NHCP Anesthesia

Please contact the Rotation Director and Rotation Coordinator at least 4-5 weeks prior to the start of the rotation. Points of contact may be found under Rotation Information.

This two week anesthesia rotation for interns, PGY-2 residents and EMPA fellows takes place at Naval Hospital Camp Pendleton. Depending on the number of trainees there at any given time, it can be more or less useful as there are also CRNA students training there as well.

Check-In

Shoot an email to the POCs listed in the above link about 3 weeks prior to the start of the rotation to let them know when you are supposed to be arriving and they will send a copy of their gouge/expectations though most of that will be included here. On the first day of the rotation, you will show up to the new hospital (finished only a few years ago); try to arrive by 0700. Give the anesthesia floor walker a call (Phone: 760.685.1296) to let you into the anesthesia offices adjacent to the PACU. Depending on who is available at the time, you will get a brief tour of the offices/OR and start the check-in process, though this is far less formal than when officially checking in to NMCSD. You will need a CAC and an up to date copy of the Anti-terrorism online training certificate to get an access card from Security on the 1st deck of the hospital. Make sure to have the NMCSD command badge with you as well. You can wear NMCSD scrubs when you get there the first day and the Floorwalker can show you where to get scrubs (there is no longer a scrub machine, so no need for a scrub card).

Where to go

NHCP is directly North of San Diego when taking I-5, and is right off Exit 54-B. Once you get to the exit continue straight to reach the main gate at Camp Pendleton. After going through the gate, the hospital will be straight ahead on the right side of the road. Park on the North side of the hospital in the visitor parking deck. To get to the OR/PACU, take the North elevators to the 3rd Deck; the fastest way to the PACU is on your left as you get off the elevator. It can take between 45 minutes and an hour to get to Pendleton so you have to leave pretty early to make it on time.

What to Expect

Rotators should arrive at 0700 every day except Wednesday (when the OR opens at 0800). Grab a copy of the OR schedule from the desk and review to see which rooms would be best for potential airway opportunities. The CRNA students will manage their own room, so avoid that one, and there are some nurse anesthetists (CRNAs) who only rotate through the OR once a week and prefer not to work with trainees, but for the most part, all of the anesthesiologists and CRNAs are great about letting rotators float through the rooms; Mike Lynn is particularly good about teaching trainees and likes to pull you out of your comfort zone, so try to work with him when you can. Introduce yourself to those providers in the rooms prior to the start of the first case to avoid any issues. After you find out that the provider is alright with having you in the room, head out to pre-op to introduce yourself to the patient and do an airway exam to see how easy/difficult the airway will be. The first cases start at 0730 in all of the open ORs everyday except Wednesday when they begin at 0830. If there are other trainees overlapping with your rotation, consider alternating days so you do not end up fighting for airways.

When you roll back to the OR with the anesthesiologist/CRNA, it will be your job to ventilate the patient with the mask. You don't really need to worry so much about the meds or gases that are being used, but try to discuss the RSI meds chosen and for what reason. It is pretty amazing what pre-oxygenation will allow you to do when intubating and there is often time for multiple attempts if necessary. You should try to use a variety of blades/sizes when you are intubating and it is a controlled environment so there is time to get a little comfortable with both the Miller and Mac blades. Once you get the airway and confirm placement, you are free to float away to another room or back to pre-op. Most everyone only cares about intubations, but place a few LMAs while you are there as well for practice as they are on the difficult airway algorithm and don't be shy about placing airway adjuncts like oropharyngeal or nasopharyngeal airways. If possible, try to work with Mr Mike Lynn, one of the civilian nurse anesthetists, who is very practiced and will let you try multiple methods of intubation. Unfortunately, NHCP is not the busiest hospital and the number of available ORs exceeds the number in use every day. With the number of trainees there, it is somewhat difficult to get a decent number of tubes while at Pendleton. Log all of the airways (intubations/LMAs) under LCDR Schultz, but make note of the provider that proctored the procedure before submitting.

The rotators typically hang out in the pre-op area when not doing airways. This way, you can see the next patient come in to introduce yourself or practice starting IVs if you are so inclined. The providers there prefer smaller gauge access in the back of the hand, which is a little different from practice patterns in the ED, but still a useful skill to have. There will also be opportunities to practice nerve blocks or epidurals in some instances if you express interest.

Everyone on the Anesthesia team will expect you to have at least a basic familiarity with adult and pediatric airways in addition to proper evaluation of a difficult airway, the equipment to manage an airway, and airway management medications, so brush up before you go if you don't want to look like a rube. 

The vast majority of cases are scheduled for the morning, and you should try to leave by 1300 to 1400 to avoid traffic headed back to San Diego if you can. Sometimes, if there is not really much going on, you can leave earlier; the providers up there will not mind, and often will not even notice. If you have some down time before you peace out, there is a NEX and a galley on the 1st deck of the hospital for food options. The NEX is basically right below the pre-op area and the galley is located on the South side of the hospital.