AmiK25

I would think that someone who does it everyday would know that you should not give someone 3 mg/kg of Fentanyl. I have never heard of giving 10% of your Sux dose to defasciculate....only heard of giving 10% of the intubating dose of a non-depolarizing agent. Does the Succs actually work? Also, lidocaine is given for other reasons besides prevention of increased ICP with Succs (which really requires about 1.5 mg/kg). It also blunts the sympathetic nervous system response to laryngoscopy.

The University of Cincinnati has all clinicals in the Cincinnati area, with most being at University Hospital on campus. The farthest site away from downtown is 30 minutes.

I realize that at one point you were discussing pushing epi for anaphylactic shock. However, in your post, you did not say epi, you said neo and I don't think you were still discussing anaphylactic shock because obviously, you do push epi, regardless of whether the patient is tachycardic or not (which they should be if it is anaphylaxis). I think that instead of learning from this thread (which we all have), you just cannot admit that there might be something you don't know and you have an excuse for everything. We are all learning on a daily basis, whether it be in the OR, ER, or ICU and we should all be able to admit that there are things we don't know. I'm not trying to be rude but that is my honest opinion.

Post-operative nausea and vomiting

what if the pt iwas allergic to eggs and you didn't know that? do you have we have a kit too. and i have never seen a board certified er doc or an intensivist in 20 years put pressors before fluids. see my post above about tachyarrythmias etc. you would really do that? push neo directly for a sbp in the 60s and a heart rate of 122? do you worry about throwing the pt into svt of 160 or so? do you have adenosine ready in 3 syringes? 6/6/12? do you wonder about inducing v tach? do you compare the mean to your baseline?? now you've got bigger problems!!! Actually, Neosynephrine causes a decrease in heart rate, not an increase. Neo would be a great choice for a patient with a low blood pressure with a high heart rate, especially if it was due to the vasodilating affect of propofol. Neo, although it has other actions, works primarily by vasoconstriction. This vasoconstriction causes an increase in afterload and venous return, which results in reflex bradycardia. So yes, in anesthesia, we routinely push Neo 100-200 mcg at a time for hypotension that occurs after induction. And yes, we also give fluid, etc...

The actual course may not be $1000 but by the time you pay for hotel, food, and gas....it will be right around that amount for the weekend.

You need something like 1700 hours, which amounts to about 1 year of full-time work.

I'm with you here....our new class starts Tuesday and I feel like the second years knew so much when we started last year and now that I am a second year, I don't know anything!! Congrats to the graduates....I can't wait! Ami

I agree with midwestern....I just don't see a good reason to spend that much money to recert while in school. As a poor RNSA drowning in student loan debt, I let my CCRN lapse. Now, I do think it helped me get into school so for those not already accepted, I highly recommend getting your CCRN...and once accepted, don't worry about!!

Hope this helps!

Somehow this sentence didnt' end up in quotes but it is supposed to be "I never thought I would have the intelligence to do it, but I heard someone make the comment that CRNA schools basically take you if you have ICU experience and a pulse." Now, I'm not saying you don't have what it takes to get into an anesthesia program, but that statement is definitely not true!! There are many applicants for a very small number of positions in most anesthesia programs.

Well, I haven't done OB yet (September and October of this year) but I will give it a shot. I would do a spinal (as long as the patient does not have plates/rods/screws in the lumbar region...which is doesn't sound like she does). My concerns would be autonomic hyperreflexia (make sure she has an adequate block before proceeding....but I'm not really sure the best way to assess this given the fact that she has no sensory function below T6....do you just look at vital signs??) and hypoventilation if the spinal was too high becuase she may already have some respiratory insufficiency due to paralysis of abdominal accessory muscles. Obviously, avoid Sux if you have to do a general and I suppose I would choose Mivacron or try to do an awake fiberoptic intubation given the incidence of cannot intubate/cannot ventilate with pregnancy. Like I said, I haven't been to OB yet just wanted to venture a guess. I may be way off. How did you handle the case?

Yeah, you're right...six months is probably closer to being accurate! I definitely still have days when I am all thumbs and feel like I don't know what I am doing, but it is getting better each day. Of course, now I have my OB rotation coming up soon and it's right back to not having a clue what I'm doing Ami

Sigma, Just remember...you will feel like a total idiot and completely out of place for the first month or so. Even something as simple as starting an IV, which you may have done hundreds of times, feels totally foreign in anesthesia school. Eveyone else feels that way, too, but it will get better. Sometimes, I even feel like a know a little bit of what I'm doing these days (10 months into an integrated program). Just have a positive attitude (it's very hard sometimes) and remember that there are a hundred ways to do anesthesia so when someone tells you you are doing it wrong, just smile and say "Ok, thank you." Good luck, Ami

Brian, We have them furnished in all our rooms...whether or not they work or the batteries are current is another story I would definitely not buy one...wait until school starts and then ask a rep if you want your own. Ami

Yes, that's true. I got a subscription to the AANA journal about a year before I joined my program. Just go the AANA website and look under publications...there is an application. It is pretty cheap, something like $40-50. Ami

I have to agree that this protocol is outrageous...who in their right mind wrote this? I also intend no offense to the RNs that work in this institution, but I guarantee the first patient who goes into pulmonary edema or even Vfib (yes, that can happen) after getting this dose of Narcan, it will not be good enough to just say "It was in the protocol."

