RNFPC

I'm going to have to disagree with a bunch of y'all here and say that I do not think a manager should give you a good recommendation if you'd only worked in the unit a year. It is unfair to the unit, staff, manager, and hospital to not give at least 2-3 years of work in the unit. It is extremely expensive to orient, precept, and send a new grad through classes to not even have them stay a year. From a manager's prospective, it shows a lack of commitment to the unit and poor professional ethics. If you have worked in the unit for at least 2 years, however, I think it is perfectly fair to want to go to grad school and the manager should provide a fair recommendation based on your work performance.

I think the point that is trying to be made is that if you are looking for someone that is intelligent my order of greater likelihood goes like this janitorIs it too difficult to agree that a doctor (most of the time) will be more intelligent than the nurse/CRNA?? Actually it is too difficult to say that... We need to establish three things: 1) knowledge does not equal intelligence - We'll all agree that physicians are very knowledgeable and are at least above average intelligence. This said, this does not mean that they are more intelligence than any other health care provider. 2) job does not determine intelligence - people choose their professions for a variety of reasons. Their intelligence does not determine their job. 3) People choose to become nurses because they like nursing, not because they're not "good" enough to be physicians. FYI - Many pilots out there do not have college degrees. BTW - Don't use the term doctor - we have plenty of nursing doctors who conduct essential research (and many science doctorates who lead the way). Since you don't understand the above things, I suggest you just stay out of health care altogether.

It's only disrespectful to address the physician by their first name if they address you by your last name. Very simply, address the physician as they address you... It is important that we be recognized as professionals and equals. Each discipline is unique in its role in health care and each discipline is essential for health care...

BTW - in regards to paralytics not being needed for Emergency Intubation, you might want to take a look at Ron Wall's Manual of Emergency Airway Management...

Stop belittling those that have gone to medical school, you should not open your mouth about it unless you have been through it, you have NO idea... Perhaps anesthesiologists and med students should stop belittling nurses, CRNA's, NP's, etc... unless you are one, you have NO idea what it means to be one...

One more thing: Am I the only one not impressed by the premed prerequisites??? Some of y'all act like the prerequisites classes are masters level chemistry or physics... Guess what, they're not... Here's what they are: 2 Semesters of Calculus (less for DO): Hmm, got that through AP credit in HS 2 Semesters of Biology with lab: Hmm, also got that through AP credit in HS 2 Semesters of General Chemistry with lab: Hmm, also got that through AP credit in HS 2 Semesters of Organic Chemistry with lab: Just about any science major will take this (and a prerequisite for many CRNA programs) 2 Semesters of Physics with Lab: Didn't have time to take the AP for it in HS So, only 2 classes not available as AP credit in high school... Very advanced.... Let's be honest, the undergrad prereq's for medschool are about 30-40 credits - only 1/4-1/3 of the undergraduate degree. I personally find it insulting to be told that: 1) the undergrad prereq's are "advanced" science (they're not - advanced means upper level) and that 2) I couldn't possibly do well in those classes... I guess all of our science PhD's who are leading the way in research weren't smart enough to be physicians...

Well... I respect your achievement of becoming a CRNA, but I'm disappointed with your post. Let me tell you why: *Knowledge does not equal intelligence/"smartness" - A physician/MDA has knowledge not intelligence. Receiving your MD is a demonstration of knowledge not intelligence. Are they intelligent? yes. Are they more intelligent than anyone else? not necessarily. *Some of us are not nurses because we are not "smart" enough to be physicians. Some of us have chosen this path for a variety of reasons. *I am not your average paramedic or nurse, but I will say this: As someone who has always scored in the 98-99 percentile on standardized tests, as someone who entered schools with nearly 3 semesters worth of credit that I earned in high school, and as someone who went back to nursing school and finished with a 3.9 while working 76+ hours per week, I am absolutely insulted by your suggestion that as a nurse (and as someone who's goal is to become an CRNA) that I am not as intelligent or as smart as a physician. *Your attitude that regarding your own profession serves to hold back nursing as a whole. Why do we have to fight our own to be recognized as intelligent?!

Would you like to expand on the higher M&M associated with CRNA provided anesthesia? Aside from one study, that when published included serious criticism regarding its questionable methodology, you'll be hard pressed to find that evidence. If you look at the most recent study, the Pine study, you'll see that there is no established difference. CRNA's have established themselves as highly qualified anesthesia care providers. Are they educated as physicians? No, but has physician education ever been demonstrated to be necessary for anesthesia care? No...

Usually for rotor wing transport, boyle's law doesn't come into play... As far as barotrauma is concerned, its just important to set your peak pressure alarm and to pay attention to your PIP's and MAP's. It helps to be conservative on your TV's (6-8cc/kg) and just titrate your TV's to maintain an appropriate ETCO2's. I usually only use Pressure Control with kids and asthmatics (or other restrictive airway diseases). Usual starting settings for a patient that I've done a rapid sequence on: Volume Control Assist/Control Rate 10-12 Vol. 6cc-8cc/kg PEEP 5 keep ETCO2 between 37-43 (I'm using an LTV1000)

SWtooth, I'm going to have to respectfully disagree with your comments regarding RVI's. Metoprolol may be used in RVI's... they are preload dependent for the cardiac output, however, metoprolol can be used cautiously. Addtionally, both nitrates and morphine can be used. Nitrates need to be used with caution, but they can be used and they can be effective in dilating coronary arteries (NB - don't use sublingual NTG - 400mcg is just too much, use a NTG drip). They just need to be given with fluid. As to morphine, there's two things to keep in mind: 1) morphine causes a histamine release which will cause mild hypotension (again have fluid going) and 2) most of the reduction in BP that we see with morphine is due to decreasing pain and decreased catecholamine release (all analgesics will do this). When it comes to pain control with AMI's, I personally prefer to use fentanyl and avoid the histamine release. Also, most of the inferior wall MI's I have dealt with have not been bradycardic and most have not been hypotensive and most have tolerated IV nitrates well. Just my 0.02...