Friday was my last day of orientation. It was a whirlwind ending: my preceptor made herself available, but explained she had a project she needed to complete if I could work on my own. I had been doing the Litho room since the previous Friday and felt comfortable, so I said she was fine working on her project.
The first case went well, had to scramble to finish my charting before the case ended, but otherwise I felt really good about the flow of the case.
Then the patient went into laryngospasm after extubation. I knew it, I knew that wheezy sound. My scrub, who is really good at her job, jumps in to help the anesthesiologist, but doesn't know the drugs that are being asked for. I try to get in at the head of the table to help, but the scrub won't relinquish her spot. I also start calling in help: the anesthesia tech, and my preceptor. I pushed propofol in then I grab the succinycholine for the anesthesiologist, she asks me to push that in as well. She gets an LMA in, then tries to get an endotracheal tube in. The anesthesia tech is in the room and is helping as well now. No fogging on the ET tube, put the LMA back in. The oxygen saturations are coming back up and we are getting air movement into the lungs. Now I am asked to push some fentanyl. At this point my preceptor is back in the room and we are all just standing and breathing while the patient is breathing too. She looks at me and I explain the situation. She had been finishing her break, just about ready to come give me mine when I called. We watch to make sure the patient is stable for a few minutes, then she says she is going to go put her stuff away and come back to give me a break. Our patient is going to be intubated for at least another 15 minutes since the succinylcholine is a paralytic and needs to wear off before extubation. When I get back from my break the patient is still intubated, we are all just waiting. The anesthesiologist is being cautious now and waits until the patient is almost fully awake before she removes the tube. We get the patient to recovery just fine, the patient has a bit of a sore throat and admits now that he has been coughing a bit lately. The anesthesiologist is cautious for the rest of the day. She does acknowledge that I showed my experience in the situation - I knew the medications she wanted, knew she needed help and stayed calm.
Next time I may assert myself and ask the scrub to step away so I can handle the drugs. But really, the only thing I think I could've done better is to call for the anesthesia tech as soon as I heard the wheezing and knew we were going to have to re-intubate. As it was, the patient outcome was excellent and the entire team had a reminder of how important it is to work as a team.
Luckily the rest of the day went a little smoother than this. We had no more airway issues. On the last case we did have equipment and supply issues, which required me to call my preceptor back in to help. Overall, though, as my scrub left for the day, she said I had done a good job.
I had the pleasure of talking to one of the CRNAs as we finished up the last case. She asked me if I knew the criteria for extubation and then educated me. What a pleasure! She thinks I should think about CRNA school. I have, but I also have thought about the time: I have to work 2 years where I am now, then to get into CRNA school I have to have at least 1 year in ICU, CRNA school is 3 years, then I would have probably a year of residency - 7 years more of education and training. I am not that young! I do still consider this as a potential option, though. We'll see. Going to get the MN first.
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