what's up everybody my name is max feinstein and i'm an anesthesia resident at the mount
sinai hospital in new york city. in this video i'm going to be giving advice for starting your
anesthesia residency. i've already made a video about starting your intern year so if you'd like
to check that out then click the link right here. if you find this video interesting or
helpful i'd really appreciate it if you liked it and subscribed to the channel. let's dive in
i'll start this video off by sharing the most important things that you can buy as a new
anesthesia resident and to kick it off that'll be a portable phone charger. in addition to
serving the obvious benefit of charging your own devices, it's a great way to make friends
with that attending who spends a lot of time in your OR but always happens to forget their phone
charger. next up is my strongest recommendation for a writing utensil that you can upgrade to.
in a video that i made about intern year, i was talking about buying a multi-colored pen
and how it's helpful for being an intern. you're way past this. let's talk about your next upgrade.
that should be a sharpie. that's right, not a pen, it's a sharpie. let me show you what can happen
if you walk into the operating room with a pen thinking that everything's going to go smoothly
so excited to start my first case as an anesthesia resident. just make sure
i have all my drugs in order here, got my propofol and my rocuronium,
and where's the label for it? i guess i can just use this blank label here and
just write in that this is rocuronium so i can go ahead and paralyze the patient just write it
in here-- r o c u r and you can kind of read it, that should be fine. yeah that's fine, alright.
all right kid you ready to do some anesthesia?
i'm ready!
okay i'm gonna go ahead and push that propofol
sir you ready to get off to sleep? all right we're giving you that medication,
you're gonna drift off in about 10 or 15 seconds
good, looks like patient's right off to sleep. let's go ahead and paralyze them.
i'll just give the, uh, what is this? i can't read this! i don't know what medication this is!
we can't paralyze the patient. case is canceled! everybody go home! it's done
and specifically i'd recommend buying a sharpie that has a retractable top,
that way during a long anastomosis when you're waiting on the surgeon
you can sit there and subtly click your pen. really push them along a little bit
since you've made it this far in your medical training you've of course taken
a lot of multiple choice tests, so i've got one multiple choice question for you.
which of the following four items is the most powerful and potentially dangerous
item that an anesthesiologist has in his or her possession? is it
a: succinhylcholine
b: rocuronium
c: vecuronium, or..
d: a portable bluetooth speaker
i'll let you think about that for a second.
did you guess it? that's right. turns out that the anesthesiologist's most
powerful tool, and also the most potentially dangerous tool,
is not a neuromuscular blocking drug. no. it's a bluetooth speaker because when you start playing
music in the operating room that the surgeon doesn't like, you're going to have a bad day.
but if you happen to turn into DJ Anesthesiologist in the operating room,
you're going to be requested by surgeons by the end of your CA-1 year.
there are attendings that aren't even requested by surgeons, so if you can
pull it off this is going to be your most powerful tool that you've got with you.
i've gone ahead and included some links in the description for this video where you can
find these products that i'm recommending. and i just want to be upfront and say that i do make a
couple cents worth of affiliate marketing revenue if you purchase anything through these links,
but let me use this opportunity to make a pledge, because every day there are CA-1s
who walk into operating rooms without a sharpie and they write illegible labels on their syringes
and risk having their cases cancelled. and so for that reason, any extra pennies that are
generated through this amazon affiliate marketing i won't spend on anything frivolous like adidas
ultraboosts as i am wont to spend my money on. no. i will contribute that money to buying sharpies
of the retractable kind for sharpie-less CA-1s who might otherwise have their cases canceled.
i'm just kidding, my locker is full of adidas
ultraboosts and i'm gonna just use any extra money i get to buy more.
next i'd like to share with you what i thought were the most important resources for my learning
throughout the first year of anesthesia residency. instead of just sitting here and listing them off,
i'm gonna do what i thought i would never in my life do. that's right, i'm gonna do one
of those pointing style videos that's very in vogue. right now let's see how that goes
uh well, so that was terrible and i'm never gonna do that again.
but my recommendations do stand so go ahead and check out those resources
and see if those are helpful for you during your first year of residency.
for the last part of this video i'd like to discuss what i think are the
most important recommendations for safely and effectively learning in the operating room,
and the first part of that is knowing how and when to call for help. in my hospital, calling
for help is very easy from the operating room- either i can pick up the phone or i can ask the
circulating nurse to pick up the phone and dial a five digit number and within 20 seconds i will
have a room full of attending anesthesiologists. i have only had to do this twice during my intern
year- once was when i was in an off-site rotation and the power went out on my monitor equipment,
which i actually made a video about and you can check out the link right here, and so i had to
call for help then. and there was another instance where a patient had a seizure on the operating
table and i wanted to get some assistance, so knowing how to get help is extremely important,
and i think particularly towards the beginning of your residency and anesthesia it's important
to have a low threshold for calling for help if you're in the operating room by yourself.
the other thing i'll point out about procedures is that they can be really streaky. so this
is something that i've noticed and some of my co-residents have noticed which is that
we might be able to go a month and get every single IV that we place and then we miss the next
five IVs so it seems like there are patterns that can go back and forth, and just keep that in mind
and don't get concerned if you're unable to get a procedure right for a certain period of time. the
last and probably most important thing that i can recommend about intraoperative learning is to take
what you want from each attending that you work with. one of the things that's very unique about
anesthesiology is that everybody really develops their own way of doing things and as a trainee
you're going to be with different attendings all the time who are probably going to be doing things
pretty differently from each other. so as you see attendings doing procedures or anesthetics
in certain ways, take what you like, understand their reasoning for doing it that way, and then
develop your own anesthesia practice based off of that. keep in mind however that it can be a little
bit frustrating when two attendings have polar opposite ideas about how something should be done.
so max i want to go ahead and just show you this really excellent tool that you
can use to monitor the depth of anesthesia in your patients.
it's called a BIS monitor and all you have to do is just apply it to their forehead and during
surgery you can see exactly how deep they are with anesthesia. i highly recommend that you use it.
oh nice, thanks Dr. Attending! i'll go ahead and use that for
all of my cases. i really appreciate the tip
okay, go ahead and put the BIS monitor on the patient's forehead just like i was taught.
okay, perfect, just like that
Hey Feinstein what are you doing over here? this this is useless! why are you putting
a random number generator on the patient's forehead? you might as well tape a piece of
trash to his forehead. take that off man, don't ever use that again, not not a single time.
well that wraps up this video. i hope you found it helpful, and i wish you lots of
luck as you start on your anesthesia residency. it's been a very fulfilling and rewarding year.
it's a lot of work, and especially the first couple months can be really tiring,
but you'll get a lot better as you go along and hopefully you'll enjoy it along the way.
thanks very much for watching and i'll see you next time