OR clinical

[Epi-do]

So, I had my first OR clinical the other day at the local children's hospital. It has to be one of the best clinicals I have had to date. While I have gotten to do alot of skills on my other clinicals, this was the first one where I actually spent the entire day with just one doc. She did quiz me some about airway anatomy, as well as the various types of airway adjuncts that are available. We also discussed the different meds used in the OR for induction and maintenance of anesthesia. I learned so much, had a great time, and was able to get 6 tubes. Four of them were oral tubes, and two of them were visualized nasal tubes. I also placed a couple LMAs. The patients ranged in age from 20 months to 17 years, so it was a great opportunity to see all sorts of airways in different ages of peds patients.

Later in the week, I go to the adult OR. Hopefully the experience there is an equally good one.

 

[LucidResq]

A good clinical with a good preceptor is a great thing.

Are OR clinicals a common aspect of most paramedic courses? Did you stay through the whole surgery? Was your preceptor the anesthesiologist or someone else?

 

[Epi-do]

We had the option of staying to watch the surgeries if we wanted to, but the anesthesiologist I was with was super busy for the day, so I stuck with her instead. She was one of the attendings on duty, and had residents in two or three different ORs that she was responsible for. We would go into the rooms for induction, and then again when they would wake them up. We then would go to recovery and check on them as well.

I don't know how common OR clinicals are for paramedic classes in general, but I believe it is a pretty common thing around this area. We spend one OR clinical at the children's hospital, and then a total of 3 at the adult OR at one of the big hospitals in town.

At the children's hospital, we are assigned to a doc, but at the other hospital we are pretty much on our own. Once we are introduced to the docs it is up to us to develop a rapport with them and get the tubes. Since it is a teaching hospital though, they can be tough to come by if there are alot of other students floating around that day. We have to try and get into the room before the med student, respiratory students, etc.

We are only required to have a total of 10 intubations by the end of class, but I am hoping that with my next three OR clinicals I have the opportunity to get more than that. I know it isn't something we do in the field a whole lot, but the more practice I can get now on the "easy" ones, the more confidence I can build for when I have to do it on the 350 lb guy who just went unresponsive and is puking up his spaghetti dinner while stuck between the bed, a dresser, and the wall, KWIM?

 

[LucidResq]

Yeah I asked my teacher how hard it was to learn intubation, and she said "oh it's really easy to learn how to do it, it's just that so many pts have difficult airways."

It makes sense that they would have you tubing pts destined for surgery. More of a controlled, relaxed environment than the resus room I'm sure.

 

[MSDeltaFlt]

Yes, medic students go through OR for controlled live intubations under either an anesthesiologist or nurse anesthetist. They can teach you alot because they do it all the time. Simple things like your body position and center of gravity and the like.

Intubations are not unlike IV's. They are easy to learn, but hard to master. The knowing of when and when not to do something will be the toughest thing to learn; and you will learn it after you get your patch.

Good luck

 

[firecoins]

Love the OR rotations but no 1 doctor will do that. I free float through the OR finding surgeries that need intubations.