St.Joe's_Surgery

=**Surgery at St. Joe's**=

Most of these attendings won't let you do much sewing unfortunately. Kimball will let you tie some knots. If you scrub in with Jeff Mancio or Farah Mansoor (residents), they often let you close.
 * Blue service**: Thyroid, Breast, Hepatobiliary
 * Kimball: Does most of the thyroid/parathyroid surgeries. Is the only one that really pimps, but you actually learn stuff.
 * Kreske: The hepatobiliary guy. does a lot of lap choles.
 * Pomerantz: calm and quiet during surgery.
 * Arneson: the breast guy. his breast surgeries are pretty interesting. will do a lot of retracting in mastectomies etc. if you do a breast biopsy with him, he will take you to the breast clinic to have the biopsy interpreted.


 * Green service**: Colorectal
 * Cleary: Super nice guy. remembered my name after meeting him once on my on call night.
 * Mazzeo: Supposedly this guy lets you do a lot of sewing.
 * Vascular**
 * Don't know any of these people... but AAA's are supposed to be cool to see...

__Typical Day__ Cases go for the rest of the day. for the first two weeks you are supposed to stay "on service" ie go to all the cases that your team's attendings. but on the last week of your site rotation, they let you go to any surgery you want. i saw a glioblastoma resection, hip replacement, parotidectomy w/nerve graft etc. was pretty cool.
 * 5:30a** pre-round on the patients you operated on the day before or pick some up if you didn't operate on any, or if yours already went home/died. can be a really quick interview. just do a very focused exam: abdomen, extremities, incisions, etc.
 * 6:30a** (usually): rounds. you will follow 2-3 patients each day and make short presentations. be assertive in making yoru presentations (ie. dont let them just proceed without you doing your presentation). this is the primary factor we are graded upon according to my chief, so make these good. must be short, and focused. longer presentations are NOT better ones. they just want the minimal amount of information that is important. ex. if it was a thyroid surgery, verify that the patient is not experiencing sx of hypocalcemia (most common complication of thyroid surg is removal of parathyroid), ie. perioral tingling, arrythmias, tetany, mental status changes, etc. and see if the patient is hoarse or has had changes in their voice (recurrent laryngeal damage)
 * 7:30a** usually the first case of the day. if you want to go to this, they will definitely let you leave rounds to do so. however, if your patients are late in the census, then you will not hav epresented them by the time this case starts... try to present patients who are early in the census.

__Format of vitals in your presentation__ (they are particular about this)

Tmax Tlast HR RR BP O2Sat Ins/Outs Urine: 24hrs ago/16hrs ago/8hrs ago any tube drainage (NG, chest, abdominal {jackson-pratt etc}) in the same format (24 hrs ago/16hrs ago/8hrs ago)

__High yield Dr. Kimball pimping guide__ Those were the only ones i remember.... she will keep asking until you don't know the answer. Also memorize the MEN syndromes for her.
 * What is hyperparathyroidism? **Inappropriate levels of PTH.** Don't say high levels of PTH! if you had low levels of calcium, there would be a normal physiologic response and release of PTH and this wouldn't be hyperPTH. However, if you have high calcium AND high pth, this is hyperparathyroidism.
 * Most common cause of hyperparathyroidism? **Adenoma in ~85%**. followed by hyperplasia in ~14% and carcinoma in 1%
 * Symptoms of hypocalcemia? **Perioral tingling, arrythmias, MS changes**
 * Common complications of thyroidectomy? **Parathyroid excision** (can be re-implanted in SCM or arm), **recurrent laryngeal nerve damage**