DO any blocks, but watched a couple. Last cases of the day were generally at 2-3pm, so out at a good hour. 30-40 tubes during the month.

 

[Arch Guillotti]

Got to do several elective needle cryco's as well. 2-3 blocks.

What were the "elective needle cryco's" for?

 

[leviathan]

What were the "elective needle cryco's" for?

Sounds like an oxymoron, doesn't it?

 

[2ndyear]

What were the "elective needle cryco's" for?

Transtracheal for awake fiberoptic?

 

[Idiopathic]

you all get a lot of regional/block experience? i understand that ring blocks etc and infiltration for lac repair, but do any of you think peripheral nerve blocks are out of your realm of training?

 

[VentdependenT]

you all get a lot of regional/block experience? i understand that ring blocks etc and infiltration for lac repair, but do any of you think peripheral nerve blocks are out of your realm of training?

I plan on using a ton of regional if I ever get accepted anywhere. True I won't need to do sciatic blocks, lumbar plexus blocks, or interscalene's ever but the other stuff is relevant. Popliteal, ankle, hand, elbow, femoral, axillary are the main ones I think would be useful. Why not do paraspinals on a dude with a rib fracture so he can leave the hospital without being narced out? Sounds decent to me.

I'll grab an ultrasound and teach some blocks to the crew.

As far as spinal taps go? Oh its on like donkey kong.

I'll induce em, tube em, block em, and have em ready for dispo directly to the OR.😀

 

[jay Raymond]

[quote=roja;7167795]What did/does your anesthesia rotation look like?

how many intubations? do you jump from room to room? do blocks? LMA's?



curious because there seems to be alot of variability out there.[/quote]

I am on my way for Oral exam in april2009 please help me with your recommendation and experiences that what icourse should i take and what to do to get best result..
Thank you all

 

[deleted109597]

I am on my way for Oral exam in april2009 please help me with your recommendation and experiences that what icourse should i take and what to do to get best result..
Thank you all

?

 

[kungfufishing]

you all get a lot of regional/block experience? i understand that ring blocks etc and infiltration for lac repair, but do any of you think peripheral nerve blocks are out of your realm of training?

I don't think so. I think it all depends on your interests and what you have been trained to do. I really like regional anesthesia. I mostly do hands, feet, and face/head, but I've learned and used (probably should do more) femorals and intercostals. There are so many conditions that you are never gonna give enough pain medicine which can be safely anesthetized. I probably perform more regional anesthesia than average, which also opens me up to more liability than average, but if the procedure is not contraindicated, I know how to do it, and it will benefit the patient, why not?

 

[ditch doctor]

What did/does your anesthesia rotation look like?

how many intubations? do you jump from room to room? do blocks? LMA's?



curious because there seems to be alot of variability out there.

One month, about 100 total tubes (80/20 ETT/LMA). Bounced from room to room. Responded to in hospital codes/emergency intubations/emergency lines (usually one tube and one line per week this way). Put in about 10-12 central lines. Floated 2 swans. About 30-40 art lines. ~10 IV's a day. Glidescope(sp?) once or twice a day for "practice". Did 2 Axillary blocks. Witnessed 2 awake fiber-optic intubations. No resident program; worked mostly with Staff or CRNA's.

 

[crewmaster1]

Kind of crazy, but my program doesn't have an anesthesia month!

As interns we do one week of peds anesthesia in the ENT/GI room and get about 20-30 peds tubes. In the last 2-3 months of intern year the R2s (procedure docs) throw us some ED tubes, then as R2 you get all airways that happen in the ED when you're working (only one R2 on at a time). I have done 1.5 months of 6 ED months as R2 so far and have about ~30 adult tubes (~25 ED, ~5 Air Care) (AVG about 1 tube per day). I think most of our residents graduate with about 75-100 adult tubes (all in emergency situations which I think are a lot more useful than controlled anesthesia settings).

 

[ecCA1]

"LMAs if the MDA wants it based on the case."

Why would you refer to us as "MDA?"

Because you heard the CRNAs do it?

Maybe you'll be an "MDE" when the NPs/PAs get more aggressive and encroach upon your future field?

