putmetosleep

Just wanted to update my original post--the CCRN materials have already been sold, but I do still have the CMC DVDs available. $50 plus shipping takes them. Let me know if you're interested.

Hey everyone-- I'm cleaning house right now and rather than just throw these out I thought I would see if there are any takers out there. I have the Laura Gasparis Vonfrolio CCRN Review Cram DVDs, as well as the CMC Review Course DVDs (by the American Association of Critical Care Nurses). If you're interested in buying either of these, PM me. PMTS

Hi everyone, I'm an SRNA with just under a year left in my program. While I think right now may be a bit too soon to begin the job hunt, I'd like to get a general idea on how to proceed and I'll likely start the process in the spring. I'm wondering how to start the process of job searching as a student? I check gaswork.com frequently, but I also am aware that not all employers post to that site. Many of the CRNAs in my area belong to anesthesia groups (vs. being employed by the hospital) so it seems CRNA positions are not listed on the hospital websites. I'm afraid I'm going to miss out on job opportunities in my area because I don't know how to find out about the openings. Is working with a recruiter a good idea? What are the pros/cons of this? Any advice or words of wisdom are appreciated, I just want to know where to start! Thanks!

Anyone have any tips for arterial sticks/a-line insertion? I have attempted a few now and let's just say...well I have not been very successful! Don't know what the issue is, even when I'm palpating a great radial pulse I can't seem to get the needle in the right place. Obviously I'm doing something wrong but even the CRNAs who've watched me do this haven't had much feedback/advice for me. Any feedback is welcomed! Thanks!

As a current SRNA, I can personally tell you that while it can be frustrating sometimes to be corrected on things that seem miniscule (i.e. EKG lead placement, IV taping, etc), it's important to take a step back and realize that your grad is not doing it to belittle you (I've never met one who was hostile or did things just to make it difficult for me). They are doing it because they want you to know how they do things and why. And it is impossible to develop your own practice without having the advantage of seeing mutliple ways of administering anesthesia. So try not to be offended when you're corrected, instead look at is as a learning opportunity (no matter how small the detail is). When you're on your own you can pick and choose from all that advice and create the perfect practice for you. Most CRNAs are at least a little bit Type A...but this is what makes them so diligent. Until then, try to keep the attitude that you are a guest in the OR, and be thankful there are people willling to teach you. Be open to suggestions..this is key to being a good student. Take it all in. When you're on your own you won't have the opportunity to see how other CRNAs practice...now is the time to find out all the different approaches to anesthesia and then decide what works for you (when the time is right!). Of course I am counting the months until I graduate, but I feel lucky to be where I'm at and can't believe how MUCH I've learned in such a short time. It's amazing. Anesthesia school has been one of the best decisions of my life.

A supine healthy patient, I should say!

Thanks for the responses so far. Just to be clear, I don't lie on one side or the other on this topic. In my limited experience as a student, I haven't even used all that many LMAs yet (mostly ETT), so my question was more or less for future reference, and so that this makes sense to me. Of course not for every patient or every case would it be appropriate or safe to give relaxants with an LMA(and not just succs, what I had in mind was a non-depolarizing relaxant) for all of the reasons stated above...but then again for an obese pt or a pt who you suspect would need high inspiratory pressures to ventilate, an LMA would not really be the ideal airway choice for them in the first place. And I do also have to say...that the idea of using an LMA in a prone or lateral case (or even for a laparascopic case due to the increased probability of needing higher PIP) makes me shudder!! NO way! :) So.. my hypothetical question was geared towards a healthy pt (no obesity, airway disease, etc).

But why is what I want to know? Why do you feel it is unsafe/not the best practice? I agree that you shouldn't need relaxants to place an LMA, but what if you already have one in, and then the surgeon decides he wants the pt relaxed? I have perused my anesthesia texts and can't find any reason why it would be unsafe to use NMBAs with an LMA in place.

What are your thoughts/feelings on using neuromuscular blockers during a case with an LMA in place? I know relaxants are not necessary for insertion, but are they contraindicated? I've heard yes and no...personally, I can't think of a reason why it wouldn't be okay to use a NMBA if the surgeon needed relaxation during the case. Others have said it's a big no-no. I've heard that this is done routinely in Europe, as well as mech. ventilation via LMAs (with low PIP)---another topic where there are opposing views in my current rotation. Thoughts please:)

Hi, The final exam is not too bad. It's open book/ open notes and you are allowed 4 hours to complete the exam. It took me the whole 4 hours b/c I had to look up every answer;) I got a B in the class. Let me know if you have other questions.

Duh. Haha sometimes the most obvious answers are the hardest ones to come up with. I didn't even think about smooth vs skeletal muscle. Thanks for clearing that up for me! Can you tell that my brain is in a state of overload or what?!

How does administering pitocin immediately after the baby is removed during a C-section really prevent uterine atony if there is neuromuscular blockade on board? Doesn't the NMBA in itself produce uterine atony? Thanks so much.

Can somebody please explain to me what oscillating ventilation is and when it would be indicated? I've never seen it used or used it before. Thanks

Thank you so much for the Advice. Just to clarify, I have all the support I could ask for; my family & friends are behind me 100%. This is completely my own internal struggle...I'm beginning to feel a little better about starting school. We all know that it's not as simple as just waiting a year-- just because I was accepted this year does not mean I'd be accepted next year.