Core Clinical Competencies in Anesthesiology

The core clinical competencies in anesthesiology can be pretty blurry - just how do they apply to real life? This book answers this question, incorporating the core clinical competencies into an engaging format that anesthesiologists like - case studies. So, far from being a ‘dry and dusty volume of forgotten lore', this book actually makes learning the competencies fun! Written in the same engaging style as a number of other anesthesia books (specifically, the Board Stiff opus) by leading anesthesiologists from leading medical centers across the United States, this book will bring the core clinical competencies to life for medical students. - A chance to read diverse, relevant and real life content from a variety of sources - A case-based book that brings the core clinical competencies to life - A serious book, written in an engaging, funny style by leading anesthesiologist Edited by Christopher Gallagher State University of New York, Stony Brook Michael Lewis University of Miami School of Medicine Deborah Schwengel Johns Hopkins Medical Institutions, Baltimore, Maryland CONTENTS Rogues' Gallery of Contributing Authors xi Introduction: “From the mountain” 1 1 An anesthetic view of the Core Clinical Competencies 3 2 Anesthetic cases through the Core Clinical Competencies looking glass 7 Part 1 – Contributions from Stony Brook University Medical Center under Christopher J. Gallagher Case 1. Pop goes the aneurysm Christopher J. Gallagher and Tommy Corrado 11 Case 2. No Foley, no surgeon; what now? Christopher J. Gallagher and Khoa Nguyen 18 Case 3. Bad airway in the Andes Christopher J. Gallagher and Khoa Nguyen 23 Case 4. Wedge is 18; he must be full Christopher J. Gallagher and Dominick Coleman 28 Case 5. Calling across specialties Christopher J. Gallagher and Kathleen Dubrow 34 Case 6. Extubation wrecking a perfectly good Sunday Christopher J. Gallagher and Eric Posner 40 Case 7. The sin of pride after an awake intubation Christopher J. Gallagher and Eric Posner 43 Case 8. Brown-Sequard and the orthopedic knife extraction Christopher J. Gallagher and Tommy Corrado 46 Case 9. When were those stents placed? Christopher J. Gallagher and Matthew Neal 52 Case 10. Flame on! Christopher J. Gallagher and Matthew Neal 56 Case 11. What date would you like carved in stone? Christopher J. Gallagher and Anna Kogan 61 Case 12. Spasm, spasm, how do I treat thee? Bronchospasm in a stage IV breast cancer patient Bharathi Scott and Shiena Sharma 65 Case 13. Why don't you join the HIT parade? HIT in a cardiac surgery patient Bharathi Scott and Jason Daras 69 Case 14. Bad lungs in the ICU Shaji Poovathor and Rany Makaryus 73 Case 15. A simple breast biopsy Neera Tewari and Ramtin Cohanim 79 Case 16. Fast-track perioperative management of patients having a laparoscopic colectomy for colon cancer Brian Durkin and Sofie Hussain 83 Case 17. Treatment of complex regional pain syndrome when the payer doesn't know anything about what you are treating Marco Palmieri and Brian Durkin 86 Case 18. OB case with cancer and hypercoagulable state Joy Schabel and Andrew Rozbruch 90 Case 19. E x t u b a t e d a n d j a w s w i r e d s h u t Peggy Seidman and Ramon Abola 95 Case 20. Code Noelle: A tale of postpartum hemorrhage Rishimani Adsumelli and Ramon Abola 102 Case 21. Are you sure there's a baby there? A tale of the morbidly obese parturient Ellen Steinberg and Ramon Abola 108 Case 22. Smoking, still smoking, and won't quit Deborah Richman and Rany Makaryus 114 Case 23. Pseudoseizures following office extubation Ralph Epstein and Andrew Drollinger 119 Case 24. What happened to the ETT tip? Ralph Epstein and Tate Montgomery 123 Case 25. Jerry and Terry want one more baby Rishimani Adsumelli and Vishal Sharma 128 Case 26. Overhextending yourself Helene Benveniste and Jonida Zeqo 134 Case 27. Broken catheter after Whipple Xiaojun Guo and Khoa Nguyen 137 Case 28. Pierre who? Ron Jasiewicz and Khoa Nguyen 142 Case 29. Submandibular abscess Syed Azim and Jane Yi 147 Case 30. ERCP with sedation: A Big MAC (monitored anesthesia care), supersized! Tazeen Beg and Michelle DiGuglielmo 153 Case 31. On call in labor and delivery: The morbidly obese nightmare Ursula Landman and Kathleen Dubrow 158 Case 32. Kidney transplant Syed Azim and Louis Chun 164 Case 33. Electrical glitch Daryn Moller and Joseph Conrad 169 Case 34. What do you mean you stop breathing in your sleep? Deborah Richman and Vishal