Anaesthetics: Phase 3b and SSC Acute and Critical Care
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Module leads:
Dr George Thomas-Kattappurathu
Phase 3b Lead Anaesthetics Tel: ext 8332 Email: [email protected] Dr Mark Smith
Tel: ext 8335 Email: [email protected] |
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Anaesthetists:
Offices and seminar room A3/A4 Corridor, first door on the right. Can also be accessed from the other side through phlebotomy suite.
Helen Turner (Dept. Organiser) ext 4550.
Offices and seminar room A3/A4 Corridor, first door on the right. Can also be accessed from the other side through phlebotomy suite.
Helen Turner (Dept. Organiser) ext 4550.
Contacts
To call an extension beginning with 4 or 7 from outside the hospital: 01709 30****.
Bleeps:
Dial 7411, when prompted, dial the 3-digit bleep number you require, then your 4-digit extension number. Replace the handset when prompted and wait for reply.
Theatre Fobs:
For a £10 deposit, you will receive a fob giving you access to the changing room and theatres. At the end of placement, please return this fob and collect your deposit.
Location
The Anaesthetic Department and seminar room is located on Level A, Junction 1 off the A3/4 corridor. You can also gain access to the department via the phlebotomy department during normal working hours. Theatres are located on B floor.
Theatre list sessions
Morning lists: 08.30 – 12.30
Afternoon lists: 13.45 – 17.45
Theatre lists are usually available from theatre reception in the afternoon the day before.
To call an extension beginning with 4 or 7 from outside the hospital: 01709 30****.
- U/G Office: Kay Jaques 4122: contact the Undergraduate Office
- HDU: ext 7883
- ITU: ext 4227
- Acute Pain: Sr Ruth Roddison / Suzanne ext 7246, Office on A5/A6 Corridor
- Outreach: Sr Dawn Adsetts ext 7157
- Pre-Assessment: Sr Jenny Lynock ext 4584, C-floor to the left in outpatients or up the red steps outside ‘Education’
- Hospital Number/switchboard: 01709 820000
Bleeps:
Dial 7411, when prompted, dial the 3-digit bleep number you require, then your 4-digit extension number. Replace the handset when prompted and wait for reply.
Theatre Fobs:
For a £10 deposit, you will receive a fob giving you access to the changing room and theatres. At the end of placement, please return this fob and collect your deposit.
Location
The Anaesthetic Department and seminar room is located on Level A, Junction 1 off the A3/4 corridor. You can also gain access to the department via the phlebotomy department during normal working hours. Theatres are located on B floor.
Theatre list sessions
Morning lists: 08.30 – 12.30
Afternoon lists: 13.45 – 17.45
Theatre lists are usually available from theatre reception in the afternoon the day before.
Areas of Responsibility and Clinical Interest
Associate Specialists:
Dr. S. Thambirajah
Dr. S. Maz
Dr. B. Nanayakkara
Staff Grades:
Dr. J. Wildish
Dr S Sambamurthy
Dr. D. Jones
Dr. M Singatullin
Dr Prasan
Dr I MacInnes
Dr. S. Thambirajah
Dr. S. Maz
Dr. B. Nanayakkara
Staff Grades:
Dr. J. Wildish
Dr S Sambamurthy
Dr. D. Jones
Dr. M Singatullin
Dr Prasan
Dr I MacInnes
Aims
This attachment will introduce you to the clinical assessment and management of critically ill and peri-operative patients relevant to your F1 post. Your learning should be based on the appropriate core clinical problems as well as other learning opportunities arising depending on case mix.
The appropriate core clinical problems are:
The appropriate core clinical problems are:
- 2 bleeding
- 9 pain
- 12 lacerations
- 13 trauma / injury
- 16 loss of consciousness
- 45 cardiac arrest / sudden death
- 46 chest pain
- 49 cyanosis
- 50 low blood pressure
- 56 shortness of breath
- 61 acute abdominal pain
- 90 abnormal blood sugar
- 91,92 abnormal electrolytes.
