Clincal advise for the first month?

[ivypetals]

I am about to start clinicals. Was just wondering from some other students that are in clinicals if you could answer this question (in hopes that I wont look stupid on my first day).

What do you wish you would have known on your first day of clinicals?

Would appreciate the advise. Please dont think anything is too simple.

[mark2climb]

I'm about to finish my first month of clinicals. The answer to your question would depend a bit on your clinical site, your preceptor, and what your program expect from you.

In general, I'd encourage you to try and relax. That's not easy to do. I know because my body attempted to throw up any breakfast I was able to get down for the first three weeks. I've heard many stories of GI distress during clinicals.

If your preceptor and program have low expectations for the first month/rotation, take advantage of it and enjoy. It won't last long before the questions will come fast and furious and the expectations will rise. Some preceptors will want you to start taking over pt care the first day, so just go with the flow.

PM me if you have specific questions.

[FLAreN]

I would know the anesthesia machine basics and the flow of process...i.e. setup machine...see your patient (preop)...go back to check that you now have your setup tailored to your patient:

tube size?

meds?

better sniffing position?

know your doses!!! (patient weight / allergies? basics)

know somewhat about the pathophysiology of your patient diabetes? HTN?

Then the flow of it all once you patient is ready:

Wait in holding to take your patient back with CRNA (versed should have been given unless contraindicated)

Bring patient in room:

Transfer to bed (first, take IV bag and put on IV pole in the room before transfer - note which hand the IV is on so you can place it on the same side)

Transfer patient to bed once you have someone at patient feet and sides. They will wait for you to say it is OK to move.

Connect (in this order):

pulse ox

BP cuff then take a BP

then EKG leads

Turn on oxygen and place mask on patient (make sure you remember to tell patient what you are doing as they are still awake LOL)

Tell patient to take deep breaths

Then you are ready for the attending

Have drugs and intubating equipment ready

Induction:

More versed?

Fentanyl?

Lidocaine

Propofol? Etomidate? Whatever - check lid reflex...no reflex - tape eyes

Can you ventilate? Verbalize...if not, place in oral airway...can you ventilate? verbalize

Then paralytic is given...wait till it works, i.e. onset?

then OK to intubate

inflate cuff

check bilateral breath sounds

check for end tital co2

(Turn on gas, turn down o2 and add air : 1/1 or whatever)

secure tube

THIS is the basics...

I wish I would have been able to visualize this and do this first semester. You are so nervous that you just forget...in the meantime someone is asking you a dozen questions while another is telling you what to do and you have no time to hear your own thoughts...LOL

Thus, I would have just wanted to get the mechanics down so that I didnt need brain power for it cause I basically had none...LOL.

Good luck!!!!

[adamrj8282]

Wow Flaren, that seems like really helpful info. I can feel myself getting a bit tachycardic just thinking about it! I start in August so I guess I have some time to get acquainted with the flow of things.