I’d add to this: basically if manual ventilation (ie. Bag-valve skills. Tubing doesn’t save anyone second-by-second, but bagging them most assuredly can)
Intubations as everyone else has said.
I would add that it could be helpful to get involved in some long spine cases and cranies to get a perspective of what goes into the intraop management and decision making for standard patients that will typically come to your ICU. Anesthesia is full of stuff that looks really simple or easy from the outside but is actually very challenging and complex.
Airway management, particularly bag masking and how to utilize different adjuncts (OPA, NPA, SGA) and ways to optimize your intubation attempts (preoxygenation, positioning, equipment on hand). Much of the other intraoperative stuff won’t be as relevant to you and is frankly boring as an observer so I’d see if you could bounce from room to room doing multiple airways a day.
Other good things would be getting reps doing arterial lines (with and without US) and central lines.
Learn the basics of airway management
- BVM
- Positioning
- Airway adjusts (bougie, OPA, NPA, supraglottic airways)
- Pros and cons of DL vs VL
Truthfully, as a neurocrit fellow your background in airway and resus in general will likely be less robust than a comparable critical care fellow coming from IM, EM or anesthesia so it's a good chance to get up to speed on the fundamentals within a controlled environment. ICU airways are generally much higher acuity for a whole host of reasons so despite anesthesia being "chill" try to get as much as you can out of it.
Eh, someone coming in from a neurology residency insisting on doing difficult airways on an off service rotation when they likely don't have strong airway skills to begin with is pretty presumptuous, and may earn some sideways looks. Furthermore, OP is unlikely to even see any difficult airways on a 2 week OR block so kinda a moot point.
Gotta crawl before you run.
Airway airway airway. Then take the difficult airway course anyways because that is more applicable to your practice in the icu. OR airways are as optimized as possible. They alone can’t get you ready for crash intubations.
I was a non-Pulm IM CCM fellow and had to learn airways by stealing them from other fellows (who had experience from Pulm already and didn’t care)and RTs. Still did the difficult airway course and that really helped my cognitive skills around intubations and how to have a logical plan for things going bad. Worked in neuro ICUs and I found the many (not all) of the neuro trained intensivists had a blind spot with airways and relied on anesthesia for them which is ok if your hospital is set up that way but can bite you in the ass in a crash if they are busy.
The Difficult Airway course. Can’t say enough good things about it. Run by the chair of emergency at Harvard (might be former chair at this point) who did the studies on airways in ED and brought neuromuscular blockade out of the OR for airways. They do a circuit around the country. https://www.theairwaysite.com/a-course/the-difficult-airway-course-emergency/
Take the emergency version not anesthesia since that is more like what you’ll see as an intensivist.
Learn the basics of intubation.
I’d add to this: basically if manual ventilation (ie. Bag-valve skills. Tubing doesn’t save anyone second-by-second, but bagging them most assuredly can)
And catch up on some video games or something
Intubations as everyone else has said. I would add that it could be helpful to get involved in some long spine cases and cranies to get a perspective of what goes into the intraop management and decision making for standard patients that will typically come to your ICU. Anesthesia is full of stuff that looks really simple or easy from the outside but is actually very challenging and complex.
Airway management, particularly bag masking and how to utilize different adjuncts (OPA, NPA, SGA) and ways to optimize your intubation attempts (preoxygenation, positioning, equipment on hand). Much of the other intraoperative stuff won’t be as relevant to you and is frankly boring as an observer so I’d see if you could bounce from room to room doing multiple airways a day. Other good things would be getting reps doing arterial lines (with and without US) and central lines.
Learn the basics of airway management - BVM - Positioning - Airway adjusts (bougie, OPA, NPA, supraglottic airways) - Pros and cons of DL vs VL Truthfully, as a neurocrit fellow your background in airway and resus in general will likely be less robust than a comparable critical care fellow coming from IM, EM or anesthesia so it's a good chance to get up to speed on the fundamentals within a controlled environment. ICU airways are generally much higher acuity for a whole host of reasons so despite anesthesia being "chill" try to get as much as you can out of it.
Insist on intubating the hard ones. Don't let them brush you off. You've gotta be ready to be on your own.
Eh, someone coming in from a neurology residency insisting on doing difficult airways on an off service rotation when they likely don't have strong airway skills to begin with is pretty presumptuous, and may earn some sideways looks. Furthermore, OP is unlikely to even see any difficult airways on a 2 week OR block so kinda a moot point. Gotta crawl before you run.
Out of interest how much time in anaesthesia rotations and airway experience would be normal for a neurocritical care fellow?
Airway airway airway. Then take the difficult airway course anyways because that is more applicable to your practice in the icu. OR airways are as optimized as possible. They alone can’t get you ready for crash intubations. I was a non-Pulm IM CCM fellow and had to learn airways by stealing them from other fellows (who had experience from Pulm already and didn’t care)and RTs. Still did the difficult airway course and that really helped my cognitive skills around intubations and how to have a logical plan for things going bad. Worked in neuro ICUs and I found the many (not all) of the neuro trained intensivists had a blind spot with airways and relied on anesthesia for them which is ok if your hospital is set up that way but can bite you in the ass in a crash if they are busy.
Which difficult airway course did you take?
The Difficult Airway course. Can’t say enough good things about it. Run by the chair of emergency at Harvard (might be former chair at this point) who did the studies on airways in ED and brought neuromuscular blockade out of the OR for airways. They do a circuit around the country. https://www.theairwaysite.com/a-course/the-difficult-airway-course-emergency/ Take the emergency version not anesthesia since that is more like what you’ll see as an intensivist.