Docs need to stick together to repel the invasion of the mid-levels. Part of that effort involves not succumbing to the use of their lazy-minded terminology.

 

[Hamhock]

you all get a lot of regional/block experience? i understand that ring blocks etc and infiltration for lac repair, but do any of you think peripheral nerve blocks are out of your realm of training?

Certainly not. Now that many peripheral blocks are ultrasoud-guided (based), there is no reason why these blocks are "out of your realm of training" (if you get the training for a skilled preceptor).

Our senior residents and a good chunk of our faculty (admittedly, we have an umcommon amount of ultrasound fellowship-trained faculty) are quite skilled in ultrasound-guided radial/median/ulnar, axillary, supraclavicular (RARELY scalene), femoral, popliteal, etc. blocks.

Juniors, with a little motivation, can get plenty of instruction and experience with ultrasound-guided regional blocks and can quicly claim this within "realm of training".
HH

 

[dchristismi]

We did anesthesia in the mornings, bouncing room to room and ultrasound in the afternoon. I did about 50 tubes, if I remember correctly.

As we have a tertiary peds hospital we also went there, where there are tons of mask cases, LMAs and pediatric anesthesiologists to get the tricks down. There's also a peds outpatient surgery center, where the rapid-turnover ENT cases can be had... thus, lots of peds experience.

 

[DOrk]

50 tubes (zero peds). About 1-2 central lines/art lines each day (in CABG rooms). No blocks, 5-6 LMA's total

 

[DOrk]

"LMAs if the MDA wants it based on the case."

Why would you refer to us as "MDA?"

Because you heard the CRNAs do it?

Maybe you'll be an "MDE" when the NPs/PAs get more aggressive and encroach upon your future field?

Docs need to stick together to repel the invasion of the mid-levels. Part of that effort involves not succumbing to the use of their lazy-minded terminology.

Glad I'm not the only one irked by the "MDA" thing....Agree with the above poster about docs sticking together to prevent encroachments on physician scope of practice.

BTW, If I were an anesthesiologist, I'd be called a "DOA." I'm sure this title would be a comfort to my patients 🙂

 

[pgg]

Certainly not. Now that many peripheral blocks are ultrasoud-guided (based), there is no reason why these blocks are "out of your realm of training" (if you get the training for a skilled preceptor).

Sorry to dredge up a 2-week old thread but I was browsing your forum ...

The fact that most blocks are now trivially easy with the aid of ultrasound is a red herring. The question isn't so much whether or not you can do the blocks (any physician, PA, nurse, student, or moderately well trained monkey can do an u/s guided femoral after a couple of guided reps), but whether you're prepared to manage the complications.

Note that I'm not criticizing emergency med docs for doing these blocks, or trying to suggest that they're not equipped to handle seizures, CV collapse, pneumothoraces, inadvertent epidural/intrathecal injection ... I assume they all can manage an airway, support hemodynamics, give intralipid, find the 2nd intercostal space without a map, etc. 🙂

I'm just saying that by declaring ultrasound's technical ease the reason blocks are within the EM physician's scope of practice, it sounds like you're missing the point. The real danger of a block has nothing to do with its difficulty and everything to do with ignorance of, and/or inability to manage, potential complications.

/ off my anesthesia high horse now 🙂

 

[deleted109597]

Glad I'm not the only one irked by the "MDA" thing....Agree with the above poster about docs sticking together to prevent encroachments on physician scope of practice.

BTW, If I were an anesthesiologist, I'd be called a "DOA." I'm sure this title would be a comfort to my patients 🙂

So then I should only ask for the ologist? Walk in to the OR and say "I hate CRNAs". Hey, we didn't make your bed. You want to complain about verbage, go find a mirror. "MDAs" sold out your specialty years ago trying to make more money.

 

[cleansocks]

So then I should only ask for the ologist? Walk in to the OR and say "I hate CRNAs". Hey, we didn't make your bed. You want to complain about verbage, go find a mirror. "MDAs" sold out your specialty years ago trying to make more money.

Making beds, selling out professions, hating CRNA's, asking for ologists? Yay for non sequiturs. All the docs are saying is that they prefer to be called anesthesiologists rather than MDA's, which is a confusing abbreviation especially to patients.