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Helpful Tips for Your Anesthesia Rotation at Miami Childrens
From: Shawn T Kern, SRNA Class of 2005 I get there about 545am, most days you don’t know what room you are in, cases, or which anesthesiologist you are with til that day, it will be on the schedule board. You will clock in and out at volunteer office, they will show you the first day when you get your badge made, and hand in the orientation I already told you about. Go to website for Miami chlildren’s-www.mch.com, go to tab-for MCH employees, the tab-student orienatation, then do the student orientation, print it out when done so the first day make sure to have the printed out copy of orientation, ACLS, PALS, CPR, RN licenses to give to Grace in volunteer office. Maryann sends your licence etc. but take a copy just in case MCH has lost it. You will go down between cases during the first day. You will also get TB test and Chickenpox titer drawn that day. When you get your badge and stuff made, the volunteer office will send to the lab to get them drawn. Berta Armesto does the scheduling, you guys can make your schedule, there has to be three there everyday. So you can stager your days off depending on how many of you are there. Remember there must be three everyday there. You will have early, middle, and late days assigned, again you guys make the schedule, I can fax you a copy of how we did it. The schedule has gotten much lighter past couple of weeks with school back in, but if you are there you can be there anywhere from 3-900pm, typically we have gotten out by 800pm, that is the late person for that day. Numbers: OR 305-666-6511 ext 3420 anesthsia office is ext. 3415 Staff is great there. Anesthesiologists: Dr. Hui, Peggy and Dr. Hui, Debbie they are sisters.
Dr. Wang-he likes deep intubation and deep extubation
Dr. Gonzales, Dr. Munchi, Dr. Sadecki, Dr. Negrin
Just get to know them all, they all do things little different. Once they know you,
you can do anything you want if you have good reasoning, drips, tiva, opoids, etc. They are all very helpful and you learn many different ways to do things with the different attendings so you will build a good basis for your own practice. Routine: Set up all IV’s for the day for your cases, >1yr old LR with 10gtt tubing, extension tubing, and hep-lock, <1yr old D5LR with buretrol, extension tubing, hep lock. I also set up my tegaderm packet with two IV’s, one gauze, 2 alcohol pads stuffed in tegaderm packet. Most all have no IV’s unless they are inhouse patients, or generally older than 13yr old, but this is not always the case. Set up drugs, This is how I set my drugs up: *KNOW THE DOSAGES OF ALL YOUR DRUGS FOR PEDS THIS WILL HELP YOU OUT A LOT, LIKE ANTIBIOTICS, DECADRON, ZOFRAN, PARALYTICS, OPOIDS, ETC ETC WHICH YOU SHOULD ALREADY KNOW, IF NOT BRUSH UP, REMEMBER ALL WT. BASED* Gycopyrulate-TB syringe 1cc, .2mg-draw up at least 3, and add as you go during day Atropine_Tb syringe 1cc, .4mg, 1 syringe Sux-2 ½ cc in 3cc syringe, and 5cc in 5cc syringe with 22ga needle-emergency IM drug
Vecuronium-3cc syringes, with 2-3cc, depending on wts of the kids.
Neonates-TB syringe 1cc, again due to wt.
Decadron-TB syringe 1cc, 4mg only for tonsillectomies, no adenectomies. Lidocaine-3cc syringe, 2cc of 20%, in case of bronchospasms etc. Machine check, etc as well. At first you will stay in the room, change it over between cases. The anesthesiologist or RN for the room will bring in the patient, you move them over, call anesthesiologist in and then either mask induce, or IV induce depending. once past stage 2, they take over the masking and you go and start the IV, give the drugs, go back to head of bed and take over airway again. Once ready, Intubate, confirm, vent. Settings, etc. anesthesiologist leaves the room. Call them back when ready to extubate. While your running the case they are prepping the next case. Once you extubate, they will take the patient to the recovery room, you change over the room, and in comes the next. I still always go out and see, at least visually the patient, and know wt. and allergies. The anesthesiogist will give you a quick overview of the next pt so you can plan accordingly. Now, again once they know you, they will let you take them to recovery, then go back set up room, see next pt, and start all over again. But you don’t have to take them to recovery, they will do it every time, but I like to completely finish my cases, so I try to always take them to recovery. You will do a wide variety of cases, Crani’s, Backs, T$A’s, BMT’s, TEF, Pyloric stenosis, fractures, lap’s, hernias, circumcision, cysto, dentals, egd’s, etc etc.
• JUST REMEMBER THESE KIDS EAT UP THE DRUGS, YOU WILL NOTICE
THIS, SO KEEP CLOSE EYE ON PARALYTICS , JUST USE YOUR TWITCH MONITOR WISELY, REMEMBER LARGE VOL. DIST. ETC. AND ALL THOTHER PED. DIFFERENCES*
I have a copy of our last months schedule we made and handed in to Dr. Bauer, and Berta if you want to see how we did it, call me and I can fax it to you, I also have a quick cheat sheet for drug dosages, and made a bunch of other little charts on it if you want it, call and I can fax it too. But have the schedule made for the first day as well to hand to Dr. Bauer and Berta. One last thing, almost everyday except Thursdays typically there is a 30min. conference in the recovery room at 700am, so have your set up etc. done before this time and go to recovery for the conference, it is an educational review of different disease states, surgeries etc. There is a schedule on the message board upon entering the OR with the schedule of topics and who is presenting. Hope this helps shawntkern
TABELA DE ACTOS MÉDICOS E CO-PAGAMENTOS 2012 1- CONSULTA 10109 Consulta de Urgência(com exclusão de tratamentos) 10110 Exame clínico/consulta 10111 Exame prevenção oral em grávidas 10112 Exame prevenção oral na menopausa 2-ODONTOLOGIA PREVENTIVA 20630 Destartarização, polimento (Limpeza) 20610 Aplicação tópica de flúor 20620 Selante de fissura (por quadrante)
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