Knowledge
Learning opportunities will improve your knowledge of medical science in the following areas:
- Pathophysiology of respiratory and cardiac failure
- Role of HDU, ICU and outreach
- Role of invasive monitoring
- Oxygen therapy
- Fluid resuscitation
- Electrolyte imbalance
- Renal pathophysiology
- Pre-operative assessment
- Pharmacology of local anaesthetics, sedatives and general anaesthetics
- Pain management and the pharmacology of analgesics.
Skills
You will be presented with learning opportunities to improve your clinical / practical skills, depending on case mix, such as:
- Manage a compromised airway
- Assess pain and sedation scores
- Construct a pain management plan
- Plan and administer fluid resuscitation
- Manage nausea and vomiting
- Interpret blood gases
- Assess sick patients
- Prepare drugs for administration
- Prepare iv infusions
- Use invasive and non-invasive monitoring
- Administer O2 Therapy
- Insert iv lines and take arterial and venous blood
- Assess conscious level
- Work as part of a team.
Rota
Dr Thomas-Kattappurathu will e-mail your rotas, usually on Wednesday for the following week. Please e-mail [email protected] before Tuesday any requests for the following week’s timetable.
SSC
Most afternoons and some full days, you will be rostered for SSC. This is for self-directed learning, eg follow up a patient from ITU / theatre / A+E, attend a list with practical procedures (intubation / local anaesthesia / lines), attach yourself to a clinician who you have had good teaching from etc.
Learning Opportunities
Your learning will take place in a combination of the following settings:
- Operating theatre
- Day Surgery Centre
- HDU and ITU
- Critical Care Outreach
- A+E Resuss
- Acute Pain Team
- Pre-Assessment Clinic
- Teaching Sessions: Dr Blackburn / Sr Roddison: Acute Pain; Dr Harling: ITU; Dr Joshi: Blood Loss and Replacement; Dr Lee: Paediatric Emergencies; Dr Thomas-Kattappurathu: Anaesthesia in a nutshell; Dr Lynch: IV Fluids
- 4 ILAs from Minerva.
Critical Reading
Remember that our aim is to nurture self-motivated practitioners who will continually learn throughout their career. We will facilitate your learning but you should make efforts to gain from learning opportunities as they arise. 'Oxford Handbook of Anaesthesia’ is a good resource for many peri-anaesthesia topics (available from the Library & Knowledge Service).
Advanced learning opportunities
Laparoscopic procedures in general surgery
During attachments to general surgical lists where Laparoscopic procedures are to be carried out, trainees should gain some appreciation of the following:
Oral and Maxillofacial surgery
OMFS surgery in Rotherham encompasses a wide range of procedures including surgical extractions, osteotomies, diagnostic biopsies and a significant amount of emergency work including trauma and dental abscess drainage. Patients range from fit children through to older patients with significant co-morbidities due to tobacco and alcohol usage.
You will gain an appreciation of some of the following:
Dental Outpatients – GA lists
There is an excellent opportunity, whilst in Rotherham, to become familiar with ‘outpatient general anaesthesia for dentistry’ anaesthesia. This is a field that has recently come in for much criticism and adverse publicity following tragedies as reported by the media. All these occurred outside hospital premises.
The practice of general anaesthesia for dental extraction is frowned upon by some, as the procedures can be performed under local anaesthesia. What is often omitted from this reasoning is that the person who is to undergo multiple dental extractions is typically only 5 to 7 years old.
On attachment to this particular service, student doctors can acquire useful skills which can readily be put to use outside the confines of anaesthesia for dentistry and others which are not often seen outside this field:
TIVA
There are a number of Consultants and Middle grade doctors who routinely use total intravenous anaesthesia.
Paediatrics
Although many of the theatre lists are currently ‘mixed’ adult and children lists there is a dedicated paediatric afternoon once a month in the Day Surgery Centre. (General Surgery and Urology).
Regional anaesthesia
There are a number of Consultants who are skilled in regional anaesthesia for upper and lower limb surgery. We have designated ultrasound machines for use in theatre. Priority will be given to the senior trainee who is doing the Regional module but there will be opportunities for student doctors to realise that you don’t need a general anaesthesia for all operations.
