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louloubell1 specializes in Anesthesia.

louloubell1's Latest Activity

  1. louloubell1

    This is how it really is for this new CRNA

    Is there not a minimum requirement for central line placements? I could have sworn that students had to place a minimum of 5 to fulfill requirements.
  2. louloubell1

    Should We Work And Go To School?!?

    Jess, please look at what forum you are posting in. No offense, but as a CNA I doubt that you have any idea about what kind of workload a student registered nurse anesthetist can tolerate. To the OP, not only will it be nearly impossible to work very much at all while attending anesthesia school, many schools have policies in place that strictly prohibit you from working in the 8 hours preceding the start of your clinical or didactic day (meaning you could not try pulling night shifts and then head off to clinicals in the morning). Anesthesia school is a full time endeavor, with a mountain of information to study and learn. FT work outside of this is just impossible. Lou, CRNA
  3. louloubell1

    Switching careers from Pharmacy to CRNA

    What is it that attracts you to anesthesia? It sounds like you are looking for a quick route to an advanced health care career, so I feel obligated to tell you that the road to CRNA is not a quick one. Say you get right into an accelerated RN program without having to take any prerequisite classes (1-1.5 years), then spend the required time working in critical care (at least one year, but may be more in the range of 2-3 years before you are competitive with other anesthesia school applicants), then take on anesthesia school (the shortest programs are 27 months). You are looking at a longer time frame than the 3-4 years you've said you would need to get your PharmD.
  4. louloubell1

    CRNAs with Tattoos

    A moderately tattooed CRNA here. I currently sport 7 pieces, several of which are fairly extensive including a half sleeve on my right arm. I also have several piercings, including a tongue ring that I wear all the time. Like it or not, right or wrong, some people will judge you.... I know I don't need to tell you that. It's just the way of the world. Take for instance the reference to people like us being low-brow (I'm paraphrasing of course) made by JediWitch. I guess all the rhetoric in nursing about cultural acceptance just doesn't apply to tattooed and pierced folks. Generally my tattoos don't show at work, unless I take off my scrub jacket, and then my arm piece shows, but that is a rare event considering the frigid temperature of the ORs. My tongue ring does show I'm sure. I do not slur my words, nor is there a "bell" associated with my jewelry. People do indeed listen when I speak to them, and answer me appropriately, so I can say with some degree of confidence that they are not focused on how much pain I went through to get something that makes me so white-trashy. I don't wear any of my other facial piercings at work simply because jewelry isn't allowed in the OR. I have had my tongue pierced for about 15 years, and have never been turned down for any job for which I applied. I got into nursing school with it; I got into anesthesia school with it. I experienced absolutely no difficulty in finding my first job as a CRNA with it, and in fact had my pick of several jobs. I am also well liked and treated just as professionally and respectfully as any of my colleagues. I have had several patients who have specifically requested me to do their anesthesia, and have received letters that were sent to the hospital's CEO from patients thankful for my professionalism and caring manner. Guess some people must have missed the memo that us tattooed and pierced folks should be held in such low regard....
  5. louloubell1

    Brave, or just crazy?

    Like LightattheEnd, I too graduated anesthesia school this past December (still waiting on my board results though, so I can't yet say that I am a CRNA). I have four small children (10, 8, 6, and 3). I'll be honest with you and tell you that it was rough. Many days I did not even get to see my children, and I spent a lot of time out of town clinical rotations. When I was home, I was tired, often crabby, and needing to spend a lot of time studying. Though my children were never neglected, I was definitely not the parent I wanted to be. However, it was my darling husband who had the worst of it. He took on so much extra headache and responsibility while I was in school. Anesthesia school is hard to do with children at home, but it is do-able. Good luck with your endeavor.
  6. louloubell1

    IV drugs RN's can give?

    The definition of conscious sedation is a pharmacologically induced depressed level of consciousness in which the patient maintains cardiopulmonary stability without externally provided support and in which the patient remains able to respond purposefully to light tactile or verbal stimulation. If you are administering a freakin paralytic (which since you are not a CRNA, I'll clue you in: SUCCINYLCHOLINE IS A PARALYTIC) you really, really need to brush up on drugs appropriate for procedural sedation, and even the basic definition of procedural sedation. That's one of the most ridiculous things I've read in weeks.....
  7. louloubell1

    Graduated anesthesia school today!

    I've been coming here to read the nurse anesthesia forum for more than 6 years, and today I took one more big step toward adding CRNA after my name. Just sharing my elation that the past 27 months of sheer hell has come to an end! Graduated today from SIUE, & I am so excited; Bring on the little quiz! Lou
  8. louloubell1

    I woke up during surgery, Have you?

