Starting my CV rotation in a week. Probably not interested in CV fellowship but would like to get as much out of the rotation as possible. What are some resources to look over? Common pimp topics? Tips/tricks you have developed or wish you knew about during residency.
Starting CV rotation
- Thread starter thetoddJR
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I’m not cardiac anesthesia, but I liked this book, especially as a first year anesthesia resident, there’s so much about the bypass machine, the surgeries, the potential complications, you need a quicker chapter to be able to read about all these things.
Amazon product ASIN 1496372662
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Bring your own lube
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Learn the setup, make sure your line placing skills are good and know the basics. Have all the emergency meds drawn up and ready. Have your lines all good to go. If you can't intubate or place a lines well they probably won't let you look at the tee or cvl.
www.uptodate.com
echo.anesthesia.med.utah.edu
UpToDate
www.uptodate.com
If You Don't Look, You Don't Know! - Echocardiography and Perioperative Ultrasound
Echocardiography and Perioperative Ultrasound
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deleted697127
Learn the setup, make sure your line placing skills are good and know the basics. Have all the emergency meds drawn up and ready. Have your lines all good to go. If you can't intubate or place a lines well they probably won't let you look at the tee or cvl.
UpToDate
If You Don't Look, You Don't Know! - Echocardiography and Perioperative Ultrasound
Echocardiography and Perioperative Ultrasound
Agree with the above. If you haven’t done a lot of lines before this rotation, especially if you’re a ca1 doing this in September, you will likely be overwhelmed just by making sure you have the room set up in addition to the large IV, arterial line, central line, and intubation.
Conceptually, the first things you need to know and that you are most likely to be pimped on are the basic steps of going on and coming off pump. What cannulas go where and why? You should know why and when you are giving each drug you are giving. IE TXA, small dose of heparin, full dose of heparin, midazolam, calcium, magnesium, protamine. Hint: what happens if you give protamine too early? Are there any side effects you should be concerned about? What are the most common causes of hypotension coming off pump or in the ICU post op? You should know these basics before expecting to move on to TEE. I doubt many residents get much out of TEE their first few cardiac cases.
If your attending leaves you alone, ask them “when would you like me to page you back.” This tactfully sets expectations and reminds the surgeon to give you a heads up if you’re a junior resident that probably doesn’t know exactly what’s going on. This can be particularly important if you’re a competent ca1 doing cardiac for the first time late in the year. Neither your attending nor the surgeon want you on your own coming off pump on your first day.
As far as TEE goes:
Print out the basic TEE views image from Google images and spend some time labeling it. Bring this to the OR. If your attending sees you put in some groundwork outside the OR, you are likely to have a better experience overall on the rotation.
The American Society of Echocardiography has excellent guidelines in easy to read PDFs. The PDFs are in the links. I feel like the guidelines were more organized a couple of years ago but here are a few that I found most relevant. If you need convincing, start with aortic stenosis and you’ll see how high yield and relevant these are.
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1. Follow a checklist for the room setup at your institution. No one has time to teach you anything advanced if you're perpetually missing basic equipment necessary to do the case.
2. Read about indications and contraindications for arterial, central lines, and pulmonary artery catheters. Watch some videos on proper technique. If you're at a swan heavy shop, learn some basic hemodynamics about MAP, CO, CI, SVR, SVO2, and the normal filling pressures for the right and left heart chambers.
4. Read the Morgan and Mikhail or baby Miller cardiac anesthesia chapters a couple times. Read the uptodate cardiac anesthesia articles. Know the basics of inotropes and vasopressors. Know the basics of how a bypass machine functions and the cannulae positions, including those for cardioplegia. Know the steps of an on and off pump CABG, common valve replacements, and ascending aortic surgery. Memorize one of the various mnemonics for things that must be assured before weaning from bypass.
4. Get to work earlier than you think you need to, especially if your techs are bad/ no techs.
5. If in doubt, ask, ask, ask. There are almost no stupid questions when you're a brand new resident on CV, and the best way to kill a patient there is acting hastily without calling your attending first.
2. Read about indications and contraindications for arterial, central lines, and pulmonary artery catheters. Watch some videos on proper technique. If you're at a swan heavy shop, learn some basic hemodynamics about MAP, CO, CI, SVR, SVO2, and the normal filling pressures for the right and left heart chambers.
4. Read the Morgan and Mikhail or baby Miller cardiac anesthesia chapters a couple times. Read the uptodate cardiac anesthesia articles. Know the basics of inotropes and vasopressors. Know the basics of how a bypass machine functions and the cannulae positions, including those for cardioplegia. Know the steps of an on and off pump CABG, common valve replacements, and ascending aortic surgery. Memorize one of the various mnemonics for things that must be assured before weaning from bypass.
4. Get to work earlier than you think you need to, especially if your techs are bad/ no techs.
5. If in doubt, ask, ask, ask. There are almost no stupid questions when you're a brand new resident on CV, and the best way to kill a patient there is acting hastily without calling your attending first.
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I also used this LV axis model. ‘The 20 Views’ Annual Comprehensive Review & Update of Perioperative Echo. - ppt video online download to prep for OSCE. If you have these down, you'll be fine for the pimping.
Know these basic view and of course the blood flow relation to regional wall motion.
Know these basic view and of course the blood flow relation to regional wall motion.
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We had a weird schedule my CA-1 year because of some senior residents on away rotations, pregnancies, etc…so in September me and another CA-1 were thrown into the heart and major vascular rooms for the month. Holy f*** was I lost.
I can’t expand on anything that was written above, because they nailed it. Be prepared, and be quietly confident in yourself.
However, there is a fine line in this world between confidence and arrogance. Arrogance in a new trainee can kill someone. Put the time in to be prepared for the basics, but always understand there is more to learn. When you know what you don’t know, but can admit it to yourself and aren’t *scared* of that fact, you will learn a great deal more. Healthy fear in CV anesthesia is a great thing ha.
I can’t expand on anything that was written above, because they nailed it. Be prepared, and be quietly confident in yourself.
However, there is a fine line in this world between confidence and arrogance. Arrogance in a new trainee can kill someone. Put the time in to be prepared for the basics, but always understand there is more to learn. When you know what you don’t know, but can admit it to yourself and aren’t *scared* of that fact, you will learn a great deal more. Healthy fear in CV anesthesia is a great thing ha.
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deleted875186
I will second everything above. I will put another plug in for Hensleys practical guide to cardiac anesthesia, it gives you a quick chapter in bullet point format about all the things you didn’t even think tk question …. Where do the cannulas go, which one goes first, where does cardioplegia go, steps for coming off pump, weird complications of bypass pump …. Etc
