I completed my first clinical rotation and I can say it was amazing! Prior to starting clinical I was having doubts about whether I made the right decision to start CRNA school, but once I was hands-on, actually intubating patients back-to-back, titrating anesthetic gasses, adjusting ventilator settings and extubating, realized how much I truly enjoy it!
It reminded me a lot of my CVICU days, adjusting my medications based on what I need to do for the patient...you're constantly thinking, planning, and just enjoying the ride.
I had a pretty successful rotation, I missed about 8 intubations, with two esophageal intubations. I'm still getting used to the "lift" of the mac blade. No broken teeth yet (thank the Lordt!) but I'm struggling to pull correctly to lift the epiglottis to see the vocal cords. Learning my airway skills was the fundamental part of this rotation. Some of the older CRNAs told me how when they first started out they would literally just do mask cases and go around intubating (I wish we did that!).
I've been a mac blade girl from the beginning and that's all I've used for most of my rotation. I used the miller once, on a whim per my preceptor recommendation, but the blade wasn't long enough to lift up his epiglottis....(fail.) Other than that, I've used the glidescope and did about 4 blind light wand intubations which are pretty cool. You basically use a lighted stylet and lift the patient's jaw. After you've inserted the tube into the throat, you look over at the patient's neck and wiggle the light wand until you see the light directly midline, you advance through the cords making sure the light diffusion doesn't change. It's pretty neat, but also kind of tough.
This clinical site mainly does routine and elective surgeries, so I haven't dealt with many complicated cases yet. I did a lot of hysterscopies, ortho, laparoscopic cholecystectomies, and robotic hysterectomies. I was also able to do about 8 spinals for c-sections (which were awesome), and I placed an arterial line!
The best thing I've learned during this month is to just be humble but confident in your abilities. Some of the providers can be uptight, especially if you show that you're a first year. I hate to say, fake it till you make it, but just showing an ounce of confidence and a willingness to learn will make your experience much better.
Also, never ever argue! At times you're going to get conflicting information from what you read vs. what is actually done in practice. As long as you're not harming the patient, it's ok to nod and say ok if your preceptor is not open to new studies or information that you may provide. My favorite saying is, "Oh, I had no idea it could be done that way, thank you for that advice," or if I know my preceptor is ok with new information, I generally ask, "Have you heard about this study, or what Miller says about the certain topic?" It definitely helps open up the conversation in an nonthreatening way.
I hope to better my DL (direct laryngoscopy) skills as the months go on and continue to try and study daily. I've been slacking a bit, and while this clinical site didn't do much "pimpin'", I know I'll need to be more prepared as I advance. I recently purchased APEX ANESTHESIA which I will be using in conjunction with the Valley book and Prodigy to do a continuous review.
Next semester starts next week. Our school gave us about a week off (not including weekends) in-between semesters. I took that opportunity to go to Miami and relax on the beach!
Next semester I will be at a clinical site 2 hours away from home =( That means class in one city on Mondays, then I have to travel out to another city for 3-4 days of clinical. I'll keep you guys updated on how that goes!
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How did your first clinical rotation go? I'd love to hear your experience!