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 Allen (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

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 two floors of ORs: Ground floor (hand +/- shoulders), 3rd floor (newer, knee/hip +/- shoulders)
• Codes: Block cart (0531), 3rd floor staff lounge (2019)
  

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

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)
• 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 the first day or two. Eventually the 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

Miscellaneous

• There is a full gym (free weights, machines, cardio) adjacent to the anesthesia offices in the 33rd Street Professional Building
• Nearby cafes for studying if preparing for ITE/Advanced:
  • Bird in Hand (free wifi, outlets for laptop/phone, good food/beverage selection)