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EmeraldNYL

EmeraldNYL BSN, RN

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SRNA

EmeraldNYL's Latest Activity

  1. Scope of practice can vary widely depending on the culture of the institution you are at. This is definitely something to consider when you are applying for jobs. I work at a teaching hospital (however we do not have anesthesia residents) so the CRNAs do a large number of cases involving very sick patients. We do cardiac (if desired) and neuro. However, our scope of practice states that we are not allowed to perform peripheral blocks or epidurals, while we do perform spinals and arterial and central line placements. Some hospitals are definitely more "CRNA friendly" then others.
  2. EmeraldNYL

    CRNAs specializing in trauma

    Yes, that is a correct assumption. Very exciting, but very high stress as well. Don't plan on seeing the call room at all during the night if you work at a very busy trauma center.
  3. EmeraldNYL

    CRNAs specializing in trauma

    Lots of CRNAs take call in trauma centers. I work in a very busy Level II trauma center and a CRNA always has the trauma beeper. We respond to all trauma activations and manage the airway in the trauma bay. If the patient needs to come up to the OR, we will travel with the pt. and then continue to resucitate the patient in the OR. Once in the OR, we will place additional lines if necessary, hang blood, send labs, whatever is necessary.
  4. EmeraldNYL

    Tee

    I do cardiac anesthesia at my facillity under the supervision of an anesthesiologist. Even our anesthesioligists aren't really subspeciality trained to read TEEs-- when we do use one for a valve case we utilize a cardiologist in the OR to read it.
  5. EmeraldNYL

    CRNA continuing salary

    With my group, all of the CRNAs get paid the same, so someone with 20 years of experience makes the same as me with 6 months of experience.
  6. EmeraldNYL

    I took the certification exam today- yikes!

    Congrats and welcome to the CRNA club!!
  7. EmeraldNYL

    Where do you work???

    It all depends on the setting you work in. I know many CRNAs who work 60 hours a week between their full-time and per diem jobs. My schedule varies somewhat, but I usually work 7-3:30 mon-fri. I also pick up a call shift about one weekend a month. This year I have to work Christmas Eve but that is my only holiday.
  8. EmeraldNYL

    Question for the AW gods........

    I think the key is to try not to get yourself in difficult situations in the first place. The more people that muck around in the airway, the more edema the pt. will have. Did you and the PA anticipate her being a difficult airway? If she was intubated 2 weeks ago, did they have trouble intubating her at that time as well? Why were you having so much difficulty ventilating? Was it just her anatomy (was she fat?) or was she in bronchospasm? You could have tried to place an LMA to see if you could ventilate her better that way, or if your facility has FastTrac LMAs, you could have tried to intubate her that way. Dexamethasone is useful for airway edema, although this certainly would not have helped immediately. Did the anesthesiologist wind up doing a fiberoptic? The can't intubate/can't ventilate scenario is every anesthesia provider's worst nightmare, especially when you don't have a surgeon in the hospital who can do an emergency trach!!
  9. EmeraldNYL

    How broad is your scope of practice as a CRNA?

    What kind of nursing skills exactly?? I don't have to clean up poop anymore, thank god!! I see the patient pre-op and go over the anesthesia plan and the patient's history, start the IV, and then manage the patient during the course of the anesthetic, whether it be general anesthesia, or spinal, or sedation. I also see inpatients after their surgery to follow up. Really the best way to understand what a CRNA does is to shadow one!!
  10. The "captain of the ship" doctrine, where the surgeon is responsible for the actions of the OR staff members, no longer holds up in a court of law. Therefore, a CRNA is legally fully liable for his or her own actions, just as an anesthesiologist would be. So no, this will not effect CRNAs practicing independently. Being a CRNA is an enormous responsiblity, and this case further drives home that point.
  11. It is a ridiculously huge settlement but Philly juries are notorious for that. The news media doesn't really depict a complete picture of what happened. I know several people who went to watch the trial who knew the CRNA. Apparently Dr. Glunk was scrubbed in the next case and calls for him to go eval the patient fell on deaf ears. The CRNA couldn't leave because he was the only one there and the surgeon refused to go see the pt. I also heard that the surgeon demanded that the ambulance go in through the back door so that no one in the waiting area would see. I certainly don't think a fat embolus is preventable, however I think the real issue here was the response time and slow recognition of what was happening.
  12. EmeraldNYL

    For current CRNAs...

