Technical Skills

[hndrx1a]

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Hey folks...might be dumb question, but, going into your first yr Gas, are there certain procedures that you are expected to know how to do?

 

[Skrubz]

the feeling i've gotten on the interview trail is "no." i think most programs expect you to come knowing little to nothing about anesthesia, either intellectually or technically. at almost all of the programs i interviewed at, the first 1-2 months are spent in basically a crash course teaching you the basics of anesthesia with daily lectures and 1:1 or 2:1 resident:attending ratios in the OR.

of course, if you already know how to do some things, it's your chance to shine. but unless you finished your intern year rotating in anesthesia, you're likely to be a little rusty on intubating, starting lines, and all that.

 

[Tenesma]

the one thing you need to practice a lot is putting in IVs... peripheral IVs!!! you'd be surprised the difference that makes!

 

[NaeBlis]

Originally posted by Tenesma
the one thing you need to practice a lot is putting in IVs... peripheral IVs!!! you'd be surprised the difference that makes!

🙁 UhOH, I've done more intubations and central lines than peripheral iv's. 😛

 

[doc_strange2001]

How do you go about placing a peripheral IV on an obese person whose veins you cannot see?

 

[huktonfonix]

All kinds of tricks you can try. Pump the fist, use a heating pad over the site, tap the vein. There are often problems on chubby peds cases with not being able to see a vein. If not, take an educated guess, blind stick, and pray. The favorite sites I've seen are the saphenous in front of the med. malleolus, the lateral wrist near the radial styloid, and the ex. jug. If its a little more urgent a central or intraosseous even in adults is a better shot.

 

[UTSouthwestern]

The cephalic is a chip shot in the deltopectoral groove. Just don't do it on a vascular patient who may need that vein for a harvest.

 

[Tenesma]

ultrasound guidance is great for obese patients ...

there is a new device that uses infrared thermography that was initially designed for burn surgeons to find staples, but when they noticed that they could see all the veins/arteries under the skin as if they had x-ray vision (they wear glasses that show 3-d images) they told us about it... have tried it on peds burn cases, very cool, i don't know how long it will be before it hits the market (but it should be cheap since it uses infrared technology - kinda like your remote)

 

[huktonfonix]

thats pretty tight. I haven't even heard of that one. Can't wait to try it out.

 

[UTSouthwestern]

Tenesma, it's a $40-60 unit that's disposable only with a battery life of about 500 hours. I'm actually creating my own version that will NOT be disposable, would use OTC batteries, could have varied intensity (so that not only peds or adult hands could be examined) and cost only $10-20.

 

[Tenesma]

sweet - tell me where you get those disposable ones!!!

 

[Galaxian]

As a med student, I've put in more chest tubes than IV's...🙁

 

[doc_strange2001]

Lucky you..I havent put in one chest tube

 

[huktonfonix]

Hmm, congrats on the chest tubes Galaxian, but it is kind of suspicious that a few of those chest tubes came after your subclavian attempts.......j/k sort of......Mardi Gras tonight!

 

[Galaxian]

Shut up huktonfonix, I am a master of the seldinger technique! Those chest tubes were put in MICU gomers and psychotic stabbing victims, bilaterally! Gonna get me some beads and charge up my camcorder!

 

[huktonfonix]

Holy crap dude, you overtook my posts in the last month. I see your current rotation has been good to you.