Welcome to the Anesthesia Rotation for Pulmonary Critical Care Fellows
We are happy that you chose to join us for your elective. Though you are probably here to work on your airway managent skills, we hope you will take advantage of the intraoperative attending and other staff to learn more about how we manage patients during surgery.
Though we often associate airway management with tracheal intubation, you should strive to learn other techniques such as face mask ventilation (which many anesthesioligologists consider more difficult than intubation ) and use of a supraglottic airway. The latter are "rescue" techniques for sustaining a patient after failed attempts at tracheal intubation. Though an elusive an inexact art, airway evaluation for management is critical.
Initial contact
Please plan on contacting Dr. Rosenblatt a day or so before your first morning in the operating room, by txt at 203-494-1502 or at [email protected]. Dr. Rosenblatt will let you know what anesthesia attending(s) you should contact once you arrive in the OR on the first day of the rotation. Plan on being in touch with Dr. Rosenblatt (or his designee ) each evening before coming to the OR thereafter.
Teaching priorities
Please appreciate that there are several services that ask to rotate through the operating rooms. Apart from these requests the department of anesthesiology has a student and intern teaching mission. This includes medical and nurse anesthetist students, and anesthesia interns. There may be up to 16 "externs" in the YSC operating rooms on any particular day. There may be days when your attendance can not be accommodated, though this should be rare. Fridays in particular may have a low patient census.
Location
Though you may be assigned to any of the operating room suites, most pulmonary critical care fellows will be in the North Pavilion (Smilow) operating room, 3rd floor.
Scrubs
You will need to have YNHH-York Street Campus OR scrubs (see picture here for color). You can secure the scrubs at the South Pavilion Operating Room (ask at front desk). If you have trouble obtaining the correct color scrubs, consult Dr. Rosenblatt (it would be very helpful if you know your size (S M L XL)
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PPE
In general, airway procedures are considered aerosolizing. You are required to have an N95 or P100 mask and eye goggles or eye shield for for all airway procedures. An N95 can be obtained a the anesthesia office in the South Pavilion operating room. At all times a hair cover "bouffant" is required. At all times a surgical mask is required (when you are not wearing an N95 or P100)
Unsure where you're supposed to be?
To know what rooms you are supposed to be in, you can always check the EPIC status board (posted around the operating room). Look for the An Ext 9 staff - this is you.
Morning in the OR
Meet the attending(s) of your assigned room(s) in the North Pavilion PACU or in the OR to which you are assigned by 7am. Most cases will start either at 7:15 or 7:30. Start time is one hour later on Fridays for most of the operating room. You will often be given a cell number for your attending, but it also may involve "asking around"
Other staff
Your attending will be working with a resident or CRNA (occasionally they will not be with another staff). Please introduce yourself to this person.
Sign in (formally "time out")
During the mandatory "sign in", when all staff are present, but before the patient has been induced, all team members introduce themselves. This is typically done in a "round robin" fashion and you should just say your name and title (e.g. " Johnathan Siner, Pulmonary Critical Care Fellow")
After airway management
The attending will likely be covering 2 to 3 rooms and may "disappear" after after the initial airway managment. Dont feel obliged to stay in the operating room, but pay attention to the EPIC status board for your next airway management opportunity.
Don't expect to manage every airway
Obviously, the attending has the responsibility to provide care to the patient. Several considerations will inform the choice of how a patient will be managed and who will perform tracheal intubation and other procedures. These include the patient's airway evaluation, ASA physical status, physiologic status, NPO status, airway history, and the anesthesia attending's competing clinical and teaching responsibilities. There will be times when the attending has another clinician manage the airway.
Problems
Reach out to Dr. Rosenblatt (203-494-1502) or the charge attending with any complaints or problems. If Dr. Rosenblatt or his designee is not available, you can reach out to the South Pavilion charge attending (the "floor runner") at 688-8388.