Just before the crna intubates...

[traumaguy8]

... a patient, what stats or sats or vital signs are they watching just before they take off the mask to intubate? I was recently shadowing a crna who was vigorously watching the monitors as the patient was loosing consciousness and just before he took the mask off. I wanted to ask him what he was watching but when it was time, he handed me the laryngoscope and let me put the tube down. (ssshhh... dont tell nobody! the MDA and CRNA knew it was an easy intubation.) Needless to say i soo excited i completely forgot to ask after the procedure was over.

[London88]

No I am not kidding you. When you walk into a place and you are new you sometimes have to adapt to the culture of the organization. Failing that you are free to go work elsewhere. In all 5 heart rooms the monitor alarms are turned off. Chief of anesthesia is okay with this as well as the anesthesiologists. Most of them have been there for a long time as well as the CRNAs and this is the way they have it. You pick your battles and I'll pick mine, and this is not one that i am ready to pick! Let us not try to dictate to each other what to do.

[Tranman]

Hey, Im not battling you. Im just speakin in generalizations is all. Sorry if that sounded horifice. My apologies. Sounds like your circumstance is maybe a special one. If everyone in the department is oK with it, well then.....crap this is a hard one. I'll only do if I feel like I am watching the monitor often enough.

I haven't done hearts, so maybe that flies there. Plus I heard Cardiac surgeons think they are god anyways. But I have tried to turn off the monitors before and found that I was still missing things despite trying to be very vigilant. Made me very uncomfortable, so I just won't practice that way. Sorry no hearts for me at your hospital....I agree with you about being new and doing as the Romans do. Also don't forget, that the other anesthesia providers have been there a long time. they are comfortable with those surgeons, they know their how the surgeons operate and their picularities. What I mean is they know who's slow, who's fast, who loses too much blood, etc. When you're experience and good, then you can take it easy and maybe turn your alarms off. I understand what you said about the heart room, but I hope you don't have your alarms off in other cases too. When you're new, you can't afford to do what the others do. Again, this is a special case so I understand. Also when a new grad CRNA messes up, he gets treated differently then when an experience MDA messes up. The later, they'll cover for him. the new guy, they sell down the river. Seen it before. Another example of this is the CRNA that gets busted with drugs = usually fired. MDA = rehab baby.

For everyone else out there. Turn your monitor alarms on.

London this is not a dictation. I'm a CRNA, I know better. I know how CRNA's don't appreciate being dictated too. I know mostly students read this board. This is good solid advice to the new ones, not you. You do what you want and I'll practice the way I want. I agree with that. good point.

[London88]

You are right it is a slightly different game in the heart room and we do primarily hearts. You are constantly watching the monitor as things change by the second. When we are on bypass you get to relax a little. If we are doing off pump then you are glued to the monitor. On another note chief of anesthesia is awesome not just as a director, but as a person in general. When the CRNAs who have been there for 25 years tell you that you will never work for a better boss you know that speaks volumes. He is very supportive of us as CRNAs and even when there is an issue I have yet to see him go against the CRNA. That is not to say that he goes against another physician but he always seems to be the peace maker.