Union Memorial (Regional)

About

Union Memorial (MedStar Health) is a regional anesthesia elective available to CA-3s who have completed their initial regional rotation downtown. You will work directly with attendings (some remote Hopkins grads) and interact with experienced CRNAs.

Getting Started

Site Coordinators

• Joshua Dishon (Chair of Anesthesiology Department at Union Memorial)
• Nicole Mitchell (Administrator)

The Experience

• 2 week call-free rotation at major orthopedic surgery center
• Expect to get significant experience with both upper and lower extremity blocks. Arguably, the rotation rounds out blocks we do not perform as often at other sites. Most commonly:
  • Total Shoulders: Interscalene (single-shot)
  • General Hand: Infraclavicular, often with catheter placement (preferred over supraclavicular per general institutional preference)
  • Total Knees: Post-op adductor catheters
  • Miscellaneous Knee Procedures: Adductor/IPACK
  • AKA/BKA: Fem/Sciatic catheters
  • Other (less frequent): PECS catheters, TAP catheters

Onboarding Process

Approximately two months prior to the start of your rotation, you will receive an email from the X-Rotators team. This email will include:

• Login credentials for the New Innovations platform
• An onboarding checklist outlining all required items to be completed before the start of your rotation

Please review the checklist carefully and complete all required steps as soon as possible to avoid delays in your onboarding.

TB Testing Requirement

You must provide documentation of one of the following:

• TB test completed within 360 days of your rotation start date
• Chest X-ray (CXR) completed within 5 years of your start date

Important:

• TB test results typically take 3–5 days to return.
• It is recommended to complete testing well in advance to avoid delays in your rotation start date.

Potential TB test locations: (Note: Johns Hopkins Occupational Health no longer offers TB testing)

• CVS Minute Clinic (confirmed option)
• JHOC Lab Testing (unconfirmed)

Additional Onboarding Documents

You will also be required to submit the following:

• Medical school diploma
• Current BLS and ACLS certification
• Curriculum Vitae (CV)
• Proof of influenza vaccination
• Contact information for current and prior residency programs

First Day

• Union Memorial Hospital is located at the Hopkins Homewood campus (201 E University Parkway)
• You'll park in Garage A first day and park in Garage B once you have your parking associated with your employee badge.
  • If there is a parking attendant outside the garage that asks if you are a patient, just say yes otherwise they won't let you into the garage
• You'll confirm your Powerchart access, get scrubs/meal card, and meet with Dr. Dishon (Josh) who will take you around, expect to jump into a block as soon as opportunity arises
• There are three floors of ORs: Ground floor (hand +/- shoulders), 3rd floor (newer, knee/hip +/- shoulders), 4th floor (cardiothoracic and vascular [AKA's, BKA's, AVF's])
• Codes: Block cart (0531), 3rd floor staff lounge (2019)
  

  Union Memorial Hospital Campus - Parking located off Calvert Street (turn onto 34th street).

Contact Info (please do not distribute)

• Nicole Mitchell (Admin Assistant) 410-554-6559
• Josh Dishon MD 443-904-2026
• Mark Jensen MD 585-953-9797
• Kerry Blaha MD 410-258-5758
• Tandi Mohammed MD 443-4447-5946
• Jane Radov MD 443-691-3000
• Rahul Guha MD 734-223-3061
• Marcelo Quezado MD 443-801-8889
• Sumanth Kuppalli MD 443-224-3500
• Bob Andrews MD 410-375-5442
• Nadya Averbach MD 703-728-8346
• Rani Emad MD 410-258-8198
• Denisa Pavlickova MD 917-530-5354
• Alyssa Salisbury MD 713-419-2621
• Jane Anh MD 718-962-5774
• Ming Fang MD 443-928-1604
• Kathryn Simms MD 607-280-2081
  

Block Recipes

• By and large, you will be using 0.5% ropivicaine for everything
  • General volumes (more than you'll be used to):
    • Interscalene: 20 cc
    • Supraclavicular: 20-40 cc (I'm serious)
    • Infraclavicular: 30 cc
    • Adductor/Saphenous: 20 cc
    • Popliteal/Sciatic: 20 cc
  • 21G 100 mm block needle (exception: shorter needle for interscalene)
  • Fent/Versed sedation universally
• For catheters, supplies include:
  • PNC kit
  • Vial(s) of 0.5% Ropivicaine
  • Chloraprep, large/poptart Tegaderm, CHG Tegaderm dressing, sterile ultrasound probe cover (standard for all blocks, whether sterile or not), ultrasound gel, sterile gloves
• If two catheter sites, each pump is run with 0.2% ropivicaine at 10 cc/hour intermittent bolus (PIB) without demand. Otherwise patients with single PNC (e.g. single adductor PNC) have PIB pumps programmed as 8/4/20/3 --> cc per hr / cc demand bolus / lockout interval in minutes / number of demands per hr.

Subsequent Days

• Arrive by 7:00 AM to catch attendings for any first start blocks (in room by 7:30 AM)
• Anticipate bouncing between floors for 1st case starts -> PACU catheters -> preop blocks
• Expect to feel like a medical student until you get to know attendings better
• Josh will often help connect you with attendings doing regional cases in the morning, but you will need to hover frequently
• Some attendings will get better about texting you when there is a block
• APS is a good opportunity for blocks/catheters on the floor. Dr. Jensen (Mark) runs APS service and is very good about keeping you in the loop, and proactive with creating block opportunities
• Fridays start with administrative meeting, thus case starts are at 8:30 AM
• Before going home, peek at the list of cases for the following day to figure out the best OR to show up to and when
  • The anesthesia schedule is published separately and around 3 pm, so you'll likely have to ask someone if you want to know where specific attendings will be

PowerChart

• To get to OR board
  • View (Toolbar on very top) > Perioperative Tracking > UMH Main OR Whiteboard
• To get to APS list
  • Hit the drop down to the right of 'Amb Huddle MPage' > CORES Handoff > Select the following:
    • UMH
    • Acute Pain Service
    • Active List
    • None

Miscellaneous

• There is a full gym (free weights, machines, cardio) adjacent to the anesthesia offices in the 33rd Street Professional Building
• Good hiding spots - Resident Lounge (fully stocked with yogurt, fruit, snacks) directly across from the main cafeteria, free lunches in the Physician Lounge located next to the Resident Lounge
• Nearby cafes for studying if preparing for ITE/Advanced:
  • Bird in Hand (free wifi, outlets for laptop/phone, good food/beverage selection)