Thursday, January 26, 2012

CRNA week: Pauly said......

17 years ago, golly it seems like only yesterday, I took my youngest child, who was seventeen at the time, to work with me, in the operating room.  He had just recently graduated from high school and would be leaving in a few weeks to begin his college experience, and I wanted to give him a glimpse into the world of an anesthesia provider to add to his list of yet to be determined career choices.
At the end of the day, riding home with me, I asked him what he thought of anesthesia as a career choice.  His response after taking a few minutes to collect his thoughts: "No offense dad, but anesthesia is pretty boring.  I know, you have to know a lot to make sure it is boring but just the same....."

He was right on the money so-to-speak; one of the great satisfactions for an anesthesia provider is, in fact, to take a situation fraught with risk for catastrophe and make it safe and, yes, boring.
Yesterday, Paul and I split up the cases in the ortho room.  In the early afternoon while I was administering anesthesia to a patient undergoing an achilles tendon repair´╗┐, Paul came in to get set up for his to follow case; an arthroscopic shoulder surgery in the sitting position.  The airway management of these types of cases can vary from institution to institution and even from provider to provider, but in our setting oral endotracheal intubation (OET) is the standard.

He comes to the head of the table wheeling the Storz video larygngoscope.  This is a device used to facilitate placing an OET in a patient with a known or even supposed difficult airway. A difficult airway being one that is hard to visualize using a regular laryngoscope.  Next he prepares an endotracheal tube by inserting a malleable Teflon coated stylet.  I say to him tongue -in-cheek; "wow, you're going all out today.  Do you anticipate some difficulty."
Paul says the patient has a pumpkin shaped head, short bull neck, and small oral opening showing a Mallempati III.  He then off handedlysays:

"It's OK to say that you'll deal with that bridge when you get to it; but make sure you've have the toll money in your pocket."

 MSMAID is the toll money

Which makes dealing with a difficult airway look boring. 
Boring is the result of proper and complete preparation.

Caveat: My son's career choice: CPA.


Anonymous Anonymous said...

which he finds boring :)

9:51 AM  

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