Stories from the OR: Ex lap
So a couple weeks ago, I was doing an emergency exploratory laparotomy for a perforated bowel with a resident.
The patient was actually not that sick, but this type of case is usually a bigger case. We prepared the following: awake arterial line, videoscope, hot line, central line, and began transfusing blood, etc.
As we were getting the room ready, I began my little routine. Every anesthesia provider has a routine, their own system to help reduce mistakes and increase safety. Part of my system is to have a little emesis basin with emergency drugs that I always keep ready, on the side. This is because as an SRNA, I rotate through different hospitals every month — and each hospital has different equipment, Pyxises, log-ins, medication concentrations, etc. So it's just quicker and safer for me to always have emergency drugs readily available, rather than scrambling and pulling out every drawer in the Pyxis trying to find atropine. Also, if there was ever a situation where I needed to direct someone to get the medication for me, it'd be easy to say "I need drug ABC, it's in the emesis basin."
In this basin, I always keep: succinylcholine, esmolol, phenylephrine, ephedrine, atropine, glycopyrrolate.
As I was making this basin, the resident took the esmolol out of my hand and said "you don't need this for this case."
Quinn: Oh, I just like to have my emergency meds out ready in a little kit like this
Resident: *continues to put the esmolol away* Trust me, you're not going to use esmolol.
Quinn: *Says nothing because she's too tired to fight for what she believes in*
Just in that little vignette, multiple themes from SRNA life are are illustrated:
Resident vs. SRNA
Readiness vs. waste in the OR
When other people want you to use their system/routine, instead of yours
Being too tired from working with new people/hospital systems every day to explain myself or assert my opinion #introvert #tootiredtotalk
Multiple anesthesia providers in one case can result in chaotic, spastic care
Anyway. We can touch on all those topics later. And no hate to residents, I've worked with some really great ones. I just wanted to share an anesthesia tidbit that I've been thinking about.