Tenesma

Tenesma

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All Content by Tenesma

  1. CRNA or Anesthesiologist

    Tenesma replied to 8YRSAWY's topic in Certified Registered Nurse Anesthetist, CRNA

    subee - i find your post to be somewhat confusing. first, you say that nursing treats wellness and medicine treats disease... as a CRNA what does nursing provide that leads to increased "wellness" of...

  2. laparoscopic inguinal herniorraphy

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

    the only laparoscopic procedures that require an ETT (not that there are any true rules about this - so this is based on my opinion): 1) patient who would be an ETT no matter what (severly ill,...

  3. First Wives Club author dead--Anesthesia related death?

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

    i have had more people code from aortic stenosis than i would care for --- most of the time you can resuscitate them, but it is still a

  4. First Wives Club author dead--Anesthesia related death?

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

    she arrested upon induction last week - has been in a coma since then.... the most common complication is cardiac (malignant hyperthermia is way down on the list of

  5. laparoscopic inguinal herniorraphy

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

    actually that isn't true... you can do laparoscopic procedures in the pelvis without general anesthesia - in fact many pelvic laparoscopic procedures (tubals, oophorectomies, hernia repairs) can be...

  6. liver failure and LR

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

    D5 isn't hyperosmolar it is about 250 - D10 is hyperosmolar... while the body does consume it, the initial change in plasma osmolarity is what interferes with what you are trying to do when...

  7. liver failure and LR

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

    while you are right about glucose not being a good thing for neuro patients ... the reason why LR is not used is because of its low osmolarity (273-274) compared with normal saline (304)... that is...

  8. liver failure and LR

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

    mittels.... 1) there is no glucose in LR 2) there are 4mEq of K per liter of LR 3) potassium does not get metabolized --- what would the breakdown product be??? 4) what does administering potassium...

  9. liver failure and LR

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

    mittels what is your point about the K??? and what does that have to do with liver

  10. Panniculectomy

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

    a few thoughts: i agree with the caution regarding the airway... however I also agree with both epidural and getting pre-op echocardiogram. However since the patient is in his 30s i doubt he has any...

  11. liver failure and LR

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

    i think there are a lot of misconceptions about lactic acidosis associated with lactated ringers... while you are right that in hepatic failure there is no/minimal conversion of lactate to...

  12. CRNA or Anesthesiologist

    Tenesma replied to 8YRSAWY's topic in Certified Registered Nurse Anesthetist, CRNA

    once you have your MD it is pretty straightforward getting into most Anesthesia residencies after internship - in 1995 it was ridiculously easy to get into the top programs because of the huge drop...

  13. straws and aspiration risk

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

    it is very easy --- no straws for patients with aspiration risk: the act of using a straw requires the quick reflexes of switching from active inhalation to a swallow - something that patients with...

  14. Need advice from a CRNA ASAP, PLEASE!!!!

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

    you have to understand that you are exposing yourself to a higher risk of atelectasis/pneumonia... while I have done cases on patients with similar situations for elective cases, in retrospect - i...

  15. Spinal with AAA

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

    while i can understand the benefit of depressed peripheral resistance at time of aortic cross clamp - i think the duration of a spinal is a major drawback and doesn't have the advantages of an...

  16. triple A surgery

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

    brenna's dad: you bring up a good point... first those two examples represent 2 extremes, but i still feel that a Cardiac Output of 4-8l/min is fine regardless of size in adult patients (unless they...

  17. triple A surgery

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

    Diprivan/Vented: while you are right that CVP is an estimate of RVEDP - it is in no way an estimate of left venticular pressures by any means. While you are also right that in a normal heart, not...

  18. triple A surgery

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

    1) esmolol is a short acting beta-blocker (which the best choice of beta-blocker in this patient as it is short-acting and his behavior sounds so labile) and as such will not drop your blood pressure...

  19. Atropine and Amiodarone

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

    amiodarone is a great beta-blocker... you can cause increased heart rate with atropine, but you just need a far larger dose than usual... amiodarone dosing in my experience hasn't prevented me from...

  20. Atropine Paradoxical Bradycardia

    Tenesma replied to charles-thor's topic in Certified Registered Nurse Anesthetist, CRNA

    Of course we try to avoid sux in children - but in certain circumstances you have no choice whatsoever - (and a muscle biopsy won't be

  21. Atropine Paradoxical Bradycardia

    Tenesma replied to charles-thor's topic in Certified Registered Nurse Anesthetist, CRNA

    Paradoxical brady occurs with less than 0.4mg of atropine in adults and 0.2mg in pedi (in neonates you shouldn't use less than 0.1mg).... Sandman is very close to the right answer - do a literature...

  22. Sufenta

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

    yes sufenta can be injected intramuscularly or subcutaneously.... it is less painfull if it is subcutaneously. the problem with sufenta is that even though it has quick onset, it can be very...

  23. Should i go to Crna schol or become m.d?

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

    I think the biggest difference between CRNA and MDA is the breadth of stuff you can do during your career... forget about the money, because you will make enough with either career to have a...

  24. Elective Surgery for Pregnant Patients

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

    elective anesthesia for pregnant women is a very dangerous path to tread on ... the lap chole is more semi-elective than truly elective so it should proceed the umbilical hernia is a farce!!!! and the...

  25. Residual NMBA in cellsaver

    Tenesma replied to g8rlimey's topic in Certified Registered Nurse Anesthetist, CRNA

    deepz... i wonder how using a drug effectively and safely is a lazy man's technique... one of the surgeons here can literally pull a gallbladder out 10 minutes after betadine is on the patient... the...