clinical question?

  1. Was wondering what you guys use for sedation on lithotripsy procedures? ( outpatient)

    I have been using a different combo of versed and fentanyl. Recently I have tried using only F--which seems to work ok, they have no pain and kinda just lay there and stare off into space.

    I know I could try to use propofol but my group frowns on this, they say you might as well put them to sleep.

    Sometimes its good to hear what others are doing because sometimes institutions tend to "get set in there ways" of giving anesthesia till a newcomer comes along or somebody comes up with new reseach.

    Lee
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  2. 21 Comments

  3. by   nilepoc
    Sometimes I wish I hadn't gone to afront loaded program, then other times I am happy to just focus on classes.

    I wish I could help, but 10 months to go, until I get to inflict my knowledge on the general public.

    Good luck;

    Craig
  4. by   kmchugh
    We put our lithotripsy patients completely to sleep. Tube, the whole nine yards.

    Kevin McHugh
  5. by   meandragonbrett
    We used a Versed and meperidine combo. Works pretty well.

    Brett
  6. by   MICU RN
    Brett:
    Just curious are you in nursing school yet and if not how have you learned so much? I thouht I remember you saying awhile back that you were even thinking about medical school. I work in a major teaching hospital and I think you should fully explore that idea, crna route 4yr BSN, 1yrexp. plus another 24-32 months is a big commitment four more years of training you could be a MD. One of the common things I read on this forum whenever the MDA/CRNA debate comes up is that nurses tend to be better pt. advocates and that most doctors are jerks. My experience doesn't reflect that at all, most docs I work with are strong pt. advocates and are pretty nice. I have met just as many nurses who are not strong pt. advocates as doctors who are not. I think as Kevin and others have stated that we as nurses and doctors need to find ways to work together as a team and there by assuring that the patients get the best care possible. My experience on my unit as been very good the MEdical staff and residents try to incorporate the nurses as much as possible, this leads to very little we vs. them attitudes. Also ,I realize ever one's circumstances are different, I plan on applying to crna school for next fall, however, I am 36 and have two small children, so for me it more practical to pursue the crna route as oppose to the MD route. But I feel all avenues should be explored. Good luck in whatever you decide to pursue.
  7. by   meandragonbrett
    Anthony,
    I've considered both options. I've never really wanted to be a doctor. I don't know why, it just doesn't appeal to me that much. I know sounds crazy, huh? lol. No, i'm not in nursing school yet. But the doctors and nurses that I work with have all been very nice and receptive towards me. Thev've taught me a lot in the past two years. I'm a surgery volunteer. I'm invited to observe cases all the time. For the most part everybody treats me more as a staff member than as a volunteer. They've taught me quite a bit, but I know there's still a LOT to learn. I haven't completely ruled out becoming a MD, but I'm leaning towards CRNA. One thing about MD is that I don't know what I'd major in in undergraduate, I don't want to do a Bio or Chem major and then it take me a while to get into med school. By going to nursing school, I feel like I'd have something that I can do that I enjoy until I'm accepted to CRNA school. What do you think? Am I just nutz? I've also thought about applying to CRNA school and Med school, i.e getting my BSN and taking the pre-reqs for med school. I don't know yet for sure.....but I'm leaning towards CRNA. Any adivce\input?

    Brett
  8. by   Tenesma
    hey brett,

    my biggest mistake prior to med school was majoring in the sciences... if i could do it all over again and taken some arts and humanities courses, of course i still would have had to take the prerequisites... so the message is, if you do go the MD route you don't have to major in the sciences - in fact, interestingly enough, most english/philosophy students actually have a better chance of getting into medical school (more well-rounded)...

    2 cents,
    tenesmus
  9. by   Notanurse
    Hey Brett,
    How did you land the surgery volunteer position? That sounds interesting and, obviously you have learned more by observing than most people will have on an application to school. Also, did I read correctly that you are not in school or just not in nursing school? What else are you doing to prepare for school and could you share more about your volunteer experiences? Thanks, Bill
  10. by   meandragonbrett
    Bill,
    I'm still in HS, I'm a senior this year. At the hosptial where I volunteer, there is a summer program for teenagers, they're called "VolunTeens" and it's open to people 14-18yrs old. For the most part there is not much patient contact. It's mostly passing out ice, Gift shop work, things like that. I sent in the application two years ago and was accepted. I was THRILLED!! Let me tell ya! There was a spot for pre\post-op in our surgery department. I wanted that spot becuase I knew that it was similar to what my mom does. She's the Holding, PACU, and OR supervisor at the hospital where she works. After the first day of working in the preop area, I was hooked!! I continued to choose working in the pre\post op area that summer and I got to know all of the nurses very well, and I also started developing relationships with the physicians that use our ORs. It got to the point of everybody in the hospital knew who I was and wanted me to come and work in their department! lol. I enjoyed that department a lot that summer b\c I was able to have a good deal of patient contact. I helped the nurses get them ready for surgery, I brought them back from the waiting room (All of the surgery patients come in through AM admit) to the pre-op area, helped them get changed, explained what was going to happen that day, etc. I also answered the phone, which rings off the wall. The Director of surgery sent me a letter at the end of the summer thanking me for my hard work that summer and that she hoped to see me again. I found out later that she called my volunteer cordinator and asked her if I could continue to come up there and work even though the volunteen program was only during the summer. My cordinator said that was fine. As the relationships with the Docs, nurses, and CRNAs grew I started being invited to watch cases. The first time I was in the OR I spent the day with anesthesia, and after the induction the CRNA let me look down and see the cords before he intubated the pt. That was really cool. I've seen everyting from a lap chole to a CABG. I absorb every opportunity to observe cases. This is how i've been able to learn so much, they treat me more as staff\student than volunteer. Now, I know this is not the common volunteer experience b\c most hospitals don't allow their volunteers to get within 100 feet of the OR, but I've been VERY lucky, and have made some good contacts and some great friends. With school going on, I don't get a lot of time to go up there b\c we don't operate on saturdays unless it's an emergency. Although, when I'm out of school I do go up there and work. I love being up there and I would not trade spending the last two summers up there for a "Real Job" that pays $$$. The best thing that's happened from this is that my best friend had to have her second liver transplant last october, and the transplant surgeon knew me and told me that I could come in until anesthesia did their magic b\c jennifer was scared to death and wanted somebody to come in with her. I'm so happy that I had that opportunity b\c that was that last time that I ever saw Jen. I love volunteering and I will continue to do it until I am a RN or MD, whichever I pursue. I hope this is what you're looking for Bill. If you have any questions let me know.
  11. by   MICU RN
    Brett:

    I was in the same quandary prior to going to nursing school, the big difference was I was 26 and newly married when I decided to go back to school. I had very few college credits and didn't do well the first time right out of high school. So there was plenty of doubt wether I could get nursing school much less med school. However, nursing school turned out to very competitive at the time( not to mention very hard), my class had 450 appl.s and accepted about 60. I started out in an AD program that was in a medical center setting, I am now going to graduate from a RN/BSN program, within the same university setting, this fall. I went into nursing school with the long term plan of becoming a CRNA. Mistake #1 was going the AD route, for the average student it takes 2-3 years to complete the RN/BSN programs if you are also working full-time. I was lead to believe it could be done within 1-2 for the average student. Also, I have observed that most who intend to go back after their AD never go back. So if I had to do it again I would go the BSN route. Then as you mentioned you have the option of taking prereq.'s for med. school or applying to CRNA school. Bottem line you have more options. I have worked in academic teaching hospitals and have really enjoyed it, I have met peole from all over the world. So, it wasn't too long after working in this setting that I realized I really liked medicine and started to think about med. school again, right now I am leaning CRNA route b/c I think I would really enjoy it and as I stated before it is a more practical route, 32 months compared to 7or 8 years. The other factor for me is that I have two small children and I don't want to be away that much for the next 7-8 years. However if I was younger and just staring out I would probably go the MD route, one of the reasons is all the BS you have to put up within nursing school and at the bedside until you can become a crna. A friend of mind who just started med. school and who just grad. from a BSN program 1 1/2 yr.s ago said it was the best decision she ever made, she said her nursing background has helped her alot with time management in regards to handling the huge amount of material she is now exposed to; she also mentioned that she felt their was alot less BS so far in regards to the teaching style compared to the nursing style. Now don't get me wrong, I have the greatest respect for good nurses they are truly the backbone of healthcare but it is just not for everyone, it takes a special person who is willing to do most of the hands on work (good and bad) and be okay with not getting much recognition or finacial compensation. I always wondered why the residents and med. students I work with have no problem providing a well needed service and expecting to get well compensated for it. I think alot of it stems from this foolishness in nursing which goes something like this " it's a calling", " nurses really care about the pt", or " I am not in for the money my husband takes care of that";I squirm when I see the Johnson & Johnson commercials about how nurses really care. Of course most nurses care, but so do the doctors, resp therp. and ect. Nursing needs to get away from those types of slogans and show what else we do in regards to taken care of patients in todays hi-tech setting. Nursing is a sleeping giant if they could unite and leverage their power, sadly, I don't see it coming any time soon and I can't afford to stay at the bedside I have kids and a wife I need to support.
    P.S.
    I know I went off on a tangent, but I guess I just had to vent. I have really enjoyed this forum and have been addictively reading it almost everyday for the last few months. And I am actually in the best bedside job I ever had, I work in an 11 bed MICU and we are fully staffed and have great management and work very well with our medical staff. The problem is I know these jobs are very hard to find in nursing right now. Most of my RN friends do not work in these conditions.
  12. by   MICU RN
    Brett:

    I didn't realize you were still in high school that is awesome that you are so focused at that age. You are light years ahead of where I waswhen I was in high school. Keep up the good work!!!!!!!!
  13. by   Tenesma
    the wonderful thing about anesthesia is that you can provide a million different types of sedation for the exact same procedure...
    in my practice, if communication is not a problem or no psychiatric/age-related issues (pediatric) then i usually provide MAC, otherwise i just LMA them (unless ETT is indicated)
    My MACs vary from: propofol/remi, fent/versed, versed/dilaudid... my favorite though is running a remifentanyl drip and then just titrate the dosage to a respiratory rate of 10-15 and then for long-term pain control (they usually have mild musculo-skeletal aching for a few days) just go with tylenol/motrin/non-narcotic.

    anybody else with interesting ways?

    Tenesmus
    Last edit by Tenesma on Oct 5, '02
  14. by   TexasCRNA
    What is the mix concentration you use for your remi infusions? Remi is off the formulary at my hospital and I am trying to get it back on so that I can use it. I have the support of my chairperson they ( pharmacy) don't have it cause they say its expensive and well you know the lingo.

    They also frown on the use of Zofran but I use it anyway and so do my classmates. The funny thing is that we (students) are all very concerned with ponv and use it regularly and at the last dept. meeting it was noted that the dept as a whole had a decrease incidence of ponv, go figure. Lee

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