PattyD404

Yes, small doses of versed & fentanyl (& especially propofol) can be dangerous. Too often, it is taken for granted that "I've given it 100 times before and so far nothing has happened." Well, I have an example: How many times have we given a pt 50-75mcg of fentanyl? I did just that and the patient went into respiratory arrest. She was very difficult to ventilate via mask and jaw thrust was not working. Luckily, we had just entered the recovery room and had a nasal airway at the bedside. We were able to get that in and ventilate her much better. Some narcan and we were doing well again. However, what if that had been somewhere less prepared? No dose is "just a small dose." As for the propofol, if you check the nurse practice act, the manufacturers warnings, and the protocol in your institution, it is likely that as a non-anesthesia provider, you are NOT to be utilizing it for non-intubated patients and you are not to be giving it IV push. I believe that it must be on ICU, intubated pts, and on an infusion pump. Know your risks and know your laws.

Our CRNA program requires all final grades in the class to be above a "C." We are only allowed to have one C and it must be in a course that is outside of the CRNA courses. We are not allowed any C in the core courses at all. This is right in the standards and the handbook. It is clearly stated. I have read some of the other postings and I must say that others make good points. If it is one grade, then maybe it is a class you can retake and get things straigtened out. I know how this feels. We have a professor who does not really teach us much of anything. We have a book to read and then when we have lecture, he will take one chapter and break it down into power point. If the power point were to have 18 slides, 15 of them would be pictures or graphs from the book while the other 3 would be title slides. He really doesn't do much for us other than read from the book & provide a sort of review. It is a review that's for sure but it sure makes it hard to take his tests. As much as I read the chapters, I cannot figure out what 5-10 questions he may choose to ask from the chapter & with so many chapters on one exam, it is a little difficult. I also agree with athomas that there is a problem with nursing schools in general. I hope that Anesthesia does not follow in those footsteps & "let them through" just to fix the numbers. Yes, there is a shortage but safety of patients is much more important. So, did you do all that you could to pass the class? There is a certain amount of self-learning at this level that must be utilized. They cannot teach it all and the majority must come from your years of critical care and your self guided learning. If you can honestly say this to yourself and it is a matter that others too have been facing, then you must find an avenue to pursue the problem areas. If you all stick together and the problem seems to be the same for all of you (just this one class or professor) then you have something. Find out the proper chain of command to pursue it and get everything you can in writing. Good luck.

Yes, propofol can be used in the unintubated person. It can be a scary thing however. You know how quickly it works and the apnea can be a scary thing. It has been used for sedation during spinal anesthesia, Monitored anesthesia care, and I know that it has also been used in oral surgeons office for surgeries without intubation. There is of course someone holding the head and maintaining the airway the entire time. Sounds like your group sparks some good discussions during your shift.

I have some advice for a couple of you in this thread. I was a surgical technician in the OR and then went back to nursing school. I went to work on med-surg for too long before I decided to go to CRNA school. I only had 2 years ICU experience (& our ICU is smaller). Here are my thoughts. The OR experience was priceless for me because I was much more comfortable than some of my classmates were with positioning, how to know your way around the OR, knowing what is involved in the procedure being done, etc. It was somewhat of a stress reliever. However, it was hard to ignore that part that you do know and focus on what I needed to do now. That didn't last too long however. As for getting ICU experience in 2 years, I guess it depends on how big your ICU is. In our ICU we are getting away from lines and the only ones who really have them are septic patients and Immediate post op CABGs. The CABG usually loses the line the next day and go home in 4-5 days. So, for me, it is still a struggle to remember normal hemodynamics that well. I am into school 6 months now and have not used that information yet in school so it will be very necessary to review it big time before starting hearts & such. I say get as much experience as you can in the ICU and maybe you can do some per diem in the OR to get your feet wet??? Good luck.

It sounds like you have a big decision to make. I have some repetative advice that others have stated. I think that it is very important for you to shadow CRNAs & also physicians. I am not sure what kind of specialty you are looking into but I will put this bug out there. In my area of PA, the CRNAs make the same (or more) money than the family physicians in the area. If you are that close to completing your BSN, it sounds like you are already leaning toward a future in nursing. CRNA is an advanced practice and definitely a step up, not a lateral move as some have tried to tell you. It is important to know if you are willing to move or are staying put because independence & job availability will vary. Do your research and compare all aspects: hours, pay, education, available jobs, call time, assistance with school, and what is it that makes you the happiest. Good luck

My dog is wonderful in his indoor kennel for 10-11 hours. I have not had him in there longer than that so 13 might be pushing it. If you have an area where you can have an outdoor kennel where they would have a fenced in area and be able to have a dog house where they could get out of the weather if they needed to, this would be a great option. Maybe you could have a neighbor kid do some dog sitting for you & let them out 1/2 way through. I don't know where you will be working but a worse situation might be that you would get mandated to stay and 12 HR turns to 16. Another option may be doggie day care. A couple of people that I work with take their dogs there a couple times a week just to be with other dogs and get exercise that they are lacking. They said that it is wonderful & they love it and the dogs are so tired that they don't get up until 2:00 the next afternoon. Good luck