Ok sooooo I WAS supposed to be doing a sports medicine rotation this week, but the vet who runs the show there is out of town and wants me to come back a different week when he is there. Therefore, I am now actually on anesthesia rotation. So, I'm going to pretend that the sports medicine related events of yesterday and this morning never occurred and instead focus on the anesthesia related events of the rest of the day.
At first, I was helping transition patients from the prep room to the surgery suites and back with some supervision of anesthesia mixed in. The whole transition deal takes some getting used to. The first couple of times I "helped" with it, I was mildly overwhelmed by all of the shenanigans that were going on. Tubes and lines flying and being attached all over the place, fluid rates being set, limbs being taped down, surgery sites being scrubbed etc, etc. Now, I actually am one of those tube placers, line attachers, lead connectors, fluid rate setters, limb taper-downers and surgery site scrubbers. There are at least six different monitoring devices that we connect to every surgery patient (in no particular order): ECG leads, CO2 monitor, temperature probe in the esophagus, BP cuff, fluids/CRI and the pulse ox...there are potentially others, but these are pretty standard. When we transfer a patient from the prep room to surgery, we often completely disconnect them from the anesthetic gas if they have sufficient pre-medication and are at a desirable depth of anesthesia. Because of that, time is of the essence. We can't lollygag in the time between disconnecting from anesthesia and reconnecting because we may risk our patient waking up and causing them undue stress. We also can't waste time getting our monitoring equipment up and running in case the patient's condition begins to change. So the first priority once we are in the surgery suite is to get the patient hooked back up to anesthesia and then, quick like bunnies, get all the monitoring probes and lines and what nots hooked up.
The first surgery I monitored today was for the oncology kids. The dog had a large tumor on it's left lung that needed to be removed. As far as awesome factor goes, I think this surgery is in my top 3 of those that I've seen during internship. Various neurosurgeries occupy the other two spots. Ok so, the surgeon opened up the dog's chest to expose the lungs. The tumor on the left lung was so large and had overtaken the lung to the point that basically the entire left lung had to be removed. Meanwhile, from an anesthesia point of view, we had this dog on a ventilator due to obvious concerns with it's ability to self-ventilate. The ventilator was a touch on the finicky side so we were having issues with it delivering consistent breaths to the patient and exceeding the ideal pressure within the circuit (and what is our ideal pressure anesthesia students??? That's right! 15-20cm of H20 and what gauge do we read that pressure on??? The PRESSURE manometer!). Here's another question for you all: Why, when the ventilator caused our pressure manometer to go to 25-30 cm of H2O on our open-chested lung exposed patient, were we not overly concerned? Right again! The vet student is holding the right lung in her hand so it's not contained within the limited space of the thorax where it might burst in to a zillion pieces should the pressure get out of control. (yeah, I did say that the vet student was holding it in her hand...yeah, that is awesome...yeah, that is why this surgery ranks in my top 3 for awesomeness) Eventually, we got the ventilator to behave relatively well. We went from having two onco techs, two anesthesia techs and little old me in the room dealing with the anesthesia situation to just me all by lonesome. Things were peachy keen for a while, the ECG was gorgeous, ETCO2 was ideal, blood pressure had been low but the reading off of the arterial line had leveled out to acceptable levels and we were coasting along. The surgeon asks me how the patient is doing and I responded that she was looking good. I kid you not, less than 30 seconds after that response escapes my mouth, blood pressure PLUMMETS. We went from great numbers to low 40's for both systolic and mean super fast (systolic should be above 80 and mean above 60). Cue Mara freak out. So I hollered (that's one of the southern words I'm picking up down here) for one of the anesthesia techs to please come help me. In the meantime, I have a zillion thoughts going through my head. Why did the BP drop so quickly? Why is everything else still peachy? Should I be bolusing fluids right now? Will that really help at this point? Where the crikey is that anesthesia tech???? So my hand is 3/4 of the way to the fluid pump when the tech comes in and tells me to hold my horses. Tech: Ok let's look at this monitor. Do you see a waveform for our arterial line? Mara(silly pants): Um, crap. No.(waveform, duh, why didn't I think of that???) Tech: So that means that the arterial line isn't reading properly. Of course, of course that's what that means. I know this, I should have looked at that, I should have realized that because the BP went downhill so quickly and everything else was fine that there was a good chance the numbers weren't accurate. Buuuuuut, unfortunately that didn't happen. This is why we do internship and we build confidence through experience and we learn how to think rationally when things aren't perfect. So the tech kind of made fun of my mild freak out (it's not like I was yelling and running around like a crazy person...most of the freaking out was in my head which apparently was conveyed through "some tension" in my voice which was noted by the tech) as did I after the fact, but next time I will not freak out and that, my friends, is what's important.
The. End.
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