Monday, 4 June 2007


Today was a bit of a crazy day, and by the end of it I realised once more that I did not know a damned thing!

First off was a lecture about how to interpret and fix dodgy blood results (man I hate renal failure but I hate dodgy LFTs more and oh my word I'm on GI for some of my first block I am so screwed), then we had a lecture from two of the FY2s on what it's like starting work - one of them was a graduate of my uni, one was a graduate of the place where I'm going to work. The former was fairly positive and talked a lot about careers and stuff, the latter was less positive and said when she started work she had shadowed for 5 DAYS (compared with our 2 months) and so wasn't very organised for the first few weeks (oh hell, am I going to be expected to be really organised?!), and she basically scared the crap out of us - she apparently stayed till 10pm on every shift for a month and didn't know how to do anything. Ooooooooh goody now I can't wait to start!

Then came a lecture on perioperative management, which wasn't that bad actually, but it was in the afternoon that it all got hairy!

We had a scenario exercise where we rotated round 3 stations in groups and were taught on various aspects of acute management by some anaesthetists. The first room was fine, nothing we couldn't handle, just use of GCS and things.

The second station was to do with management of respiratory problems - basically A and B of the ABC thing. Stupidly, I volunteered for the first scenario, and MAN WAS I CRAP. I managed to get an airway and find a suitable sized Guedel, but couldn't explain how I sized it (knew it was something to do with the jaw and the chin/teeth but couldn't explain exactly, oh dear) and then put the patient on 100% non-rebreather (yes, he was breathing, I'm not a total dope) despite the fact that he had a past history of COPD (yes, that was correct too) but then when I auscultated I was told the patient had really crap air entry. By this time I was starting to freak a bit under the scrutiny of this here anaesthetist, and apparently my Reg was still 5 minutes away and my patient was going down the tubes, and the crash team anaesthetist was also 5 mins away so it was still down to me. I was faffing about trying to think of what to do while burbling something about getting lines in, and she was going, 'are you happy with breathing?' and I (having not seen the bag and mask lying on the side) was thinking, oh hell, what can I do now other than intubate which wouldn't help because the problem wasn't with the airway but with the lungs, but eventually found the bag and had my 'nurse' bag the patient. This helped a bit and got a nod from the anaesthetist so I could move onto circulation - oh dear, shocked patient, shut down, 2 large bore venflons, bloods off for FBC U&E clotting cultures and various other things, then fluids ('what?' - 0.9% saline, 'how much?' - 1 litre) then oh thank goodness my Reg arrived and I was saved and could take my seat again in shame for my poor performance!

The next station was even worse - in fairness to us, it's really hard to run a peri-arrest with a dummy because they don't do anything and we never know whether we are supposed to just get on and do stuff or wait for the supervisor to tell us the clinical situation. Anyhoo, we started off and I have to say we were a bit crap! Because we haven't had any CPR training since the new guidelines came in, we are still a bit rubbish at them, so we were a bit unsure and a bit slow, and basically pretty scared!

Question time saw one of my stupidest questions to date: 'if you charge the paddles to 360 and you don't need the shock after all how do you get rid of the charge?' - it turns out that you can just turn it down, but to do that you need several hands, and so I dug myself further into the hole and said, 'can you not just discharge them?' - OH WHAT A DUNCE apparently this is a sure-fire way to kill random people in the room! In my defence I had remembered that you could discharge the paddles at some point but couldn't remember if it was a good thing or a bad thing to put the paddles back on the machine beforehand (good!), and although it was a stupid question we were all thinking it and it was just me (as ever) who voiced it!

Anyway the anaesthetist was really nice about it and said it was fine to ask dumb questions because when else could we ask, but I still felt like a pillock.

RIGHT I'm not even going to read this post because I have just proverbially spewed it out in a big panic, so I will just post it and stuff the poor grammar and layout!

The main message is, I am terrified again, I don't know anything and I am going to SUCK. But I will try soooooooo hard and dammit I will get there in the end.

Repeat ad nauseum until you believe it!!


Xavier Emmanuelle said...

Oh my goodness! I hope it gets better! Love your blog btw.

Cal said...

Hahahhaa!! That made a hilarious read, though it probably wasn't intended as one! (Sorry...!)

Re the Guedel - you measure from either the corner of their mouth to the tragus, OR from the central incisor to the angle of the jaw, put in the Guedel upside down and then turn it around.

Sorry, I'm a bit of a trauma buff...

Oh, and in response to your question at my blog - yes, I did disable the comments from some of my entries.