[As for Columbia, the outline I viewed offered doctoral classes in health policy, research and statistics, epidemiology, legal issues, informatics and practice management. And that's the problem. In what way do those classes make you a better practitioner in the clinical area. They are calling the DNP a "clinical doctorate" as opposed to a research doctorate, but those courses have nothing to with the clinical area. If the DNP included more clinical courses, such as a residency or fellowship in a certain specialty, I would be more willing to support it. As it is now, it will do nothing but cause more problems!!

Here is how the stipend at my program works (and pretty much every hospital/group in our town offers the exact same deal). You receive $1000 month for every month you have a signed contract. If you sign for the entire 27 months, you owe three years. I have signed for 18 months so I owe 2 years. If you do not accept a job at this facility, you owe them the entire amount they gave you, plus 50%, plus interest. If you leave early, you owe them the remainder of the amount (they take off $750 per month for every month you work), plus 50%, plus interest. When you graduate, IF you are offered a position, you must accept within 5 days or you must pay them back as I stated above. Notice I said IF, because it clearly states they are not obligated to offer you a position. Now, I know this was not the case with the above poster, but I believe the majority of contracts do include this clause (someone correct me if I'm wrong). As far as finding contracts, when I was accepted into my program, I received a letter from pretty much every group in our town offering me a contract. Hope this helps.

Actually, it does have something to do with catecholamines. Severe acidosis, with pH

I applaud the fact that you want to pursue anesthesia school, especially as a single mom. I know people have done it and I do not at all want to discourage you. I am strictly going to tell you how many hours I spend away from home or studying at home. I am about to begin my fourth quarter of anesthesia school. Right now, I am in class about 15 hours a week and in the OR about 24 hours a week (three clincal days but some are cut short because I have to go to class). We also have to stay at the hospital until the OR schedule comes out (around 4-6) to see if we have an inpatient for the next day we need to pre-op (some people can go home but I live 30 minutes away and it is too much trouble to drive back in). I would say that on average, I spend about 2-3 hours/night studying/preparing for clinical....of course some nights less than others and usually spend about 8 hours on Saturday and Sunday studying for whatever test is coming up. I do take some weekend mornings or afternoons off if we don't have a heavy schedule for the week. Starting in two weeks, we have clinical every day Monday-Friday for the remainder of the program (except for two weeks vacation), which is mixed in with call shifts (16 hours during the week, 12 hours on the weekend). We do get the day off after call and two days off for a weekend or holiday call. This will also be mixed in with the remainder of our classes, which will be in the afternoon or evening after clinical. I would say that I definitely spend at least 50-60 hours/week studying or at school. I have a 2 year old son who my husband takes wonderful care of who I do try to spend a little bit of time with every afternoon/evening before bed but sometimes I gone before he gets up (have to be at the hospital around 5:30 on clinical days) and I don't get home until he is in bed (but he goes to bed early around 6-6:30). So, I know this post is really long and probably discouraging but I do not mean it in that way at all. I know there is a way to do it....you will just have to work very hard and try to find a way to balance things. Since your daughter is older, I would think she would be able to help you around the house and do many things for herself that a younger child might not be able to do. I also think maybe a front-loaded program might allow you to spend more time with your daughter in the beginning (our program is integrated and balancing classwork and clinical is definitely a challenge). Anyway, good luck with your pursuit and let me know if I can answer any questions. Again, I do think it can be done, I just wanted to offer you an honest answer as to my time requirements. :welcome:

I e-mailed our program director today and she said there is absolutely no truth to this rumor. We are on a 10-year accreditation visitation schedule, which is the longest it can be and we do not have "safe practice issues." She told me that I can feel free to give you her e-mail address so you can address questions to her directly. Let me know and I will PM it to you if you would like. She is vice-president of the AANA and will be running for president e-elect this year and she is really great so if you have questions, don't hesitate to e-mail her. Anyway, we are not nor will we be on probation and whoever told you that is just spreading rumors. I would really like to know where you go to school but I understand if you don't want to tell me. Let me know if you have any questions. Ami

I am at the University of Cincinnati and the majority of our clinical education is completed at University Hospital.

I didn't think you were trying to be hostile I was just wondering where you heard that rumor. I haven't heard anything about it and like I said, I can't imagine it being true. If I do hear anything, I will let you know. If I see our program director this week, I will ask her.

I attend the University of Cincinnati and I am pretty sure we would have been told of we were put on probation for safe practice issues. I am curious as to where you heard this rumor and what the supposed safe practice issue was. I feel that our clinical training is excellent and I just can't think of anything that would be considered unsafe! Can you provide more information please? Ami