Blog 18: Answer 2

1.  What is your EQ?

How does an anesthesiologist best ensure a patient's safety and comfort for surgery?

2.  What is your first answer? (In complete thesis statement format)

An anesthesiologist can best ensure a patient's safety and comfort for surgery by being well-versed on the drugs used for surgery to maintain body functions.

3.  What is your second answer? (In complete thesis statement format)

An anesthesiologist can best ensure a patient's safety and comfort for surgery by monitoring a patient's vital body functions through use and full knowledge of anesthesia machines.

4.  List three reasons your answer is true with a real-world application for each.

Answer 1:

• Knowing the drugs and what they do
• Anesthesiologists have to be experts in pharmacology. There are a wide range of drugs that anesthesiologists use to maintain a patient's body functions. For example, in order to render a patient unconscious, they use a sedative, like Propofol. To paralyze the muscles, they use a muscle relaxant, and a reversal drug as well. They use a large selection of narcotics to rid of pain before, during, and after surgery. Additionally, these medications have side effects, such as raising and lowering blood pressure. There are drugs to combat this as well.
• Making a patient comfortable through use of drugs
• Throughout the process of undergoing surgery, patients are often experience anxiety or fear. With the aid of drugs, anesthesiologists can ensure that patients will be relaxed before even entering the operating room. For example, Midazolam is a drug that is given before surgery to calm a patient. It also causes temporary amnesia, making the patient not remember anything that happens in the operating room.
• Labeling of syringes
• Anesthesiologists are sure to label their syringes for sake of patient safety. There have been studies showing that the labeling of syringes has greatly improved patient care, as it is less likely for there to be a faulty drug given to the patient. Most medications are clear fluids, so labeling them is a key factor to patient safety. Drugs are categorized by type, like narcotics are colored a light blue, hypnotic drugs are yellow, muscle relaxants are bright red, etc.

Answer 2:

• Wide array of machines
• There is a wide array of machinery that is used during surgery for monitoring the main body functions of a patient. For example, heart rate, blood pressure, oxygen level, CO2 level, other gas levels, and even brain waves are all monitored. Each monitor gives readings that cannot be observed otherwise. Additionally, new and improved technologies are produced every year with more technologically advanced machinery. In fact, my mentor has told me that anesthesiology is one of the fastest improving medical field in patient safety.
• Provides a warning before things go wrong
• In turn, with advanced machinery screening a patient throughout a surgery, this increases a patient's safety. Simply having all the equipment is not enough. Anesthesiologists have to be diligent and pay attention to the monitor readings. By watching the monitors, anesthesiologists can tell beforehand if a muscle relaxant is starting to wear off or if a patient is having trouble breathing.
• Recording monitor readings throughout surgery
• Every surgery I've observed, I have seen the anesthesiologist record important monitor readings at certain time intervals throughout procedures. This is not only to show that the anesthesiologist was paying attention to monitors during surgery, but also to show that the patient was comfortable. The monitors would show if the patient was not able to breath or was in an unstable condition. Thus, keeping record of how the patient was doing as the procedure progresses can have an effect on safety and overall comfort.

5.  What printed source best supports your answer?

Sources located in Working Bibliography

Answer 1: Sources 37b

Horton, Charles. "Better Living Through Chemistry." Chapter. Anesthesia Crash Course. New York: Oxford UP, 2009. 27-45. Print.

Answer 2: Sources 21

Subrahmanyam, M., and S. Mohan. "Safety Features in Anaesthesia Machine." Indian Journal of Anaesthesia. Medknow Publications & Media Pvt Ltd, 1 Oct. 2013. Web. 21 Oct. 2015. <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3821264/>

6.  What other source supports your answer?

Sources located in Working Bibliography

Answer 1: Sources 3b, 8, 15, 33, 36, 37b, 42
Answer 2: Sources 1, 21, 24, 37a, 46

7.  Tie this together with a  concluding thought.

With anesthesiology being one of the fastest improving medical fields, safety and comfort are the main focus. Every year, there are better, more advanced machines and techniques that are discovered. But the main ways in which anesthesiologists ensure that their patients are safe and comfortable are through monitoring of machines and being well-versed in the medications used in surgery. I have seen these methods used many times while at mentorship. Implementing these factors plays a role in possibly saving a person's life.

Blog 17 - Interview 3 Reflection

[Dr. Zhuang T. Fang works here at the Wasserman Building at UCLA.]

