Hardest interview questions

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Out of pure curiosity, I wanted to know what everyone's hardest interview question was. I interviewed at three schools and all asked "what can you tell me about yourself?". An easy question, but I can't keep myself from wanting to say "well, I'm 6 feet tall, 190lbs. I like punk rock and ...". Actually, the hardest question I had was at LaRoche College/Allegheny Valley Hospital where they asked me to explain all the electrolyte imbalances in a patient with acute renal failure. Fortunatley, I recalled much of the info from nursing school. That was a painful interview. What's your hardest interview question?

Good pick up asking them if he was stil alive at least. Kind of a crappy question if you ask me. You can't see a picture by putting one lead on a chest anyway. I understand what they are trying to ask though. My first thought was V1.

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I was asked what a maximum rate of dopamine was. Stupidly, I said 12-15 mcgs, but I came to look it up as 20mcgs. I guess it depends on what book you use maybe. Truthfully, I've never used dopamine over 10 mcgs/kg, and I let her know that if you needed dopamine that high, you probably need a different agent or something else to vasoconstrict as well like epi. For some reason, I don't think she thought that was an adequate answer, just from her expression. Maybe somebody can provide some enlightenment. They also asked me what normal values for c.o, c.i., pa, cvp were which wasn't a problem at all.

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Pete495,

Dopamine @ 10mcg/kg/min affects different receptors than a dose at >10mcg/kg/min. Dopa @ 10-20 mcg/kg/min affects more alpha receptors than a moderate dose that affects more beta 1 and smaller numbers of alpha receptors. This also contrasts to low dose dopa that dilates the renal arteries. Dopamines drug effects are dose dependent because it affects different receptors at various doses. Hope this helps.

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Yeah, I understand that it affects more alpha receptors at higher doses. What I don't understand is why anybody would use dopamine at 20 mcgs/kg/min. when one could use a more potent alpha constrictor without giving the patient as much volume. I forgot to mention she did ask me what receptors were affected at different doses, and I said beta and a few alpha receptors at low to med doses, and alpha receptors at higher doses. Not that it matters now much anyway, cuz I went to a different SRNA program, but I just brought it up for the sake of discussion.

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Yeah, I understand that it affects more alpha receptors at higher doses. What I don't understand is why anybody would use dopamine at 20 mcgs/kg/min. when one could use a more potent alpha constrictor without giving the patient as much volume. I forgot to mention she did ask me what receptors were affected at different doses, and I said beta and a few alpha receptors at low to med doses, and alpha receptors at higher doses. Not that it matters now much anyway, cuz I went to a different SRNA program, but I just brought it up for the sake of discussion.

Pete ... ditto on the rationale (or lack thereof on some practitioners part) for using such high dose Dopamine when there are better ways of giving alpha. The first hospital I worked at used Dopa like it was going out of style. The next one was in-love with NE. Go figure ...

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I think that I've seen a book (recently) that said up to 40mcg for dopa. I think it was that anesthesia drug pocket-sized book by Sota Omoigui. BTW, my understanding of the 10mcg+ dose is not direct alpha agonist, but by stimulation of release of norepi. If stores are depleted, alpha affect is minimal. See baby Miller for this reference.

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Clamp em with a touch of vasopressin!

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Yeah, I understand that it affects more alpha receptors at higher doses. What I don't understand is why anybody would use dopamine at 20 mcgs/kg/min. when one could use a more potent alpha constrictor without giving the patient as much volume. I forgot to mention she did ask me what receptors were affected at different doses, and I said beta and a few alpha receptors at low to med doses, and alpha receptors at higher doses. Not that it matters now much anyway, cuz I went to a different SRNA program, but I just brought it up for the sake of discussion.

I totally agree that there are better ways to achieve Alpha receptor stimulation. Phenylephrine for pure alpha agonist or Epi or NE if you need something more potent.

Versatile_Kat,

It is funny how different places stick to certain drugs just because "that's what we do here". The last place I worked, loved Dopa and would use nothing else, even if the patients HR was 120 to begin with (Trauma ICU). The docs did not even want to hear me suggest using something with a little less Beta 1 affects. It would be nice if practitioners used the drugs that are appropriate at that time for that particular patient and not just because a certain drug is the only one they use. That's one thing I love about anesthesia, I get to chose what I think is most appropriate at any given time with solid rationale.

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Trauma ... I completely agree. I went from a large teaching facility to a smaller hospital with half the open heart beds and almost threw a party the day I saw Vasopressin being used as a drip for a septic patient. I'm looking forward to what you're already doing in clinicals and to the rest of my career as a CRNA.

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Although I defintely like vasopressin for blood pressure issues, the last couple patients I've had, I've had to turn it off due to low cardiac outputs. In most cases, however, it is a good drug, more for younger patients it seems though.

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