What is up with CRNA/AA/MDA politics. - page 5
I am way not in it but long term, i am aspiring to be a CRNA so i hang out on various boards and i am amazed at what i see. I see MDAs to be talking about having nurses do the mundane work becasue... Read More
Jan 20, '05Quote from alansmith52actually this is what "valley review" has done for years and it was ignored until someone made it totally obvious and the council had no choice but to issue a statement on it. you may be appauled but it has been going on in many professions for years.I was with a very cool senior resident today. he is likeable and gets along with most of the RRNA's he got a new book to study for boards. we went through some of the questions together.
he told me that the book he had was a great one becuase the service that made the book recruited people who had just taken the written boards to "regurgitate" questions from the writen. immeaditly my mind flashed back to a letter I had received from the AANA about how apauling they felt that was.
he told me that it goes on with alot of medical board exams
i do know for a fact that durring medical school they are given "sample" questions for tests..
Jan 21, '05Deepz,
I always cringe a little when I see topics like these come up on the board because you can usually predict where they will end up going. As a current SRNA I always try to maintain my professionalism and hope that other SRNAs and CRNAs will do so as well. Whether as a CRNA, SRNA, MDA or AA we all at some time, more likely than not, be working together in a team environment or perhaps independently at the same hospital. In those situations hopefully we will work together collaboratively to deliver the best anesthesia care we can for our patients. As for the comment about the curdle zone:
Anesthesia is, after all, the Curdle Zone, where the cream of nursing rises to mingle with the dregs of medicine.
I feel that this does nothing to promote our collaboration and only serves to inflame one another. Deepz, I am not trying to pick on you, however I am only trying to use your comments as an example. As to comments like;
(Nothing personal, Doctor.) I do not know how you can take those comments as anything but personal. I think it is much more beneficial to us all when we get on with professional discussions concerning the practice of our trade, not who is better, who spends more time in the OR, or who brings more practioners in from a foreign country. IMHO. I am climbing down off my soapbox now.
Quote from deepzLooks like you count hours on call (sleeping, eating, TV, etc.) as hours of clinical experience. Rather bogus. But, as noted previously, typical of MDAs' characteristic mode of exaggeration. 10,000 hours, 300,000 cases.
Further, the implication that two news stories in '95 somehow led to a sudden influx of FMGs in anesthesia residencies is laughably off-base. Non-English-speaking and poorly educated FMGs have flocked to anesthesiology since the '60s, for all the obvious reasons.
Anesthesia is, after all, the Curdle Zone, where the cream of nursing rises to mingle with the dregs of medicine. (Nothing personal, Doctor.)
Jan 21, '05Although it is my understanding (from informal conversations only), that Anesthesiology historically has attracted the so called dregs.... I no longer believe this to be the case. Many of the newly graduated MDAs I work with are top notch practitioners and I imagine this will continue to be the case for the anticipated future.
Thank you very much for Tenesma's post regarding Anesthesiology residencies.
Obviously the approach between physcian and nurse anesthetist education is very different. I can't help but imagine that it must be more difficult for a physician to learn the mechanical aspects of anesthesia, than a professional critical care nurse who has been doing many of these skills in the ICU.
Jan 21, '05this puts a name on what I 've been thinking about.
I just couldn't fomulate what I see going on with the CA1's that I work with. Iam making a top 10 list of funny things I hear attendings say. here are a few.
1. the apex gets far more ventilation that the base (my personal favorite)
2. "oh oh, wait I see a buble in the line we got get that out so we don't give an air embolism.
3. whenever you attach a needle to a syringe don't touch this part (pointing to the threads) with your finger"
4. "desflurane step change? I ve never heard of such a thing"
anyway its a work in progress, I am gonna make T shirts
and don't argure about the apex deal. we where talking about an upright sv patient.
