Welcome to Anesthesia Bootcamp!

Basic Goals for Each Week of Bootcamp

Week 1

Overall goals-

• Pre-op your patient

• PMH, surg hx, anesthetic hx, soc hx, allergies, labs (should look up all of this the night prior), NPO status, labs/vitals, listen to heart and lungs

• Start attempting PIVs (and thinking about which side/size to place depending on surgery and if pt has any restrictions)

• Call senior the night before to discuss case (use Jaffe as resource for type of anesthetic/summary of surgery)

Room setup-

• MSMAIDS (should learn in boot camp lecture)

• When getting started, may need to get here around 6 but ultimate goal is to set up room in ~30min (then also need time to preop pt)

• Drawing meds, pushing meds, spiking IV bags, turning on gas, where things are in omnicell, drawing ABG/flushing line

• Familiarize yourself with where things are and anesthesia workroom

Week 2: ONLY ONE DAY IN OR

Overall goals-

• Case start

• Move pt OR table (untie gown, make sure IV doesn’t get ripped out, make sure nurse is on other side of table, etc)

• Correctly place monitors and ensure they are not in the surgical field

• Cycle BP cuff

• Participate in timeout and antibiotic/concern discussion

Skills to work on-

• Mask ventilate

• ETT/LMA

• IV

• technique aline placement

Week 3

• Continue to worse on case start as above in Week 2

• Contact attending the night before (ok to contact senior first to ensure plan is adequate and attending preference on form of contact)

Intra-op management (skill and read about)-

• Vent settings

• End tidal CO2 waveform

• Case specific items (neuromonitoring, laparoscopic insufflation, steep Trendelenburg, vagal responses, etc)

• Fluid management

• Opioid dosing and type/anti-emetics

• Temp management

Week 4

Intra-op-

• Establish differentials for each vital sign increasing and decreasing (i.e. hypertension, hypotension, hypercapnia, hypocapnia, hypoxia, etc)

Wakeup-

• Reversal drug, dosing, and when to give

• Weaning anesthetic/stages of anesthesia

• Extubation criteria

• Laryngospasm management

• Removing monitoring and getting to hospital bed without removing IV

PACU signout-

• PMH, surgery, intraop issues, fluids/EBL/urine, intubation, meds

• Post op vitals and treating if necessary

• PACU issues: PONV, post op pain, hyper/hypotension, etc

Week 5

Intra-op-

• How to treat/manage differentials made in week 4

• Smooth wake up

• How to hang blood (warmer, blood tubing, checking blood, spiking, etc)

• NG/OG placement and management

• Start giving your senior 15min breaks

Week 6

Intra-op-

• Improve! Start looking up and setting up for your next case, give your senior a lunch break, etc.

• OR crisis management: Bronchospasm, cannot ventilate, cannot intubate, anaphylaxis, PE, air embolism, MTP, etc

Week 7 & Week 8

• FLY SOLO!

• One attending, one senior (CA3 preferred for first bootcamp group) and two interns (one in each room)

• Some ideas for assessing readiness to frontline:

• Checklist (needed to be kept by intern but signed off by seniors) on knowledge/skills

• Final simlab session to assess case start to finish (maybe one intraop management of hypo/hypertension, brady/tachycardia, etc)

• Ensure mask, intubate, switch ventilator/settings, tie/tape/temp/ABx, antiemetic, reverse, untape eyes, extubation criteria, suction, etc (also can be part of checklist for seniors to signoff)