hocus POCUS

being a live model on a regional anaesthesia course

Was part of a point of care ultrasound (POCUS) course today, for the second time! While the first was for emergency medicine doctors learning POCUS in the context of trauma and looking at the heart, this was for anaesthetists hoping to take a post-graduate qualification in regional anaesthesia.

Regional anaesthesia refers to targeted injections of local anaesthetic into/around specific nerves. This can be used in surgeries, with or without general anesthetic (“being put to sleep”), to provide pain relief immediately or afterward. Ultrasound is used to find the nerves so people aren't just blindly stabbing around!

I was the live model for simulated vivas, where candidates got an anatomy question, demonstrate how they would do a specific nerve block, anaesthetic complications and demonstrate anaesthetic reasoning through a clinical case. All I really needed to do was to sit there while candidates scanned my neck or armpit or knee and talked about the anatomy they saw.

Listening in on the vivas and the feedback was oddly encouraging though: a surprising portion of the stuff, I already had, even in part, in my distant or not-so-distant memory! Compartment syndrome? Got it, got the buzzwords to go with it. Epidural haematoma? I actually know what that is! (Thank you anaesthetic tutor!) During today's session, anatomy actually mattered! Minutiae that I forgot immediately after second year were now being interrogated. Sometimes they even had clinical implications.

One of the things I picked up was exam techniques. If you're not sure, go broad, not necessarily deep: demonstrate your knowledge. Know the buzzwords? Use them. Prepare a few handy explanatory phrases to save time. Recognise when certain strategies can be used for multiple procedures.

As promised by the organisers, I got to play with the ultrasound machines, though with limited success... We looked for veins (especially the internal jugular vein). We looked for nerves in the arms, and the cervical plexus. I could not find them. I would use an artery as my landmark, move the probe a little, and immediately lose everything. It was like using Microsoft Word when there's too much invisible formatting: change one margin and the text disappears entirely!

Met Twitter medics as well, which was fun! It can be refreshing to meet people who are very certain of what they want to do, because while I know what corner of medicine I want to be part of, and I know what aspects I want to work with, I don't know what that job looks like. I quite enjoy learning about the technical complexities of anaesthetics and the problem-solving aspect, but don't fancy being in theatre all that much. I like the idea of emergency medicine, but haven't seen enough of it to be absolutely certain. I see the appeal of HEMS, wilderness/expedition medicine, military medicine... but I'm not the typical outdoorsy type.

So, you know what? I'll work on gaining lots of experience and being as good as I can be, rather than chasing a dream I've seen in someone else.

#notetoself #POCUS #reflections