ECT / Cardioversion
We have 2 ECT lists each week and one cardioversion list. If you feel that you would benefit from being attached to these sessions then please discuss with you Module Lead.
Preoperative assessment
Throughout the week some Consultants have sessions based in the Preadmissions Centre. Part of their role is to review patients who have been referred by the surgeons for anaesthetic assessment.
During attachments to general surgical lists where Laparoscopic procedures are to be carried out, trainees should gain some appreciation of the following:
- Pre-operative assessment
- Physiological effects of the pneumoperitoneum
- Monitoring requirements
- Potential for CO2 embolism
- Discussion of the management of CO2 embolism
- Patient positioning
- Surgical requirements of anaesthesia
- Post operative analgesic requirements
- Principals and practice of enhanced recovery.
Oral and Maxillofacial surgery
OMFS surgery in Rotherham encompasses a wide range of procedures including surgical extractions, osteotomies, diagnostic biopsies and a significant amount of emergency work including trauma and dental abscess drainage. Patients range from fit children through to older patients with significant co-morbidities due to tobacco and alcohol usage.
You will gain an appreciation of some of the following:
- Pre-operative assessment with particular regard to the airway
- Airway management planning
- The importance of a team approach
- Induction of anaesthesia and the difficult airway
- Management of the shared airway
- The management of patients for extensive and prolonged surgery
- Post-operative care
- Awake fibreoptic intubation.
Dental Outpatients – GA lists
There is an excellent opportunity, whilst in Rotherham, to become familiar with ‘outpatient general anaesthesia for dentistry’ anaesthesia. This is a field that has recently come in for much criticism and adverse publicity following tragedies as reported by the media. All these occurred outside hospital premises.
The practice of general anaesthesia for dental extraction is frowned upon by some, as the procedures can be performed under local anaesthesia. What is often omitted from this reasoning is that the person who is to undergo multiple dental extractions is typically only 5 to 7 years old.
On attachment to this particular service, student doctors can acquire useful skills which can readily be put to use outside the confines of anaesthesia for dentistry and others which are not often seen outside this field:
- Gaining the confidence of small children
- Gaining the confidence of parents of small children
- Rapid and pertinent assessment of childre
- Inhalational induction of anaesthesia
- Techniques of airway management particular to the surgical technique
- Becoming happy sharing the airway with the surgeon
- Techniques of analgesia particular to the surgical technique
- The rapid yet thorough treatment of patients.
TIVA
There are a number of Consultants and Middle grade doctors who routinely use total intravenous anaesthesia.
Paediatrics
Although many of the theatre lists are currently ‘mixed’ adult and children lists there is a dedicated paediatric afternoon once a month in the Day Surgery Centre. (General Surgery and Urology).
Regional anaesthesia
There are a number of Consultants who are skilled in regional anaesthesia for upper and lower limb surgery. We have designated ultrasound machines for use in theatre. Priority will be given to the senior trainee who is doing the Regional module but there will be opportunities for student doctors to realise that you don’t need a general anaesthesia for all operations.
ECT / Cardioversion
We have 2 ECT lists each week and one cardioversion list. If you feel that you would benefit from being attached to these sessions then please discuss with you Module Lead.
Preoperative assessment
Throughout the week some Consultants have sessions based in the Preadmissions Centre. Part of their role is to review patients who have been referred by the surgeons for anaesthetic assessment.
Assessment
- ILS (Course)
- e-Logbook. Make sure your assessor is happy to sign you off before you make an entry in the e-logbook. (get their email ID when you are with them)
- Attendance. Please make sure you attend every session timetabled in for you. If you are unable to attend at short notice, please email Kay Jaques.
- Log of practical procedures and teaching received in theatres.
- Make a note of interesting cases you have come across and you should be able to reflect on what you learned from them.
- Overall assessment by Dr George Thomas-Kattappurathu.
Hope you have a fruitful and enjoyable time during your placement.
