David Feinswog, MD
Clinical Anesthesia Year 1
Rhode Island Hospital/Brown University
David is finishing up his CA-1 year here at Rhode Island Hospital. In this post, he takes us through a day-in-the-life of one of our residents rotating at our community hospital, The Miriam Hospital. TMH is a Total Joint Center with over 15,000 total joint replacements in the past 10 years. It provides ample opportunity for our residents to practice regional blocks and neuraxial procedures. The repetition lays a solid foundation to build upon once our residents start getting into more complex cases.
Here is a day in the life of one of our more chill anesthesia days. Typical primary total joint day. We do a ton of these days as CA1s so we can hit out numbers for peripheral nerve blocks and neuraxial blocks early.
Our days get more stressful and less chill in rooms with more complicated patients and surgeries with large hemodynamic shifts (vascular, cardiac, thoracic, trauma), but at the end of the day its one patient at a time. I would rather actively manage one profoundly hemodynamically unstable patient than field pages from 50+ inpatients or juggle 2 sick patients and 15 non-acute patients.
0630-0700: Morning zoom lecture in the OR as I prep my room for the day
0700-0730: Pre-op spiel, put in the IV
0730: Check out the patient and premedicate (midazolam)
0730-0745: Check-in, mepivacaine spinal, position
0745-0900: Total joint checklist (Ancef/TXA/Decadron), Propofol infusion (gtt) to moderate-deep sedation, low dose phenylephrine gtt to maintain MAP 65 mmHg
0900-0915: Coffee break
0915-1015: Cruise through the rest of the case, set up for the next case, bring patient to PACU
1015-1030: Pre-op spiel, adductor canal block, wait for the go ahead to do the spinal in preop from the circulator
1030-1040: Check out patient from preop nurse, midazolam, spinal, room
1040-1200: Total joint checklist (Ancef/TXA/Decadron), prop gtt to moderate-deep sedation, low dose phenylephrine gtt to maintain MAP 65, prep for the next case, chart review my assignments for the next day
1200-1230: Lunch break
1230-1530: Repeat x 2, maybe do one as a general anesthetic secondary to contraindication to neuraxial anesthesia, patient refusal, or re-do operation w/ unknown total operative time
1530 - 1700: finish room, get relieved by late-call resident, lecture (1-2/week)
1700: Freedom
1900-1930: Discuss plans for the next day with the attending
