Tenesma

Tenesma

Member

  • Content

    364

  • Visitors

    7,718

  • Followers

    0

  • Likes

    3

All Content by Tenesma

  1. Propofol question

    Tenesma replied to chris_at_lucas_RN's topic in Certified Registered Nurse Anesthetist, CRNA

    actually he isn't entirely incorrect --- propofol degrades with oxygen exposure primarily due to loss of emulsification due to breakdown of soybean oil (lecithin is a great stabilizer, but not above...

  2. intubation of morbidly obese patients--have tips?

    Tenesma replied to gugal's topic in Certified Registered Nurse Anesthetist, CRNA

    suzanne i agree that the size difference is considerable, my point revolved around the autonomic/sympathetic reflexes. Trachea is extremely more sensitive --- i have seen far more people code from...

  3. anesthetist vs anesthesiologist

    Tenesma replied to caffine's topic in Certified Registered Nurse Anesthetist, CRNA

    bottomline i think the original poster had an excellent question - which is bound to come up during interviews for CRNA school... My posts (in my defense) were primarily directed at those who have...

  4. intubation of morbidly obese patients--have tips?

    Tenesma replied to gugal's topic in Certified Registered Nurse Anesthetist, CRNA

    wintermute: i think epidurals are a wonderful thing for bariatric patients... but unfortunately for some of the 700 pounders we just don't have long enough needles!!!! as far as predicting difficulty...

  5. nurse anesthetist's education: quality education/ quality insight?

    Tenesma replied to susanna's topic in Certified Registered Nurse Anesthetist, CRNA

    i wasn't disputing the fact that there is a decrease in cadaveric exposure in med school - but it was news to me that "most" schools don't do it anymore... just

  6. anesthetist vs anesthesiologist

    Tenesma replied to caffine's topic in Certified Registered Nurse Anesthetist, CRNA

    jdpete - the easiest job you have ever seen for a physician... it is so "easy" that it would explain that the burn-out rate is 2nd to ER docs - that the training is longer than for internal medicine,...

  7. intubation of morbidly obese patients--have tips?

    Tenesma replied to gugal's topic in Certified Registered Nurse Anesthetist, CRNA

    it is a bit different from NGT/OGT as endotracheal is far more stimulating - especially as far as the sympathetic outflow goes --- some obese ischemic patient can be very high risk things i do:...

  8. nurse anesthetist's education: quality education/ quality insight?

    Tenesma replied to susanna's topic in Certified Registered Nurse Anesthetist, CRNA

    athomas: "a lot of medical schools don't have cadaver courses"??? where did you hear

  9. anesthetist vs anesthesiologist

    Tenesma replied to caffine's topic in Certified Registered Nurse Anesthetist, CRNA

    impartial pressure - your posting must have been written after a long shift... 1) why would anybody want to rid the world of nurses? that is just plain silly... and patients would suffer... 2) i never...

  10. anesthetist vs anesthesiologist

    Tenesma replied to caffine's topic in Certified Registered Nurse Anesthetist, CRNA

    gaspassah... it is difficult for me to compare myself to other MDAs --- i know that everybody at my residency program had similar experiences. i think CRNAs are very well trained - and that they...

  11. anesthetist vs anesthesiologist

    Tenesma replied to caffine's topic in Certified Registered Nurse Anesthetist, CRNA

    forane...i thought the original poster had a very good legitimate question, but your post just rubbed me the wrong way... 1) we don't do the same job a) MDs can supervise CRNAs and AAs and run 4...

  12. dexmetatomadine

    Tenesma replied to jbro's topic in Certified Registered Nurse Anesthetist, CRNA

    a few things: open heart surgery implies going on bypass (or else you wouldn't be able to open the heart)... nobody can walk out of bypass!!!! the circulatory system is still in a semi-state of shock...

  13. The most challenging anesthesia cases?

    Tenesma replied to UCDSICURN's topic in Certified Registered Nurse Anesthetist, CRNA

    i love dexmedetomidine... however it is tough to get pharmacy approval for it - they only let us prescribe it in the ICU and then you have to promise your first born... but if you can't use dex, you...

  14. The most challenging anesthesia cases?

    Tenesma replied to UCDSICURN's topic in Certified Registered Nurse Anesthetist, CRNA

    here is one i did this past week: 80 year old jehovah's witness, on&off schizophrenia, class IV airway (hx of being can't mask/can't intubate), morbidly obese (5'2" 340lbs), difficult IV stick,...

  15. CRNA To MD

    Tenesma replied to rigor0313's topic in Certified Registered Nurse Anesthetist, CRNA

    i know three people who did that (admittedly they were all in their early to mid-thirties when they started)... needless to say they all did pretty well because of the good preparation in CRNA school...

  16. extubating deep

    Tenesma replied to athomas91's topic in Certified Registered Nurse Anesthetist, CRNA

    best time to extubate a neuro patient... depends on several factors 1) appropriate neuro exam - cause if there are changes you don't want to have to reintubate so they hold still during their post-op...

  17. extubating deep

    Tenesma replied to athomas91's topic in Certified Registered Nurse Anesthetist, CRNA

    agreed w/ pasgasser... not a good idea to do deep extub. on neuro patient for many, many reasons... but your concept of avoiding coughing/gagging so as not to increase ICP is a good one in theory......

  18. Clinical Question

    Tenesma replied to WntrMute2's topic in Certified Registered Nurse Anesthetist, CRNA

    wintermute... 9 times out of 10 versed/ativan works great!!! (not to mention that benzos provide some vasodilation as well) as well as a good O2 mask.... if you are truly concerned about NPPE you'd be...

  19. Treatment for Pediatric bronchospasm

    Tenesma replied to Brenna's Dad's topic in Certified Registered Nurse Anesthetist, CRNA

    helium isn't a bronchodilator - but due to its lower density it can carry albuterol past spastic lung tissue for better spread and quicker alleviation of the symptoms beta-selectivity at low-dose of...

  20. Clinical Question

    Tenesma replied to WntrMute2's topic in Certified Registered Nurse Anesthetist, CRNA

    deepz... my point regarding the literature is as follows: if it is a common event that patients develop NNPE while intubated (as experienced by you and Keermie) then surely it should be in textbooks,...

  21. Clinical Question

    Tenesma replied to WntrMute2's topic in Certified Registered Nurse Anesthetist, CRNA

    ok in order to get negative pressure pulmonary edema you need to create between 100 and 200mmHg of negative pleural pressure (this was studied in animals and correlated with humans) ... and this can...

  22. Clinical Question

    Tenesma replied to WntrMute2's topic in Certified Registered Nurse Anesthetist, CRNA

    actually... i have been reviewing medical cases re: ?NPPE and ETT tubes, and it turns out that it is impossible to create enough negative intrathoracic pressure with an ETT being bitten, primarily...

  23. Clinical Question

    Tenesma replied to WntrMute2's topic in Certified Registered Nurse Anesthetist, CRNA

    two things: it doesn't sound like pulmonary edema... and you don't treat negative pressure pulmonary edema with lasix... it is treated with positive pressure ventilation (CPAP ideally) until the...

  24. Primacor question

    Tenesma replied to chaosRN's topic in Certified Registered Nurse Anesthetist, CRNA

    Nitecap... I agree fully with you --- there is more and more literature to support the use of an inotrope in patients with EF 55years)... In fact, I think milrinone is a wonderful drug... but even in...

  25. DO (school) in anesthesiology or CRNA school

    Tenesma replied to Mantibob's topic in Certified Registered Nurse Anesthetist, CRNA

    not anymore