    This thread is interesting, and to me the thing that makes it most interesting are the continued reports of "I woke up during surgery" despite several posts trying to explain some things from anesthesia providers. Folks, if you "woke up" from your conscious sedation, if you "woke up" from your spinal or epidural or other regional block, if you "woke up" at the end of surgery as they were putting on the dressings, if you "woke up" hearing the anesthetist say to you "breathe, breathe," if you "woke up" from what you are wrongly assuming to be general anesthesia and actually "spoke" to your anesthetist quickly before "being back out", then you did not "wake up" inappropriately. I just am trying to help you all clear up some misconceptions here so that the people who have truly suffered awareness under anesthesia can have some suitable support and maybe other people can understand their post-traumatic feelings a bit better. Conscious sedation is a realm of depressed consciousness sufficient to provide comfort while still the patient maintains the ability to respond. Sometimes people won't remember anything when they've had conscious sedation, but sometimes they will. That is ok. It is not expected that you will be unconscious for your procedure, hence the term conscious sedation. You may have heard conversations in the room, you may recall sounds & lights. If you recall something or "awakened" from a procedure you had done with conscious sedation, you did not suffer from awareness under general anesthesia. Regional blockade, including spinals and epidurals, are not general anesthesia. Spinals are often done for many lower extremity and some abdominal surgeries. Sometimes, a patient who has had one of these forms of anesthesia is provided with some sedation as well during their procedure: Sedation, not general anesthesia (although regional blockade may indeed be combined with general anesthesia but not usually). Again, let me stress, sedation is not general anesthesia. If you awoke from your sedation, you did not suffer from awareness under general anesthesia. You may have heard conversations in the room, you may recall sounds & lights. You did not suffer awareness under anesthesia. If you awoke and actually "talked" to your anesthesia provider before quickly being "put back out" you were likely receiving some sedation, not general anesthesia. General anesthesia involves the placement of an ETT or an LMA, or much less frequently, a very tight fitting mask. You won't be talking with any of those contraptions in your throat I can guarentee. If you awakened hearing your anesthetist or anesthesiologist saying "breathe, breathe" you were likely being awakened at the end of the procedure. There comes a time when all general anesthetics must end, obviously, and we do indeed wake you up. And sometimes we wake you up fully with the ETT still in because we may deem it to be the safest (as opposed to extubating deep under anesthesia). Likewise, if you woke up and dressings were being applied, your procedure was over, and you were being awakened on purpose. You did not suffer awareness under general anesthesia. Also, to answer a couple of other questions which have been posed: First, the BIS monitor is not utilized by every facility. BIS continues to be under study and its use is not standard of care. Mistersister posted that a BIS reading under 30 is unconscious, however, the true number range that correlates with general anesthesia is 40-60. The lower the number, the deeper the state of anesthesia. It is not desirable to run a patient too deep just as it is not desirable to run a patient too light, & I think you should know that some studies utilizing the BIS monitor to gauge depth of anesthesia have shown that anesthesia providers have a tendency to run their patients too deep, rather than too light. Many anesthesia professionals question the usefulness and accuracy of this tool, and so its use is not universal. Also, I must tell you that many anesthesia providers blame the makers of BIS for aggressive ad campaigning that has falsely led to people believing they have experienced awareness under anesthesia or believing that the incidence is astronomical. This thread is largely an example of that, of people who truly believe they had awareness under anesthesia, when they in fact were not receiving a general anesthetic. Another question: Yes, drugs with amnestic properties are utilized often for general anesthesia. Versed is probably the most common. It is a benzodiazepine with can provide anterograde amnesia. However, not all patients experience amnesia with versed. In addition, versed is not appropriate for all patients. The other drugs utilized during general anesthesia also provide for amnesia and unawareness. Another misconception that I have read so far on this thread involves pt movement under anesthesia. There are many, many procedures in which no muscle relaxation (paralysis) is necessary. Movement does not necessarily mean that a patient is not adequately anesthetized. The dose of inhalation agent necessary to prevent recall in a patient is about half that necessary to prevent movement to surgical stimulus, and the dose needed to prevent autonomic response (tachycardia, increased BP, etc) is even higher than that necessary to prevent movement. OR nurses who see a patient move under general anesthesia should be aware that it doesn't mean the patient is not unconscious. Anyway, what this longwinded response amounts to is that people who have really suffered awareness under general anesthesia have endured a traumatic experience, and need support from professionals and others who have suffered similar events. Likewise, anesthesia providers maybe need to be doing more education with the public on what awareness under anesthesia really is, and what the different kinds of anesthesia are. There is obviously, even amongst this group of health care professionals, great misunderstanding of this. Lou
  9. louloubell1

    What would you do first?