    CRNAs at my place of employment do varying shifts. I usually work Mon-Fri 7-3:30 with minimal weekend call. I have to work Christmas Eve this year but this is the only holiday that I must work this year. I usually pick up one Sunday 10 hr. shift a month for extra money. Some people where I work do a 24 hr. shift and 2 8's, and others do 4 10 hr. shifts. We have people who do the same overnight call shifts every week so the rest of us just need to fill in when they go on vacation.
  13. EmeraldNYL

    Daily grind of critical care nursing vs. CRNA

    I work in a 400 bed level II trauma center in the suburbs of Philly. We practice in the care team model but for the most part the environment between the docs and CRNAs is pretty congenial. No, I do not practice completely independently, but I do get to do big cases, like hearts, cranis, and trauma. It is very busy so if I finish my room early I am expected to do pre-ops and post-ops or make sure my coworkers have had breaks as well.
  14. EmeraldNYL

    Feeling Depressed/confused

    I can tell you that in the Philadelphia region there really is not a CRNA shortage. A number of Philly-area CRNAs were very upset by the opening of yet another anesthesia school in Philly (so far I think we have 6). People come here to go to school, but then they do not seem to be leaving to go back to wherever it is they came from. Places are still hiring, but the big sign-on bonuses and tuition reimbursements are not really there anymore and salaries are not increasing like they were a few years ago. There are also many western states (Utah, Arizona, Colorado) where it is very hard to get a decent CRNA job due to MDA monopoly. I believe that certain areas of the country still very much have a shortage, but this depends on location. If you are practicing in someplace like Kansas, you will very much be needed.
  15. EmeraldNYL

    Daily grind of critical care nursing vs. CRNA

    As a new CRNA, I still have scut work, but it mostly involves doing pre-op assessments and post-op rounds. My days are still crazy busy, but there is much less secretarial work, waitressing, and appeasing people (except for the surgeons!!). Some days can be quite long and boring, when I am stuck in a long case like a lap gastric bypass where the lights are off and I am getting sleepy and just dying to get up and walk around or talk to someone. Other days I am in the ENT room and I barely have time to finish my paperwork before we are on to the next case. On those days I run to drop my patient off in PACU, see the next patient and start the IV so the surgeon isn't kept waiting. Yes, there is still paperwork, and if it isn't right, some administrative person will come after me to fill in a surgical end time or procedure on the anesthesia record, but I am not filling out a million braden assessments or restraint documentations! If I feel the patient needs some metoprolol I give it-- no hunting down an intern for an order. I feel that being a CRNA is a lot less emotionally draining as well-- I no longer have to deal with family members who have a loved one dying on a vent and 3 pressors making the tough decision to withdrawl care. That being said, some surgeons can be very difficult to work with, and there are a lot of very different strong personalities in the OR, so it takes a certain assertiveness and skill to deal with this.
  16. EmeraldNYL

    what are the reasons

    As other posters have stated, it is extremely common for adolescent boys to wake up from anesthesia "wild". There are different stages of anesthesia-- Stage III (deep surgical plane anesthesia) which progresses to Stage II as the patient wakes up. Stage II is characterized by dyspohoria, breath-holding, disconjugate gaze, etc. and while the patient may appear to be awake during this time, they are NOT fully recovered from anesthesia. Pulling the endotracheal tube at this time may potentially cause laryngospasm, especially in younger children. We must wait until the patient is fully awake and has reached Stage I before we extubate. The patient should be spontaneously breathing with adequate tidal volumes, have adequate strength, and hopefully be able to follow simple commands. Often younger patients may wake up thrashing before they are breathing adequately or following commands, which is why we are somtimes forced to leave the tube in a few minutes longer and request the help of OR staff to hold the patient down. Hope this was helpful! EmeraldNYL, CRNA
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