militarymd said:
I was 6 months into my residency before I didn't feel like a fish out of water.
I'm about six weeks into my CA-1 year now (took two weeks vacation) and here is what I can do:
1. Set up my room really well for basic GA/MAC/regional cases. I'm not as good at knowing all the details of what you need for certain neuro cases, as well as transplants, livers which we may do on call, but are not part of our routine.
2. PIVs- even some more challengine ones. I've learned how to use a wire when things are loooking hopeless.
3. A-lines- using the techniques discussed on this board with the Arrow kit, my record has been 10 successes with 1 miss. I know how to set up, and zero the a-line apparatus.
4. Airway management- I can comfortably mask ventilate, and use oral/nasal airway devices. I can place LMAs and intubate most of the time, but I've had enough failures that my confidence that I could do it by myself alone in my room in an emergency is deeply lacking. Apnea during a MAC cases scares the **** out of me for this reason alone. I suspect that will get better with more experience. For the same reason, problems with the ETT scare the hell out of me as well, because I'm not that confident in my skills. I had a patient having a renal transplant who was having trouble maintaining his O2 sat, and all he needed was a little suctioning, but doing that without my attending in the room scared the piss out of me... what if I dislodge the tube??what if the tube is too deep and needs to be repositioned.. and I f*ck it up?? Help is a few critical minutes away.
5. Hyper/hypotension- I have a pretty good handle on this. I hate the situations where the patient's BP is dropping so low you basically have to withdraw your anesthetics to awake levels to keep their pressure up. That's scary. My most scary situations that weren't actual emergencies occured this week in some shoulder surgeries. With the patient intubated and the ortho guys repositioning the patient in the chair, the O2 sat starts playing games with me, and the pressures drop into the 60's. I'm scrambling to dump fluid in, and titrate the pressors, while trying to keep the patient asleep and oxygenated, every minute or so checking the tube to make sure those boneheads didn't knock it out.... very frustrating.
6. Blocks- I've done three interscalene bracial plexus blocks with success, but obviously I need a lot more experience before I would be comfortable on my own. I could probably do a spinal on my own if I had to. I've only done two assissted combined spinal epidurals, so I'll need more work there too.
7. Paper charting- I'm *really* good at this now. They don't have the new Datex-Ohmedas in the group of rooms I'm working now, so it's all gotta be done by hand.
8. Happy hour- probably the best skill I've picked up this year!