    Baby needs to breathe while narcan is being drawn up, administered, circulating, and exerting effect. This takes time, and if they aren't breathing on their own or not ventilating sufficiently they need PPV via mask now, not 4 minutes from now. Always, always, always breathe the baby. Matter of fact, the answer to almost every question you'll ever be asked in NRP is: Breathe The Baby. Oh, and I disagree with the notion of no narcan if mom received opioids less than an hr before birth.
  10. louloubell1

    The Sweat Book

    No, they're not the same thing. You can find out about getting sweat book by visiting the Valley Anesthesia Education Program at Valley Anesthesia Educational Programs . I don't remember if you can purchase the sweat book without also signing up for the course, but I'm sure you can find out at the site. Good luck, Lou
  11. louloubell1

    I woke up during surgery, Have you?

    Thank you. This is exactly the point I was trying to make earlier. Some people on here are describing awareness under general anesthesia, and that is indeed a shame. But what some others have described are IV sedation (MAC) or even spinal anesthetic cases. These are not the same things. Not at all.
  12. louloubell1

    I woke up during surgery, Have you?

    Not a CRNA quite yet (I don't take my boards until next month). I can, however, answer your question. No, it is not always necessary to utilize a neuromuscular blocker (paralytic) during general anesthesia. There are plenty, plenty of surgeries that do not require muscle relaxation, & in these cases the anesthesia provider may or may not use any.
  13. louloubell1

    I woke up during surgery, Have you?

    The situation you describe, Mikey, is one of the problems with the current "sensationalism" surrounding anesthesia awareness. You were not undergoing a procedure with general anesthesia, but rather IV sedation. There is a big difference, and there is not an expectation that with IV sedation you will experience complete ablation of recall. That said, many people do experience amnesia with just IV sedation, especially when versed is one of the drugs employed, however, a general anesthetic is the only anesthetic technique meant to reliably ablate all recall. In some situations it is appropriate and necessary to induce general anesthesia for c-section. See thread: primary elective c-section in the OB forum. Lou
  14. louloubell1

    I woke up during surgery, Have you?

    to all who have expressed experiencing awareness under anesthesia, i am so sorry to hear that. awareness is a real problem, though rare, that should prompt an open discussion with your anesthesia provider, along with referral to a mental health professional if necessary to help you deal with the emotional problems which may result. the most common cases for awareness to occur include traumas, c-sections under general, and heart procedures. sometimes the emergency nature of these procedures combined with hemodynamic instability prevents tolerance of our anesthetic gases, all of which drop blood pressure and depress myocardial function, effects which may not be tolerable in an unstable patient. that is not an excuse, but rather a partial explanation of why awareness may occur in these circumstances. bsntobe2009, anesthesia involves combinations of drugs that may include benzodiazepines, narcotics, inhalation and/or iv general anesthetics, local anesthetics, and paralytics when necessary. other drugs may be used to deal with various other issues, such as hemodynamics. tachycardia & tachypnea (in the non-paralyzed pt) may indeed be signs of light anesthesia, however they may be signs of other problems too. to add to that, the concentration of inhalation agent necessary to block the body's sympathetic response to surgery is much, much higher than the concentration necessary to prevent recall and even to prevent movement with surgical stimulus. if using an inhalation agent to maintain anesthesia, as opposed to times when iv agents may be used, it is indeed a posibility that the vaporizer could empty, however, one of the parameters continuously monitored during anesthesia is the inspired and expired concentration of that agent. daytonite, good for you, communicating your past experiences under anesthesia is an important part of anesthesia being able to provide you with the best care. i'm sure the difficulty of your intubation had nothing to do with you being uncooperative. we have drugs that will fix uncooperative :) , but none that will make a difficult airway into an easy one. please continue to provide you future anesthesia providers with the information on your experience with awareness, as well as with the knowledge that you have a difficult airway. though i know it doesn't sound fun, an awake intubation is often the necessary choice in a person with a known difficult airway. lou
  15. louloubell1

    What is everyone studying for boards?

    Sweat book, M&M, and memory master. I'm graduating in 15 days, so we're in the same boat! Good luck to you! Lou
  16. louloubell1

    Doing the right thing?

    I worked right around 2.5 yrs in ICU before starting the anesthesia program. AAs are not required to have this because they aren't subject to the either the board of nursing or the AANA requirements for nurse anesthesia students. Good luck in whatever you decide to do, Lou