Do you have any anesthesia helpers?

yoga crna · Jun 12, 2005

This issue never goes away. I recently had a difficult intubation and the assistant surgeon (ENT) said he would do it. He used the teeth as a fulcrum, broke a tooth and now the patient wants me to pay for full veneers. I have to deal with that one next week.

Self confidence is one of your biggest allies when you are a CRNA. There are a lot of people who don't understand and don't want to understand what we do. I make it a point to let everyone in the OR know that I am current in anesthesia and medical knowledge and have an aura of pride in my anesthesia techniques. You can have self assurance without being arrogant and it is worthwhile to develop that trait.

But, I have been known to be firm and argumentative when it is appropriate. Anesthesia is hard enough without having to put up with unnecessary BS.

Yoga

gravitycure · Jun 12, 2005

I recently had a difficult intubation and the assistant surgeon (ENT) said he would do it. He used the teeth as a fulcrum, broke a tooth and now the patient wants me to pay for full veneers. I have to deal with that one next week.

hi yoga, that's terrible! the md should come clean and stand up for his actions. (i bet that's a different story though).

i do have one q and i'm not pointing my finger or anything but i am wondering why did you let him do it? as i am new to the OR, in my 3rd semester, i wonder what prevented you from calling the chief? etiquette in the OR can be challenging in these sticky situations. i am still getting my bearings. any more info here would be helpful, a learning experience - if you do not mind sharing.

thanks.

.f.

yoga crna · Jun 12, 2005

i do have one q and i'm not pointing my finger or anything but i am wondering why did you let him do it? as i am new to the OR, in my 3rd semester, i wonder what prevented you from calling the chief? etiquette in the OR can be challenging in these sticky situations. i am still getting my bearings. any more info here would be helpful, a learning experience - if you do not mind sharing.

I work by myself--I am the worker and the chief. I have learned to let others assist me, and am too proud to ask for help. There have been many times that I have had one of the RNs start the IV when I couldn't seem to get it in.

Yoga

forane2001 · Jun 13, 2005

I am glad this topic was introduced. My facility is saturated with this type of mentality, so much that I have considered leaving. CRNA's are often "dumbed-down by other OR staff" Comments like" well you are just a nurse" are made at times. I have personally be told that I didn't count" I dont really understand why we should tolerate that type of attitude. Just because someone has seen anesthesia performed for 30 years doesnt mean they know anything about it.

I had a bit longer and more complex thread written but the forum didnt take it, so sorry for the abbreviated version.

I can say for sure that I knew very little about anesthesia before I went through school and I had researched being a CRNA for several years.. I just dont understand how people can be so arrogant and overbearing when they dont have the education or skills to back it up. I believe that everyone on the team should have respect. I can figure out how a PCT or scrub or LPN can "dumb down" a highly educated person like a CRNA and get by with it. By dumbing down I mean telling them they dont count/only the ologist counts/your not a doctor/you dont count/your just a nurse too. You get the point.

All CRNA's have walked in the RN's shoes, but only a few RN's have walked in the CRNA's shoes.

thanks

rn29306 · Jun 13, 2005

While we are on this subject, I'd like to share with you guys what happened the other night on my call shift. Young 20 something y/o male patient was a trauma victim going for lower ext fixation due to busting up his knees and ankles. Save you the long story but there was a room full of people and two SRNAs - one senior and me as the junior running the case. He was fairly unstable as far as BP goes and we had alot of products going at once. In fact he was so unstable that the ortho guys doing the surgery asked the circ RN to call the trauma surgeon and he asks us what we are doing and how everything is going. No additional input from him. For the record - I hate I-STAT machines. The senior draws a sample from a large PIV for the I-STAT to read and low and behold - K comes back as 8.0. He did have some LE muscle crush injury and we RSI'd him using Anectine due to being a trauma. Problem is that he was in NSR, not a perfect rhythm I would expect for a K of 8. We opted to draw another sample and send it to the lab for a re-read before we start treating this K level. Here is the fun part:

I ask ONE OF THREE RNs who were in the room standing there to please get some regular insulin. And by standing, I mean STANDING, not doing a damn thing else. I wanted to have this in the room should we start getting any kind of cardiac dysrhythmias or if the lab came back indeed true.

Her reply was - oh get this - "It's in recovery and feel free to go get it yourself."

We have a patient unstable enough that the surgeons called the trauma service, had trauma come to the room and this woman (night shift OR charge RN no less) had the balls to tell us to go get our own medicine just because there was two anesthesia providers at the head of the bed. Her response was to one of the other two RNs standing there - "There's two of them anyway."

I swear to God this shall not happen to me as a CRNA. And people wonder why anesthesia gets pissy and loud sometimes. The crap we take by other people - ESPECIALLY RNs and scrub techs is utterly amazing.

