Thursday, October 18, 2007

Skills Day

Last night and today were skills/lab classes. We were supposed to have an Anatomy and Physiology class in the cadaver lab this past Tuesday, but the person who was to teach the class is a third year medical student and he was doing a rotation some distance from Augusta. His motorcycle broke down, so he was stuck. As it turned out, we did the class last night instead.

Cadavers are not what I expected. First of all, they are dissected out where organs, muscle, nerves, and vessels are exposed. I was surprised at how "not gross" it was; I don't know what I was expecting, but not that. I guess the only problem I had was the smell of formalin, the preservative agent used to keep the bodies from breaking down. Dustin, the gentleman who taught the class, is quite expert with gross human anatomy. His knowledge base is extremely impressive, and from what I'm told he has more knowledge than some of the doctors that are his teachers. I think I got a lot out of it; certainly I have re-thought some of the ways that I do things with patients. It's actually been that way throughout most of the class.

During the day yesterday we had classes on pediatrics and pharmacology. The nurse who taught the classes was quite knowledgeable, but the classes themselves were "Power Point from hell", in terms of their length and content. By the time we were done all we were all fit to be tied. It was a long day.

Today we spent the day doing skills labs. I got to perform a surgical airway on a pig trachea, which was pretty cool. All we had were the trachea and lungs of a number of pigs, and we placed a surgical opening in the crico-thyroid membrane, then inserted an ET tube and ventilated the lungs. We did this with an without PEEP; it was a big lesson on the dis-service I'm doing any patient I have to ventilate. We should be using PEEP as often as possible as the lungs will have better inflation time and, with that, a better opportunity at giving the patient maximum oxygenation. At least that's what I took away from the lab exercise; I'm sure others would disagree with me, but they'd have to see for themselves how effective this is if they haven't done so already.

The other labs we did involved what are known as "sim-man" devices, which are manikins that have all kinds of technology built into them to simulate human body function. We had an adult and pediatric manikin there, and we did skill stations with them, including retrograde intubation and placement of chest tubes. I also learned something new with intubation that I had never seen before: we were shown how to take an ET tube with a stylette inserted and make it into the shape of the letter Z. From there, it is possible to intubate a patient without having to use a laryngoscope. Of course it is a last-ditch sort of technique, but it does work. And it is pretty impressive.

Tomorrow evening I am going to be working a shift in the adult ED. I expect that, all things being equal, it will be an interesting shift. After all, the weather forecast for the Augusta area and all of Richmond County is for rain and thunder showers tomorrow. Probably tonight as well, as it is rather cloudy here as I write this. It has been warm and humid; the current temperature is 87 degrees, and it is humid. It feels more like early July in New Hampshire instead of October. I do realize that it's cooler at home right now, but I have to equate it to something.

In the meantime, I will be continuing to study and work out. Right now, however, I'm taking a break. My brain is full and needs a rest.....

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