As a CA-1 and an early CA-2, our priority is learning how to manage patients perioperatively. That includes preoperative patient evaluation, intraoperative management, and recovery from anesthesia. The best time to practice these skills is during overnight call shifts, where we encounter various cases throughout the evening at our level one trauma center, Ben Taub General Hospital. On a typical call shift, we arrive at 2:30PM ready to relieve our day time colleagues by taking over the remaining cases for the day. Prior to doing so, we prepare the designated emergency operating rooms to ensure we are ready to start a case if necessary. As operating rooms begin to come down in the evening, we switch over to a rotating system where junior residents take turns doing cases for the remainder of the night. Cases can range from multiple gunshot wounds requiring massive blood transfusion to a minor toe amputation for a patient with diabetic neuropathy.
During the second half of CA-2 year and as a CA-3, we begin to take senior call shifts here. This is our opportunity to put leadership, teamwork, and everything we’ve learned over residency into practice. When we arrive in the afternoon, we meet with the operating room charge nurse and our boardrunner attending to gauge the status of the ORs in order to plan relief for the anesthesia day team. Once we have a good plan in place, we take over recovery room (PACU) duties from the PACU day resident. This includes holding the emergency airway pager and the trauma pager which will alert us to potential emergent intubations within the hospital and the imminent arrival of a trauma, respectively. We are responsible for assessing these patients and making clinical decisions that can be the difference between life and death. In between managing hospital-wide emergencies, we supervise junior residents and student nurse anesthetists in the operating room, perform regional blocks, and evaluate/treat patients in the PACU.
The most grueling part of a call shift at Ben Taub is the arrival of code one trauma, which describes a critically injured patient who must receive life-saving emergency surgery. As one of the busiest level one trauma centers in the United States, one or more emergencies may arrive in a moment’s notice. Patient outcomes are often directly impacted by our team, so being prepared is an absolute necessity. As anesthesia residents, we must act quickly to assess the patient, start an arterial line, obtain IV access, and manage hemodynamics while our surgery colleagues work to control the source of bleeding. These cases can be challenging, but solidifies foundational concepts, hone technical skills, and develop clinical decision acumen that is necessary to become a practicing anesthesiologist.
