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BigPappaCRNA 2,409 Views

Joined Jan 13, '13. Posts: 90 (69% Liked) Likes: 173

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  • Nov 19

    Like most "either or" choices in anesthesia...it doesn't matter. Kinda like a DNP. Just get one.

  • Nov 19

    A lot of people use a Macbook Pro or Air supplemented with an Ipad at times. A couple others use the Microsoft Surface Pro. A reliable laptop is really the only requirement, I wouldn't say any particular brand is going to make an exceptional difference. Recording lectures and listening to them again could be vital though, a device to record them would be a good idea.

  • Nov 19

    Lenovo Thinkpad 13. Less than half the price of a Mac and more user friendly. Also, usually best to make sure you have Microsoft Office because a lot of the Mac programs for writing and slideshows are a pain to cross over to Word and PowerPoint which are the format of most of the material in school. Also, use the money you save on the computer to buy a really good recorder, record lectures, and listen to them while you're driving or working out... great way to add more study time to your day.

  • Nov 19

    Remember the end goal is not getting into a program it's completing a program and passing boards. People are graduating from programs and sometimes never passing boards. Not many but it happens. By the stats in the example above 1of 2 failed out of a program and have to pay the expenses of a program on an RNs salary.

  • Nov 18

    FYI: Anesthesia doesn't administer propofol drips for days on end. We administer propofol usually just for surgical cases, which on average in the US are 2-2.5 hours.

  • Nov 18

    Quote from Pharmahaulic
    Thank you for the reply... is there a guaranteed number of does that a person can be on propofol before propofol infusion syndrome sets in? In other words does its onset correlate with the amount of days used?
    Just google Diprivan dude...this is getting creepy....

  • Nov 4

    Quote from wtbcrna
    I don't believe aspiration is increased risk....

    And I don't believe in aspiration of CSF at the end of a spinal injection either!

  • Nov 1

    Quote from jwk
    But they have yet to release a statement saying that an anesthesiologist was present for the Joan Rivers case, and they certainly don't say they use an anesthesiologist for EVERY case.

    I thought they had changed their story about the vocal cord bx - regardless, tickling the cords with an endoscope is pretty easy to do. I frequently have to ask some of our GI docs NOT to go back down and suction of that little bit of snot they see down near the vocal cords as they're withdrawing their scope.
    That is true, and as I have said it is all just conjecture at this point.

    We do know that it had to be either an MDA or an RN doing her sedation.

    IMHO I would still guess an MDA just from past statements by the ASA when CRNAs or RNs make sedation errors, and when MDAs make a mistake the ASA is quiet all of sudden.

  • Nov 1

    Quote from jwk
    Nobody seems to be talking - I know you're hoping it's an anesthesiologist. Honestly, the other names have come out, so if there was an anesthesiologist there (or a CRNA), you would think that name would have surfaced by now. Considering Cohen thinks anesthesia personnel are superfluous in GI cases, at this point it makes far more sense to guess that they weren't even there.
    I disagree. That GI clinic was known to have only MDAs working there, and the ASA has no problem pointing fingers when it is a CRNA involved in a malpractice case. The AANA actually refuses to do the same when MDAs are involved in malpractice cases... Joan Rivers was also quoted to say she would never have a CRNA working on her, so the two most likely cases were either an MDA or an RN doing the sedation.

  • Nov 1

    In our program they start using APEX as a supplement for lecture 2.5 years before we take boards. Essentially after the first semester they start making us hammer board prep material. Many of the seniors who graduated this Summer and took boards said APEX and SEE helped them feel confident in passing first time. From my experience with APEX for about 9 months now I have to say it's helpful and intuitive. It takes the general topics from the textbooks and breaks it down even deeper while also applying it clinically.

  • Nov 1

    Quote from Bluebolt
    I agree the dogma is rampant wtbCRNA which I find frustrating as an SRNA spending my life chained to a desk learning a tidal wave of information to only find it's dogma or not clinically applicable. The only question I have about the topics you listed (which are contentious in the anesthesia community) is the risk for aspiration after X weeks in pregnancy. We were taught that the actual number of weeks is flexible but many choose to tube after 12-14 weeks due to the progesterone effects of relaxing the lower esophageal sphincter. Have you found this to not be true?

    Offlabel, I do know people who give them mixed in the same syringe. I believe the onset is faster in the robinul which is why it can be justified to be given in the same syringe. Now if you tell me you don't give it at all and don't have muscarinic side effects you'll blow my mind.
    I don't believe aspiration is increased risk over other patients unless the pregnant patient is symptomatic/GERD symptoms. There isn't increased gastric volumes but the esphogheal sphincter threshold pressure may be reduced.
    I'm actually involved in a research project looking at eating during labor now. I think the risk of aspiration in pregnancy is more dogma than anything, but it is one of those that is hard to study.

  • Nov 1

    And there's no need to give robinul before neostigmine, ie, you can very safely mix the two in the same syringe.

  • Nov 1

    There is a lot of dogma in Anesthesia/medicine/nursing.

    Here are a few:
    Dogma/Evidence
    High concentration O2 causes absorption atlectasis in surgical patients not only is it not true but high concentrations of 80+% decrease surgical infection rates.
    Ephedrine is better than phenylephrine in OB patients. Phenylephrine is actually better for OB patients.
    Large (>0.1mg/kg) doses of decadron increase SSIs. Decadron given in >0.1mg/kg decreases Post pain scores, ponv, does not increase ssi, or significantly increase BG in Type 2 DM.
    Ancef is contraindicated in PCN allergy patients. There is no significant increase in cross-sensitivity with PCN allergy patients, no matter the severity, with cephalosporins as long as the R1 side chain is different.
    Pregnancy equals full stomach after X weeks. Gastric emptying does not change in pregnancy.

    You can find meta-analysis or sytematic reviews on all these.

  • Oct 29

    I honestly do not think the prestigious name of a program matters. I always wondered myself, why would a student attend Stanford University to get a BSN? Are they going to come out and make more money than me? No, they just have a larger educational investment. Is their program somehow better than mine? Doubtful. I'm sure the same goes for graduate school. Check out their graduation/pass rates and go from there. In the end, all that matters is that the degree you receive is from a national accredited program. Everyone takes the same boards and have the same letters behind their name, CRNA.

  • Oct 29

    Quote from offlabel
    Any non physician anesthetists, whether individually or corporately, one day realize they don't need to have their hand held by a doctor to do anesthesia. CRNA's knew that very early on and AA's are beginning to realize this now. One day there will be such a thing as a "militant AA" as far as anesthesiologists are concerned, if that entity doesn't already exist.

    The difference is that AA's practice at the pleasure of their state's board of medicine and can be dealt a lethal blow over a weekend. CRNA's are credentialed completely independently of any physician organization and as such are free to pursue or not pursue varying degrees of "independence" as they see fit.

    Take away? AA's need to play nice, regardless of the skill and experience they bring to the table. CRNA's don't.
    The problem with AAs being militant and wanting to break free is that they can not do this without going back to school and switching professions. They literally cannot practice independent of a anesthesiologist.


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