INTERVIEW LINK

1. What is the most important thing I learned from the interview?  

This interview has shown me a new perspective of anesthesiology. Because Dr. Fang teaches residents at UCLA what it takes to be an anesthesiologist, I saw that anesthesiology has a lot to do with having good judgement and knowing your patients. One thing that stood out to me in this interview was when I asked about the most challenging aspect of teaching anesthesia. Dr. Fang said that the most difficult thing for him is trying to make the right judgement. If a resident harms the patient, he ultimately is responsible for what happens to that patient. He said that it is much easier for him to go in and do the surgery himself, but he enjoys teaching others what he knows and wants to pass on the knowledge he has gained over the years. When he is with residents, he has to decide and find the balance between letting the resident have his or her freedom to develop their skills and practice but also knowing when to step in and take over. This helped me better understand the qualities that make a great anesthesiologist.

2.  How has your approach to interviewing changed over the course of your senior project?

The focus of my interviews has shifted to knowing more about what it takes to be an anesthesiologist. Because as I talk to more people about their experiences, I find that my interest grows even more. It has brought my research further into justifying the answers that I have for my EQ. I have seen the different ways people handle different situations to see what works. Initially, my interviews started out a bit broad and general, but over the course of the year, as I learn more about the subject, I find that I can get into deeper conversations about anesthesiology that I wouldn't have thought of in the beginning of the year.

Blog 16: Independent Component 2 Approval

[UCLA Wasserman Building.]

1.  Describe in detail what you plan to do for your 30 hours.

I plan to further observe procedures done by anesthesiologists from other hospitals outside of my mentorship to broaden my knowledge of how other anesthesiologists may perform procedures differently apart from my mentor. There are two other hospitals in particular that I plan on observing other anesthesiologists at work. There is a third hospital that I plan to visit as well, however I still have to arrange for a day.

2.  Discuss how or what you will do to meet the expectation of showing 30 hours of evidence.

On Friday, February 12, I will be visiting the UCLA Wasserman Building at the Stein Plaza on Westwood Blvd. It is the neurosurgery building at UCLA. There I will shadow under Dr. Zhuang T. Fang, the anesthesiologist I interviewed for Interview #3. He allowed me to observe surgeries for the whole day. (basically from 7AM until all surgeries for the day are done).

I plan to also observe surgeries at the Chino Valley Medical Center. There I will also observe surgeries throughout the day under another anesthesiologist. I have not yet arranged for a specific day, but watching more surgeries done by a variety of anesthesiologists is more beneficial.

I volunteer at the San Antonio Regional Hospital in Upland in Maternity every Sunday. There are always anesthesiologists that come by regarding patients and I often get the chance to ask them questions and if asked, observe epidurals. What I am most interested in for this case is how anesthesiologists interact with their patients to make them more comfortable.

3.  Explain how this component will help you explore your topic in more depth.

Dr. Zhuang T. Fang is an attending for UCLA anesthesiology residents, meaning that he teaches and watches students perform anesthesia procedures for training. I feel that with his many years of experience will be helpful in understanding more about my topic.

I have had previous experience at Chino Valley Medical Hospital, but have not really observed procedures there. I have known different doctors at the hospital and watching different anesthesiologists perform procedures can allow me to get a better grasp of how anesthesiologists can make patients safer and more comfortable. People in general do the same tasks differently, so being able to watch how other doctors of the same profession perform anesthesia can offer more options for what I can look into regarding research, more support for answers to my EQ, and about the topic in general. I expect that the time spent at UCLA and at Chino Valley Medical Center will take up a majority of the time for this IC. However, I feel that some time can be spent around anesthesiologists at San Antonio Regional Hospital to see how they interact with patients undergoing labor, as this is still an important aspect of anesthesiology. Also, I volunteer every Sunday at the hospital in the Maternity Dept. in which I see and interact with these patients all the time. With this, however, I aim to focus more on the anesthesiologist's interactions with the patients and how they communicate, as this is related to a possible EQ answer.

Independent Component 1

LITERAL

“I, Julianne General, affirm that I completed my independent component which represents 30+ hours of work.” My mentorship at Desert Valley Medical Hospital under Dr. Richard Kakes has helped me learn more about anesthesiology in the field and in action. Throughout my mentorship, I have seen a variety of surgeries, such as gallbladder removal, appendix removal, knee replacement (which is another story in itself because I nearly passed out from the smell), circumcisions, different prostate surgeries, cyst removal, and also repairing of fractures. Each day brings about a new experience and another set of fun stories to share.

