The pre-TCV week

The pre-TCV week is designed to introduce us to the important concepts related to thoracic, cardiac, and vascular (TCV) surgery.  The week consists of helping the TCV residents in the OR with lining up patients, getting them to the OR and to the ICU after surgery, and with various tasks during the case.  We also have multiple sessions in the Medical Simulation Center and several lectures throughout the week to complement the teaching we receive in the OR.  Below is a brief description of one day during that week.

A day of pre-TCV

6:30  We show up to meet the patients and primary anesthesia resident in the PACU, introduce ourselves, and assist with line placement.  While putting in the arterial line, I realize that when I start hearts in 2 weeks, I’ll have to show up at 5:45 every day to set up my room.  7:20  We’re rolling back to the OR after I placed a beautiful a-line on the first try and Diana Lobo placed a MAC line in the right internal jugular vein.   We get the patient over to the operating table and manage to not tangle all of our monitor wires and lines in the process.  After a smooth induction, the patient is asleep and the surgeons are starting to prep.  We verify that our shock pads are capturing and I focus on the flow and pace of the case.  There is a lot more to do and think about with these cases and patients, and it makes me thankful that I had coffee this morning.

Will Cox, CA1

9:30  We go on bypass, hang epinephrine and propofol for when we come off bypass, and wait.

10:30  Coming off bypass, this is no joke.  Our patient ends up getting defibrillated multiple times and requires several pressors.  We use the PA catheter to calculate cardiac output and guide our decisions regarding which medications to hang.

11:45  The case comes to an end, we get the patient up to the ICU, and then we grab some lunch.

13:00  Alli (the other resident on pre-TCV) and I walk over to the Medical Simulation Center for our session with Dr. Littlewood.  Once there, we’re split up and run little scenarios in an oral board like manner; this is where I think of how glad I am I read DiNardo.  Next, Dr. Littlewood gathers us and takes into an OR simulation room.  We take turns running an anesthetic induction for a sick cardiac patient and various things go wrong in each case that we are forced to think about and make quick clinical decisions about.  This is great practice for the “real deal” so to speak and having a state-of-the-art simulation center is a big plus.

15:00  Back to the ORs to help with pre-ops and then home to read.  It is funny how tired you get after these cases.