Some people just won't leave it alone will they?

  1. This was posted over at studentdoctor.net

    Hi Everyone, I've been off the forums for awhile. Busy with internship.

    I just wanted to post a couple of things I've noticed this year concerning the need for anesthesiologists. I just finished 3 months of Surgery (Transitional year) and got to know many of the community surgeons, intensivists, and anesthesiologists. After these 3 months, I feel more secure then ever about anesthesiology's future. For example:

    1. Just about every surgeon I've met (especially the CT, Vascular, and Neurosurgeons) expressed a strong desire to have an anesthesiologist present for their cases. Most of them had been burned to many times by working with CRNA's. Frankly, they said their patients were for the most part too sick for anyone but another physician to be taking care of them in the OR.

    2. The rapidly expanding field of TEE is dramatically changing CT and vascular surgery. This is not just for valve surgery, since many unexpected intraoperative occurences are being detected by TEE. Examples of these are rare things such as ventricular thrombus formation to common things like volume depletion. I don't know any CRNAs who are adept echocardiographers.

    3. The true skills of the anethesiologist really show through in the emergent cases, which many people not in the field forget entirely. In my minimal 3 months of general surgery, we took some really sick people to the OR. I'm talking about people who are in DIC, renal failure, septic and hypovolemic shock, with heaps of necrotic bowel and just a day or two out from major anterior wall MI's. The funny thing is, until you actually get into the field (surgery or anesthesia), you don't really notice how often these presentations actually are. Not to mention those with the above problems, plus being 5'0", 250 lbs, and major pulmonary hypertension. The hospitals know this and that's why they want anesthesiologists available 24 hrs a day. The major medical center/trauma center here just made it mandatory that all anesthesiologists with attending priviledges take in house call on a scheduled basis, or lose their priviledges. They already had in house CRNAs.

    Anyway, I could go on for awhile but I'll stop now. I guess the impression I've been getting during internship, is that the future of anesthesia is very bright, as long as you don't mind taking care of sick people and working hard.

    Bye the way, internship is a blast so far.
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  2. 16 Comments

  3. by   alansmith52
    OK. this guy is an intern right. wich goes right along with our previous threory right?
    I could care less what an intern thinks. like any attnending mda is gonna say " well actually intern I love crna's and I don't think we need to be involved in anesthesia anymore"
    puuullllleeeassse.

    matt
    ps I had a great interview at penn hosp last weekend
  4. by   Qwiigley
    It's their site, let them gloat. We will never be far. there is a need for all of us. Hopefully this weiny will learn the meaning of teamwork before he burns him/herself.
  5. by   smiling_ru
    For the record there are plenty of CRNA's adept in the use of TEE. There is not a cardiac or neuro surgeon in this area that would request an MDA over a CRNA, and any case that rolls through the door is taken care of by a CRNA. BUT, I am not going to that web site. It just creates more bad blood and serves no real point.
  6. by   g8rlimey
    Good for u, smiling. The vituperative nature of that web site is enervating at times (GRE next week).
    I am reminded daily of how LITTLE residents know, especially when I save their ass, me, the linen changing, butt-wiping ICU nurse.
    They should change the name of the website to something like victimdoctor.net....

    Just curious, is TEE taught in school or is that something you pick up depending on your group?
  7. by   Tenesma
    Who provides TEE certification for CRNAs?
  8. by   WntrMute2
    I just finished 6 weeks of cardiac anesthesia. All my TEE education was done by the MDs. I didn't learn enough BTW, there is just not enough time to learn it as you are so busy with other stuff and during bypass, when you are less busy, there is little to see. It would be a good lecture or 3 to incorperate but i don't see that happening. A seprate class like 12-lead probably.
  9. by   TexasCRNA
    TEEs are good to use as an adjunct to your anesthesia I got to use them at my program but I still don't know enough how to accurately use them. That goes with saying that neither the MDAs have a very good grasp on how to use them either except maybe on 2-3 out of a group of 18 MDAs.

    They like to use the TEE cause they can add more to the anes bill. and collect more money, I don't see any difference in the pt. outcomes.

    The docs that know how to use the TEEs are the new guys coming out of res. and have had formal training on the use of TEES.

    Lee
  10. by   meandragonbrett
    What's a TEE ?

    Brett
  11. by   Furball
    transesophageal echo
  12. by   Tenesma
    "they like to use TEE to add more to anes. bill"

    gowkout... give me a break. Typically your posts are a lot better thought out than that... That kind of falls into the category of: "whatever MDAs do and CRNAs don't do must be because we want more money"

    TEE is a diagnostic intra-operative tool - exactly like the PA catheter, exactly like the BIS monitor, exactly like the arterial line (except for the added benefit of quick blood draws). It provides good answers as to valvular functioning, ventricular kinesis, ventricular filling, presence of thrombi/air emboli, etc... There have been a few studies that claim that TEE does NOT change patient outcome, but there also have been TONS of studies claiming that PA catheters (as well as arterial lines) don't change patient outcome (in some instances they have shown that the morbidity is actually higher than the benefits)... But those studies aren't the gold standard. Neither do they take into account that those patients who have PA catheters placed or TEE done are actually very sick to begin with...
    Examples of when I have used TEE that didn't include cardiac surgery was for the intra-operative diagnosis of myocardial infarction (in a few patients that were becoming unresponsive to pressors and without overt telemetry/EKG changes), diagnosis of air embolism in neurosurgery patient after capnography disappears (that is a scary thing) so that we could insert a central line and attempt to "suck" the bubbles out under direct visualization... the list goes on...

    I am still curious as to which organization provides TEE certification to CRNAs? I definitely think training or at least exposure to TEE would be very beneficial for CRNAs - in MDA residency program there is an increased drive to have all residents certified in TEE prior to finishing their programs.

    Tenesmus
  13. by   MICU RN
    Tenesmus:

    Thanks for participating in this forum it is nice to get a MDA perspective. I especially enojy it because I have considered both routes, MD/CRNA, for career advancement. I currently work as a RN in an teaching hospital and have very much enjoyed working with my fellow nurses, residents, med. students and staff. At this point, I am planning on applying to CRNA school for the fall 2003.
  14. by   WntrMute2
    [QUOTE]Originally posted by Tenesma
    [B]"they like to use TEE to add more to anes. bill"

    gowkout... give me a break. Typically your posts are a lot better thought out than that... That kind of falls into the category of: "whatever MDAs do and CRNAs don't do must be because we want more money"

    Gotta agree w/ Tenesman here. I don't believe we want to get into the position of just disagreeing with what MDs do. We exist as a partnership and if CRNAs want to learn to interpert TEEs they need to seek out the training not just slap down the practice. I happen to learn a lot about reading TEEs from a bunch of Docs that didn't exclude me in their teaching.
    This battle should not extend into every area of practice. We don't want to sound like the guys on that student doc board now do we?

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