Sharma 175 Case 35. Please prevent postop puking Neera Tewari and Vedan Djesevic 181 Case 36. Mr. Whipple and the case of the guy who likes to mix a few vikes with his vodka Misako Sakamaki and Brian Durkin 184 Part 2 – Contributions from the University of Medicine and Dentistry of New Jersey under Steven H. Ginsberg Case 37. Burn, baby, burn: Anesthesia inferno Jeremy Grayson and Stephen Lemke 191 Case 38. CABG John Denny and Salvatore Zisa Jr. 198 Case 39. The Da Vinci Code for anesthesiologists Steven H. Ginsberg, Jonathan Kraidin, and Peter Chung 203 Case 40. Transhiatal esophagectomy: Do you have the stomach for it? Jonathan Kraidin, Steven H. Ginsberg, and Tejal Patel 211 Part 3 – Contribution from the University of Texas M.D. Anderson Cancer Center under Marc Rozner Case 41. Never yell fire in a crowded OR Charles Cowles and Marc Rozner 217 Part 4 – Contributions from the University of Miami Miller School of Medicine under Michael C. Lewis Case 42. Nephrectomy Michael C. Lewis and V. Samepathi David 227 Case 43. Another day at the office …based anesthesia Steven Gil and Nancy Setzer-Saade 232 Case 44. OB to the core Deborah Brauer and Murlikrishna Kannan 236 Case 45. Cut off at the knees Ashish Udeshi 240 Case 46. Neuro Eric A. Harris and Miguel Santos 246 Case 47. Cardiac catheterization laboratory to cardiac operating room Lebron Cooper and Adam Sewell 252 Case 48. Lap choly in someone great with child Amy Klash Pulido and Shawn Banks 260 Case 49. Renal transplant Carlos M. Mijares and Sana Nini 263 Case 50. Surprise! It's a liver and kidney transplant Michael Rossi and Sujatha Pentakota 266 Case 51. Left lower extremity pain Omair H. Toor and David A. Lindley 269 Case 52. Trauma Edgar Pierre and Patricia Wawroski 276 Case 53. Whack-an-eye Steve Gayer and Shafeena Nurani 281 Part 5 – Contributions from Johns Hopkins Medical Institutions under Deborah A. Schwengel Case 54. Singin’ the OSA blues Jennifer K. Lee and Deborah A. Schwengel 289 Case 55. Oxygen Justin Lockman and Deborah A. Schwengel 295 Case 56. “My patient's an airhead!” Management of air embolism during sitting craniotomy Alexander Papangelou 301 Case 57. Fifty-one-year-old female with abdominal pain, diarrhea, flushing, and heart murmur for exploratory laparotomy Peter Lin and Ralph J. Fuchs 307 Case 58. DIC: Disseminated intravascular coagulation or devastating injury to the cervix? Sayeh Hamzehzadeh and Tina Tran 313 Case 59. All I had was a knee bursectomy; now do I have RSD (CRPS)? Adam J. Carinci and Paul J. Christo 318 Case 60. Obstetricians cannot detect FH sounds, and Mom's cyanotic: What's an anesthesiologist to do? Ramola Bhambhani and Lale Odekon 324 Case 61. A case of mistaken identity Nishant Gandhi and Bradford D. Winters 334 Case 62. “To block or not to block, that is the question”: Anticoagulation and epidural anesthesia Brandon M. Togioka and Christopher Wu 340 Case 63. Anterior mediastinal mass with total occlusion of the superior vena cava and distal tracheal compression Andrew Goins and Daniel Nyhan 347 Case 64. Puff the magic dragon Steven J. Schwartz 352 Case 65. “You mean the screw isn't supposed to be in the aorta?” Massive bleeding during spine surgery Melissa Pant and Lauren C. Berkow 360 Case 66. Oh no, someone get the NO! Rabi Panigrahi, Brijen L. Joshi, and Nanhi Mitter 365 Case 67. What to do when HITT hits the fan Ira Lehrer and Nanhi Mitter 369 Case 68. “Just don't stop my achy, breaky heart …” Sapna Kudchadkar and R. Blaine Easley 375 Case 69. Too bad, so sad …it's Friday afternoon with a VAD Jeremy M. Huff and Theresa L. Hartsell 382 Case 70. The disappearing left ventricle: A double lung transplant in a patient with severe pulmonary hypertension Kerry K. Blaha and Dan Berkowitz 391 Case 71. Exit procedure – twins! Gillian Newman and Eugenie Heitmiller 397 Case 72. OMG, that's the RV! Christine L. Mai and Robert S. Greenberg 403 Case 73. Aborted takeoff Emmett Whitaker and Deborah A. Schwengel 410 Case 74. Revenge of the blue crab cake Samuel M. Galvagno Jr. and Theresa L. Hartsell 416 Case 75. Mind, body, and spirit Christina Miller and Adam Schiavi 425 Case 76. He's not dead yet! Veronica Busso and Mark Rossberg 434 Part 6 – Contribution from the Medical College of Wisconsin under Elena J. Holak Case 77. The Four Horsemen of Notre Dame or the Four Horsemen of the Apocalypse? The story of how horses tried to ruin my first night on call Elena J. Holak and Paul S. Pagel 441 Summary 449 Index 451