Jan 21, '05mechanical aspects of anesthesia: intubation, extubation, IVs, a-lines, central lines, epidurals, spinals, regional blocks, nerve block catheters.... i wasn't aware that these were skills that professional ICU nurses were doing in the ICU... i do agree that most graduates from medical school only have minimal exposure to performing some of those skills.
alan... what is your point? how are those things funny? and by the way, the apex does get more ventilation in the upright spontaneously ventilating patient...Last edit by Tenesma on Jan 21, '05
Jan 21, '05Quote from Tenesmamechanical aspects of anesthesia: intubation, extubation, IVs, a-lines, central lines, epidurals, spinals, regional blocks, nerve block catheters.... i wasn't aware that these were skills that professional ICU nurses were doing in the ICU...
Well, I can't say much for the epidurals, spinals and blocks ... but we always did our own IV's, extubated the patient and even inserted a-lines on my open heart unit. I didn't think those things were such a big deal. Granted, I'm obviously not talking about femoral a-lines ...
Jan 21, '05Quote from TenesmaThis is an issue of constant confusion to students of all ages (even us with experience are still students)and by the way, the apex does get more ventilation in the upright spontaneously ventilating patient...
Barash 4th ed, p. 801 "Despite the smaller alveolar size, more ventilation is delivered to dependent pulmonary areas". In the upright person, the bases are more dependent.
There are actually two different issues to be answered here, with two different solutions, which confuses us all so much.
In the upright person, which part of the lung gets more volume of ventilation, apex or base? Answer-base, see above.
In the upright person which part of the lung gets more volume of blood perfusion, apex or base? Answer, also base.
Here is where it gets fun. In the bases, is there relatively more ventilation or perfusion? Answer-more perfusion than ventilation (shunt).
In the apex, is there relatively more ventilation or perfusion? Answer-more ventilation than perfusion (dead space).
So in answering the question, you have to be very careful which question is being asked. Are you comparing apples to apples? (Ventilation in the apex compared to ventilation in the base). Or are you comparing apples and oranges together, and asking which location has a greater percentage of apples?
The old respiratory phys instructor in me couldn't resist getting in on this, sorry it is so off topic.
Jan 21, '05thanks loisane - but i was being facetious... (i was hoping to prove alan's point that MDs are useless ) here is the reason why the bases get more ventilation:
The base of the lung is at a less negative pleural pressure and its alveoli are at a lower relative volume. Thus, alveoli at the base are more compliant.
The apex of the lung is at a more negative pleural pressure and its alveoli are at a higher volume. Thus, alveoli at the apex are less compliant.
The pressure change due to inspiration will be roughly the same in all lung zones and thus more compliant alveoli will change their volume more.
During each breath the alveoli at the base will change volume more than those at the apex and thus they will ventilate more than those alveoli at the apex.
Jan 21, '05Quote from TenesmaGlad to hear it was facetious on your part, but believe me there is confusion out there about this. It is the number one issue in basic respiratory that I get asked about. I'd bet my bottom dollar there are people out there right now reading both our posts over and over until the light bulb clicks on.thanks loisane - but i was being facetious... (i was hoping to prove alan's point that MDs are useless ) here is the reason why the bases get more ventilation:
Here's hoping we have both contributed to less confusion.
Jan 21, '05"over and over until the light bulb clicks on."
If my head would just quit spinning maybe I could see the light from the bulb.... :imbar .........MAN, you guys are smart.
Jan 21, '05alan... what is your point? how are those things funny? and by the way, the apex does get more ventilation in the upright spontaneously ventilating patient...thanks loisane - but i was being facetious... (i was hoping to prove alan's point that MDs are useless )
Jan 22, '05Quote from alansmith52just get in sit down and hang on tight. becuase this my friend will never go away. I am at a clinical site with medical residents. I love my job, I got a really difficult cervical instability intubation yesterday and I felt very satisfied with the service I provided, I like my job more than I ever have,
BUT at the end of the day when the med-residents play politics at the OR board it makes me so mad. and I go home angry almost every night. I toss and turn in my sleep. I am fighting them in my dreams.
and there is nothing I can do about it, but commit my self to support our professional assocation.
u know what they r haters... some people have nothing better to do with their time but talk bad about someone else.. ignore them and u will be the better person.. what works for me is to pray-- there is a GOD in heaven.. leave it in his hands.. and do ur job
Jan 22, '05Not only can I not believe where this thread has gone, I can't believe God actually has HANDS! Man, that is wild! Is there a picture of this phenomenon?