How to survive CA1?

[linkin06]

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hey all, i'm in my pgy1 year but do get a month of anesthesia elective. i just recently finished it, and man, i felt a lot more stressed out than the rotation as a med student. intubation skills did get better, but i never really did IVs as a med student, and they are hard. my big concern is perioperatively. i feel like i get some main ideas. if patient gets hypotensive, maybe gas is on too high, they're not getting stimulated. back it off, some phenyl or ephedrine. but i still feel nervous overall, and i had a patient suddenly brady down into the 40s for ? reason. i know to grab the glyco or ephedrine to boost them up, but it just seems like a lot of perioperatively i am treating a symptom, but i don't know a root cause. i started to read throughout the month, but it seems like most of the reading was very specific and academic -- would be helpful for pimping, but seems less practical. is there something i can read that has a more practical approach to say hypotension, hypertension, hypercarbia, hypoxia, etc perioperatively? through the month, i got a better understanding of reading jaffe before big cases to know what considerations to think about and present to the attending, but i feel very anxious atm about starting ca1 year and getting thrown into the OR where the attending disappears after intubation.

 

[Depakote]

Most places, there's a lot of hand-holding CA-1. You're going to have help available and you're not going to be left flying solo until you've got enough experience under your belt to keep the patient stable until you can get your attending in the room.

There are a lot of things you can read (baby miller, morgan and mikhail, etc), but I've found that prior to CA-1, you should be focusing on high yield sources and moving up to the more detailed sources as you go on.
Stanford has a good CA-1 tutorial available online: http://ether.stanford.edu/ca1_new/Stanford Anesthesia - CA1 Tutorial Book.pdf

Just remember, everyone starts out feeling pretty clueless. The system is designed to incrementally increase your responsibility until you're attending. They don't expect you to be there day 1.

 

[deleted171991]

Stanford has a good CA-1 tutorial available online: http://ether.stanford.edu/ca1_new/Stanford Anesthesia - CA1 Tutorial Book.pdf

Beautiful! I hope I won't have to read more questions about whether Stanford is a good place to train.

linkin06, you are already miles ahead your future classmates. Keep walking.

Start reading the last (5th) edition of Morgan and Mikhail's Clinical Anesthesiology. Skip the parts about the anesthesia machine, and technical stuff about monitors and procedures you have never seen (as in Chapters I and IV). Read what you can already understand.

 

[norwood]

Your attitude of wanting to read, learn as fast as you can, and take good care of your pts will be a real asset.

All CA1s start out bad at IVs, unless they had unusual background (ex-medic, attending overseas just doing US residency to get a license here, etc).

Keep reading. It's only the end of January, you could knock out Morgan and Mikhail before starting CA1 year.

 

[pgg]

is there something i can read that has a more practical approach to say hypotension, hypertension, hypercarbia, hypoxia, etc perioperatively?

5 or 6 years ago (I think), some Australians put together a set of free-to-download anesthesia "cockpit drills" that covered all those kind of events. Basically a set of cards / checklists starting with a symptom (e.g. high airway pressure) moving through an ordered differential, immediate things to check and do.

I think they eventually commercialized it and it became this: http://theacm.com.au/

I don't have this product so I can't comment on its current quality but I found the old free stuff to be useful when I was a resident.

 

[bashwell]

5 or 6 years ago (I think), some Australians put together a set of free-to-download anesthesia "cockpit drills" that covered all those kind of events. Basically a set of cards / checklists starting with a symptom (e.g. high airway pressure) moving through an ordered differential, immediate things to check and do.

I think they eventually commercialized it and it became this: http://theacm.com.au/

I don't have this product so I can't comment on its current quality but I found the old free stuff to be useful when I was a resident.

For what it's worth, here's is a book review:

http://lifeinthefastlane.com/anaesthetic-crisis-manual

 

[deleted171991]

Unfortunately they have been promising those smartphone apps forever and the ebook for North America is not in Kindle format.

 

[Gaseous Clay]

Most places, there's a lot of hand-holding CA-1. You're going to have help available and you're not going to be left flying solo until you've got enough experience under your belt to keep the patient stable until you can get your attending in the room.

There are a lot of things you can read (baby miller, morgan and mikhail, etc), but I've found that prior to CA-1, you should be focusing on high yield sources and moving up to the more detailed sources as you go on.
Stanford has a good CA-1 tutorial available online: http://ether.stanford.edu/ca1_new/Stanford Anesthesia - CA1 Tutorial Book.pdf

Just remember, everyone starts out feeling pretty clueless. The system is designed to incrementally increase your responsibility until you're attending. They don't expect you to be there day 1.

Thank you for posting the link! I am in private practice but we get medical students through a branch campus and I have been putting together a month long curriculum for the students. I've been looking for something concise, yet informative, and definitely doable. Still probably more than what a MS3/4 needs, but pretty darn good!