 
INTERPRETIVE 

I completed extra hours of mentorship for this independent component, because watching what actually happens with the job is the best way to learn a topic like anesthesiology. I spent extra time observing what happens, during surgeries and this has helped me attain a greater grasp of what I read in research I find on anesthesia. I know more about the drugs used and the most I watch my mentor intubate a patient, the more I notice minor details that an experienced anesthesiologist would do to further ensure a patient's safety.

Here are some photos while at mentorship:

APPLIED

There have been several cases that have stuck out to me that have broadened my knowledge of anesthesia. For example, the story I shared during my lesson 2. My mom and I were about to leave for the day when my mom received a call from the ER saying that a woman was dying and needed emergency surgery. She had ruptured a stomach ulcer and when we saw her she was dying right in front of us. We brought her in to the OR and I sat in the corner and watched as she was quickly put under anesthesia. We were there for 2 hours and throughout that time, her condition was very unstable. In the end, we took her to the ICU because she was still in critical condition. This experienced helped me figure out an answer to my EQ, being that anesthesiologists should be well-versed in the drugs they use.

Another experience was when I walked in the OR and my mentor was wrapping up a surgery with a patient that was just waking up. But I was totally surprised when I saw the tall, grown man sobbing in so much pain after having his gallbladder removed. My mentor told me that he was a drug addict, so the drugs don't mix well with any narcotics he was able to give him throughout the surgery. He also said that this is normal for people that abuse drugs. It just surprised me because I hadn't seen anything like it before.

I can also recall one time that I was allowed to stand right where the surgeon was standing. For one case, a woman had to have 2 masses removed from her fallopian tubes. It was a long surgery and at one point the surgeon had to take a short break. When he came back, he asked me if I wanted to stand on the stepping stool to look inside and see what he had been working on. It was quite a unique experience because not only did I get to see the inside, but I found it interesting to still see her lungs moving, still breathing for her while under anesthesia.

There was one time I watched a circumcision of a 10-year-old boy. He was very scared for his surgery and I watched as my mentor calmed him down by showing him the oxygen mask while still in the holding room. He talked to him very softly and explained that he it would be over before he knew it. And after the surgery, right as the boy was waking up, (and perfect timing, I might add), my mentor explained that usually children cry a lot as a reaction to anesthesia. It was just normal. And sure enough, the boy woke up already crying and shivering.

On my first day of mentorship, I had just finished watching the first surgery of the day. And as I was walking out of the OR, I suddenly heard a woman wailing and screaming in pain across the hallway. I saw the surgical team move her into another OR. She was about to give birth but needed an emergency c-section. It was a very interesting experience because in a matter of minutes, the woman went from wailing in pain to being under anesthesia.

Lesson 2 Reflection

1.What are you most proud of in your Lesson 2 Presentation and why?

I am proud of the fact that the activity went by much better than I thought it would. From what I saw, people seem engaged and wanted to participate in the activity. The fact that it was a game brought out a competitive aspect in the audience that made it fun and enjoyable to watch. Also regarding the activity, I am proud that the idea for it was inspired by a real event that I witnessed at mentorship, because it brought about a realness aspect to my debrief afterwards that put what I had been talking about in my lesson into perspective.

2. a.     What assessment would you give yourself on your Lesson 2 Presentation (self-assessment)?

I think I deserve an AE for this presentation.

     b.     Explain why you deserve that grade using evidence from the Lesson 2 component contract.

Throughout my presentation, I referenced my mentorship many times as well as resources for the information that I presented. I knew my EQ by heart, made time by talking for more than 10 minutes while allowing ample time for the activity afterward. I also brought props with me that I pointed out during my presentation and I used several props (syringes) for my activity. I made sure to reference my answer more than once so that I don't just glance over it.

3. What worked for you in your Lesson 2?

Over these past few months I have learned a lot about anesthesiology and when I had the chance to present what I have learned, I found it very exciting. I especially love to tell stories of things that I have observed while at mentorship and one of my favorite aspects is seeing people's reaction to the tools I would bring and explain during my presentation. I also really enjoyed the response I got from doing my activity. People seemed engaged and seemed to understand the connection between the activity and the answer to my EQ that I talked about.

4. What didn't work? If you had a time machine, what would you have done differently to improve your Lesson 2?

I would have added another rule to my activity that would have people wait for me to finish my statement in the simulation before allowing them to guess. It would be a slight improvement that I think could make a good change to make it more cohesive and organized.

5. What do you think your answer #2 is going to be?

My answer #2 would be closely monitoring the patient during surgery. (In other words, hooking up the patient to the several kinds of anesthesia monitors to check heart rate, blood pressure, consciousness, etc.)