What a great break for me – I get to go to the LAC-USC hospital for a day in the OR. After calling and getting the assignment this afternoon I called my great friend Charlotte Garcia who I will be training with at Women’s and Children’s tomorrow. I will be doing GYN at the County in the morning and will first attend the weekly conference which I have missed for the past month and one half.

I am so excited to be able to go and see my friends and practice some great anesthesia. Charlotte is really “the Bomb” when it comes to providing sound safe anesthetic for her patients. It is always a great treat to work with her and learn a few of her tricks. She text messaged me the other day “pimping” me about the relative histamine release between morphine and meperidine. It took me several hours and a lot of searching before I think I found the right answer. Both of these medications are histamine releasers but I believe morphine is more. So what did I do, I fired back a question to her about meperidine. We just had the pain lecture with Dr. Berger and he showed us diagrams of all of the receptors that are involved in nociception. One of the receptors that meperidine works at is the NMDA receptor which is one of the modulators of pain in the periphery.

In the morning I am taking my camera so that I can post some pictures of my day at Women’s and Children’s hospital. It has been a while since I have done anything with the camera and I am looking forward to doing this very much.

This past Friday and Saturday morning I have spent in the County Hospital operating room providing anesthesia to the never ending trauma cases that come in over a weekend. Maybe it’s just me but the natives are too restless it seems especially when you combine alcohol and illicit drugs to the mix.

The last two cases were really special. One a stab wound to the face and the second a gun shot wound to a very drunk mans leg. The stab wound case was technically difficult to secure the women’s airway due to so much bleeding from her cheek and tongue laceration. Really it was more of a HUGE laceration. Her domestic partner, I believe, thought that she was stealing all of his cocaine or crystal meth or what ever and thought to teach her a little lesson. The stab wound went through her cheek and tongue to the other side of the face. You can imagine that there was a lot of blood in her airway. The lady was pretty hysterical and we just induced her (put her to sleep) quickly while she was sitting up on the gurney. After unconsciousness the attending anesthesiologist and I laid her down quickly while the surgeon held some pressure to her cheek. Two suction catheters going and ten seconds later she was intubated and her airway was secure. After that it was simple. I am really glad that the Attending was there to help out. Now that is not something you see everyday. The surgery was fairly straight forward and we left her intubated overnight to make sure the bleeding was under control and her airway was secure.

The next guy had the rudeness to try for another six pack at closing time at the local drive through liquor store at 01:50 in the morning. Evidently there was an altercation of some sort, who knows what really happened here because the guy was so drunk and combative. He can to us in the OR at about 3:30 in the morning just after we had finished up with the younger lady and the stab wound to the face. I could not even close my eyes for a couple of minutes. This guy was really out there jumping all over the place. We could hardly keep him on the gurney let alone transfer him to the OR table. After 10 milligrams of midazolam he saw it our way and we were able to get him to the operating room table and start the case. He ended up with facsiotomies of his calves and some vascular reconstruction. All this for another beer. Seems like to me he had had enough but who would have thunk it.

All in all doing a clinical rotation in a large county hospital and being able to take weekend call time shifts is a great clinical experience. There are things here that you see and do that are not available at other times. The lack of sleep is not something that I cherish but I would not trade the chance to do this rotation. I will be at this facility for another three months and will be taking overnight call once a week in addition to the regular days during the week that I am there.

The routine week day cases are fairly standard type cases. The obstetric floor is covered by the student nurse anesthetists as well and we see a fairly large population of caesarean sections, tubal ligations, and labor epidural placement management type things. So the mix of cases here is really nice. Right now I will catch up on some sleep and then hit the books for an exam that is coming this Monday.

Yesterday was my first 24 hour operating room call. I have had to do other overnight OR scheduled time before but this was the first time I was scheduled for an entire day. Being a Saturday night and a holiday weekend made for several interesting cases.

During the day on Saturday we were busy with pick up ortho cases that were left over from the weeks work. Nothing to big just a couple of ankle fracture repairs, an elbow and an incision and drainage of a big old abscess. Nothing like the night to come.

I thought that the Los Angeles County hospital had all of the action but I was mistaken. It seems there were a few parties that got out-of-hand and friends started shooting friends, brothers started stabbing brothers and what not. We had two ORs going until the very early morning. At 03:45 we broke the two ORs for 15 minutes and then the final gun shot wound came up. It seems this guy was shot through and through across his hips taking out some of his bowel – he had blood in his stool. This case ended up pretty messy and did not finish until 6:45 just 15 minutes before I was scheduled to leave. Oh joy I can go home now.

All in all for the 24 hour schedule I did 6 cases, a couple of them fairly long. I did get an hour nap Saturday afternoon around 4 O’clock so it was not too bad. Looking at the coming schedule I will be doing another overnighter next week and the following week another 24 hour shift on the weekend. Gladly it is not a holiday weekend and maybe the natives will not be too restless.

Generators are a good thing especially in hospitals. This last week the eastern edge of Los Angeles experienced a power outage that lasted for a couple of hours and shut down the operating rooms at LAC-USC hospital. Well, shut down is not the exact word for it really; we were interrupted by the power outage.

It was a beautiful sunny morning in Los Angeles; the birds were singing and the hillsides never greener after all of the rain that we have received in the past several months. Surgery had been planned this morning for a young girl with a pelvic fracture that occurred during a motor vehicle accident a week ago. I had just induced general anesthesia and intubated this 17 year old girl when the lights in the operating room went out. She had been sitting in the back seat of a parked car several days before when a bus slammed into the side of the sitting car injuring all of the passengers. This sweet high school student and her family had been waiting for her pelvic fracture surgery for a couple of days now. She had an unstable pelvis and today the orthopedic surgical team was planning to stabilize her SI joint (sacroiliac) with pins. We were just about to turn her to the prone position when the lights went out. Read More→

School at USC is never boring. This week we are scheduled for our group Clinical Pharmacology Group Seminar presentations. The fearsome Sixsome is presenting first. The group includes Anya, Christy, Amy, Todd, myself and Amanda. Our Case Study involves a woman that has a few problems, well here it is:

A 45 year old woman had a known history of diabetes for 30 years. She is scheduled for emergency surgery for tuboobarian abscess. She is a current smoker with a 25 pack year history, is overweight (5’2″, 90 kg), hypertension and a history of irritable airway disease. Her current medications include Regular crystalline insulin at 35 Units/day SQ; Amlodipine and Albuterol inhaler as needed.

So what do we do with this woman? The main issues need to be addressed in our anesthetic work up and include: Read More→