Why? I don't know but this sh!t ends in August of 2006.

London88 · Jun 13, 2005

I am a senior SRNA and was in the room by myself doing a pediatric case. The procedure was a short so I did not want to use too much muscle relaxant. The pt bucked so I reached over and turned up the sevo took the pt off the vent, and assisted her manually. The RN in the room takes my two way walkie talkie and calls the ologist to the room w/out me asking her to do so. The ologist comes running in and asks whats going on. I said nothing is going on and told him what happened and that the situation was under control. He looked at the RN and told her Don't you ever call the anethesiologist unless told to do so by the SRNA or CRNA and that she was out of line. She tried to defend her actions but he was not having it.

Laughing Gas · Jun 13, 2005

Just because someone has seen anesthesia performed for 30 years doesnt mean they know anything about it.
thanks

Exactly! This was my point. I had been a circulator/scrub for about 5 years. I thought I knew alot about anesthesia. I still like to think I was actually helpful and never overstepped my bounds. But I know that I credited myself with alot more knowledge than I had. Anesthesia by osmosis? Once I began to learn anesthesia, I realized just how little I actually knew. This includes the prior time spent in ICCU and ER.

I think alot of the time OR staff likes to "show off" by how they help anesthesia. When they screw up, they tend to become defensive of their actions. Alittle knowledge is deadly sometimes.

To play devil's advocate... I have also been helped greatly at times by the OR staff. Some politely ask" Would you like me to hold the mask while you get your drugs?" A good circulator in tune with your needs is so valuable. They can sense when you need help, and can disctretely assist. There, now I'm PC! :)

Medic14 · Jun 17, 2005

OR staff personnel are very good at their nitch of nursing, that is counting instruments, laps, running around getting materials, positioning patients, etc. They are the best at what they do in the OR. I too have seen how OR staff can dumb down even anesthesia residents, sad but it happens. My previous work enviornment was very demanding and busy. As a unit the OR and ICU pretty much got along, the ICU staff would assist in transfering patients onto the table, positioning, etc. However a couple of incidents, I personally drew the line, example, call from the OR telling me I had to go to the blood bank and get more products with the request forms, walking to the OR ( 1 curculator, 1 staff RN, 1 orientation RN, 2 OR techs) all for one patient in the room, as you can guess I dropped the request on the computer and said the blood bank is down the hall. Also, another interesting point, we did have one code in the OR in a 18month period, very rare, but %@#* happens, guess to ran the code, yes that's right the ICU nurse came in and the OR nurses were recording.

From the discussion above, It seems you need to pick and choose your battles wizely.

lifeLONGstudent · Jun 18, 2005

rn29306

What is the rest of the story - if you don't mind sharing with the rest of the details with us. K+ recheck from lab at 8? Hang the insulin? Trauma surg come in? etc etc etc...

Thanks,

lifeLONGstudent

DAREINGTX · Jun 18, 2005

I'm not an SRNA, but i have worked in lab while in nursing school. I STAT machines are not very accurate, but in our facility they are always very close when controls are done. The problem is usually with hemolysis when blood is drawn from an angiocath.

rn29306 · Jun 19, 2005

rn29306
What is the rest of the story - if you don't mind sharing with the rest of the details with us. K+ recheck from lab at 8? Hang the insulin? Trauma surg come in? etc etc etc...
Thanks,
lifeLONGstudent

Sample was indeed hemolyzed and no futher action was required. If he had been unstable as far as his rhythm goes, I would have certainly believed the Istat K level. All that resulted after this was agressive fluid resus and a big fat ego battle. K came back 4.something which was a little suprising given a leg crush injury and using Anectine. But hey, I'm not complaining.

Just the other day I had a housekeeper tell me to give the patient a breath. We were going prone on a young healthy male pt, preox then intubation on his bed. Several residents were going to assist in moving him to prone position. I was alone in the room. These guys said they were ready when I was, so I disconnect circuit and turn off gas. Some incident with the pt's Foley had to be straightened out, so we are looking at maybe 9 seconds without ventilation. Sats 100%, pt still paralyzed and hanging out on the intubation dose of propofol.

The resident looked at me and said "give him a breath". A look of utter amazement was probably on my face. Then the guy that MOPS THE FLOOR said "yeah, give the man a breath". Sats still 100%. All VS normal. Has been around 13 seconds of no ventilation at this point and we are ready to roll to prone position. I asked them if either one of them could tell me, in seconds, how long it takes for a preoxygenated young healty adult male to desat from 100 to 95, then I would give him a breath. No answer and we rolled. Resident kept eyeing the sat waiting for it to drop and it never did.

I honestly think the residents wait until our attendings and CRNAs leave then try to dump poo-poo on us. This summer is going to be a blast.

rn29306