volatileRRNA

Sorry for the confusion, When I said Ca++ binds to these channels, I was talking about the Sodium voltaged gated channels. What you're talking about are two different things. As Focker has mentioned, this mechanism is explained in Guyton and Hall. Also this concept is taught in depth by Dr. REINKE @ TWU, whose one of the most proven and well known A & P professor in the anesthesia community.

Focker has the right answer. Let me try to simplify though. No matter if cardiac or skeletal muscles, contractions requires the (fast)sodium voltage gated channels opening first. Ca++ binds to these channels. If too little Ca++ binds, it is easier to cause a conformational change to open these channels = hyperexcitable. If too much Ca++ binds, it is harder to cause these change = hypo-excitable. Change in Ca++ does not affect the resting membrane potential(RMP). It only affects the threshold potential (TP). Resting membrane potential is only changed and maintained by potassium. This is why you give calcium to a hyperkalemic pt during a code. The hyerkalemia will increase the threshold potential, and in order to compensate calcium is given to increase the threshold potential to make the heart less excitable.

Dobutamine has mainly B1 agonist and inotropic effects. It also has minor alpha(vasoconstriction) and B2(vasodilation) effects. Usually you will see no BP difference b/c the increased cardiac output will offset the effects of the vasodilation by B2 stimulation. Everyone act differently w/ this drug. Sometimes the increased cardiac output w/ the alpha effect has more effect than the vasodilation, thus u will see an increased BP. The greater the dosage, the more alpha effect you will see even though this effect may be minor compared to dopamine. Then sometimes the vasodilation is more profound than the increased cardiac output, in which u will see decreased blood pressure. So which way will the pt go? Mostly depends on comorbidity. And in some is just a coin flip.

I do not have an I phone, but my family does. Typing for texting and typing for programs are two different things. Yes for texting, u can master the touch keyboard and type very fast. The reason the I phone is limited in medical programs now is that they have to change the format in which u enter in the information. Some programs doesn't give you the entire screen allot for the keyboard and thus the problem. Now imagine the touch screen keyboard u are touching is now half the size. Very few people have the finger size of a stylet. Again, I'm not an expert in palm/smartphone devices. Just my opinion from my researches and going around to all the stores to play with the phones. Everyone have their own preferences. All phones have their advantages and disadvantages.

I've been researching and debating this problem for quite some time now. I love the blackberry look and style (esp 8820) but they only operate on RIM operating system which will severely limit you program choices. The programs choices that's available now for 'em, not my favorite. I have a blackberry now but will soon change to another. Next is the PALM operating system. Yes, it's been out for a long time and have tons of program for ur choosing. But is quickly becoming obsolete. Even PALM TREO is going towards Windows. PALM system is easy to use but u can only use 1 program at a time and ur really limited to the PALM CENTRO or the PALM 755 phone at the moment. Last is the WINDOWS based phone. It has the user interface that we are use to w/ WINDOWS, & can alternate b/t programs. There are tons of software. If ur not using the newest version of Windows 6.0 or 6.1, ur phone may tend to lock up occasionally (yeah it can happen to ur phone too). The best phone available at the moment for this is the PALM 800w but only on SPRINT. It has WiFi and GPS, oH mY!! Crap! Ooops. Forgot about the i- Phone. Yeah it has the cool factor, but practically use- not really. Imagine touch screening those long names of conditions and drugs when ur in a hurry. " Hold on DOC, but hey don't I look cool ? " Plus there are very limited software available at the moment. Heard there is a program coming out soon that will allow u to use other Operating system software but still not practically for the OR. But do u really need a smart phone anyways?? For school - Nope. But theres are always a couple of em- u know who u are! For clinicals - Not really. Talking to many CRNAs/SRNAs, very few uses em. Even the students rarely uses em. But a few swears by it though. Don't know about u , I just want a safety net for that just in case moment. Hopes this helps.

I see that you live in Texas and assuming that you will be applying to the different schools in Texas?? I didn't interview at the 2 schools in the south but did at TWU and TCU. the requirement is to have a minimum of 1 yr ICU experience which you exceed. To get into TCU, you must have ur CCRN which requires some CV knowledge (although u may score very high on other parts and low on CV and still pass - but unlikely). Assuming that u do get an interview and is accepted, CV system is a major focus along w/ Pulm and may be a little overwhelming w/ little background - but is very manageable. To get into TWU, you don't need CCRN but will need some CV knowledge for the interview. And along w/ that, they will also ask u questions based on the types of ICU's u worked. You've said u worked in the SICU/MICU before also. So my suggestion is (if TCU and TWU) that u stay put and study CV like u are studying for the CCRN and actually take it. These school aren't expecting u to know everything ( !!!! 1yr ICU minimum !!!!! ), but to be teachable and prove u were paying attention where u've worked. I had also interviewed at other schools ( hey!! had to keep my options open) and u definitely need 2 know ur CV and pulmonary system. So all dependent on where u want to go. Many of my classmates only had Neuro ICU experience and was very weak in CV & did fine. Hey, I thought I knew the CV pretty well until I got into school. GOOD LUCK

From the post: "Dissapointed in WC permalink I am a current WC student in full time clinicals. I am very dissapointed in the way the program is run. From a didactic point of view, they accept more than necessary and than the class is trimmed (30% drop rate). That's unfair to the students that shouldn't be here - they spend time and money pursuing something that is out of reach for them. " Saw this in a previous post. 30% is alot!!! Thought mine was bad. Is this true for WC?? What about your school?

Seems really odd to me. Have friends that had only a couple of months in the ICU when interviewed, but eventually had at least 1 year of experience when starting classes. Seems impossible to work fulltime and attend school in an integrated program. With a front loaded program, working once a week is manageable if you're usually on the top curve of your class. A friend of a friend huh??? Think I heard these stories before.

I initially went into nursing to "make a difference". But nowadays, seems like more emphasis have been placed on paperwork and charting. If there's a problem on the unit, "more paperwork or documentation will fix it attitude" seems to be route. I now know why there's such a huge shortage in nursing. Big to those who done it for 10.. 20....30 yrs. Yes they are the grumpiest of them all but, Hey, 6 months in and I was grumpy too. It's hard to be compassionate when you have to say, "hold on, I very busy at the moment, I'll be back". Hopefully, the CRNA route will be different...

Don't waste your money with all of the books and videos. Like many said, the PASS CCRN book is too dry, only do the practice questions on the CD. Also there's a small book, cost 20 something dollars. It is also written by Laura Vonfriolio. It only contains Q & A that will prepare you for the exam. By the time you are eligible to take the exam, it's all that you need. All of my friends that did this have passed (even the ones I doubted-sorry ). The test is much easier that u think. But everyone have their comfort zone. Good Luck.

I have a choice to do my OB rotation at either JPS or Parkland. I have a friend who works at Parkland OB unit as a RN. She only had good things to say about Parkland.