Anesthesia Student Survival Guide.pdf - Index of

6 ● AnesthesiA student survivAl Guide
3 rd Year
• Core anesthesia
rotation
• Specialty selection
• Select faculty letter
writers
• Study for USMLE
Step 2
4 th Year
• Elective anesthesia
rotation
• Apply through ERAS
• Interview
• Take USMLE Step 2
• Submit Match list
• Match!
Internship
• One year required
Residency
• 3 years required
(CA-1, CA-2, CA-3)
Figure 1.1 Key milestones on the road to the match (Figure Courtesy J. Ehrenfeld).
of USMLE score for prospective residents, given the current competitive
nature of the anesthesiology match, many programs have set USMLE step-1
score limits for granting interviews, often in the 200–230 range. Again, having
personal experience in a department can be a great way to gain an advantage
over competing candidates.
A Typical General Anesthesia Case
Although the anesthesiologist needs to consider various patient and procedure
factors when administering anesthesia care for a patient, there are some
routine actions that are commonly performed in the pre-op holding area, in
the operating room, and in the recovery room (PACU) during a typical general
anesthetic. Figure 1.2 outlines the phases of a typical general anesthetic case.
Now, let us discuss the flow of a routine general anesthetic:
Josh is a 33-year-old man with cholecystitis who needs his gallbladder
removed.
Preoperative Evaluation
Unlike the standard internal medicine history and physical, ours is much more
focused, with specific attention being paid to the airway and to organ systems
that are at a potential risk for anesthetic complications. The type of operation
and the type of anesthetic will also help us focus our evaluation. Prior problems
with anesthesia are noted, and physical exam should focus on the heart,
lung, and airway evaluation (to assess ease of intubation). Josh has a history of
hypothyroidism, but takes his medications and recent TSH values are normal.