keermie

The combitube is appealing because of ease, but can be cumbersome. A much better alternative which follows a lot of the same principles of the combitube is the King LT. The similarity is that there are 2 cuffs. You intubate the esophagus blind, which the device is designed to do, and inflate one pilot which inflates an esophageal and a post. pharynx balloons. The difference is that it has an opening anteriorly which makes it easy to intubate through the cords using a pedi bronchoscope, Cook, Eschman, . . . It is important to either rotate the ETT or use a Parker ETT, so that you do not cause damage to the cords while passing. Check em out.

In a TIVA, the BIS will monitor agents like propofol but not fentanyl. So depending on what you are using for your TIVA and the ratio . . . interpret your BIS from this rationale. Also, I would not only reprogram the pacer because you will be unable to get a magnet to work in this position all the time; but also increase its intrinsic rate because going prone will often decrease your bp. QUOTE=skipaway]BIS monitors hypnotic anesthetic effects on the brain and therefore, you can use it with TIVA. Sometimes, in teaching student anesthetist, we use the BIS during conscious sedation cases and try to have them keep them in the "sedative" range of 80s. skipaway

Contrary to what we had been told for countless years, the popular opinion at the moments is that there is no longer such an infusion of dopamine which helps with renal perfusion. You will find sources to support renal dose dopamine, but they are now not considered current.

Ketamine hits the NMDA receptors? I used the word MDA in an interview for school, and an anesthesiologist took offense to it even though all the ones I had worked with previously called themselves the same thing. I still got in but it got me red in the face.

I am with Craig on this one. I used to carry one around until the senior students hazed me by buying me a little pony pink fanny. The hazing is relentless. Also, I got so frustrated with having a PDA because it consumed my life to keep it off the fritz that I retired it. I am so much happier now, the release!

Being that jello is essentially a quad, I believe that a spinal infusion of vodka does remarkably well being that it is able to blunt jello's sympathetic hyper reflexia. Finding the L2-L3 is a bit of a challenge, likened to trying to harpoon a 450 lb. vertebrate. Also of note, the BIS does not account for narcotics in its "interpretation."

The hepatitis outbreak (100 and counting) was the result of using a liter bag of fluid to draw flushes. The reuse of syringes or tubing or needles is indefensible because the CDC and OSHA specifically disband this practice. The best rational not to reuse syringes is that technically a syringe is not sterile once the plunger is depressed. Look at the packaging, they all read single use only.

All of you have inspired me to post because you have all done a remarkable job maintaining your professionalism. I would like to redirect a lot of the focus on what else can be done. I was recently at the Mid Year in D.C. I was thrilled to meet anesthetists who are passionate about maintaining their profession. There is no better wat than by supporting your professional association, and being an active member. I would encourage a lot of you to direct your positive attributes to the association, which I'm sure a lot of you do. It was nice to be there this year lobbying on the hill without having to bumb heads with the ASA. In fact we were lobbying for the same things this year, most notably patient safety of all things! We have a lot of people from prior years to thank for fighting for our profession in the heated 90's, but it is imperative to never let the guard down. I am impressed that our political action committee rivals the ASA committee. We donated only a fraction less to become the fifth largest in the health care sector. Kudos! I was so impressed that I plan on running for the student PAC position this year. I hope that you will all find an area in the political arena that best serves your attributes and the association.

Dr. Ramsey (ala the Ramsey sedation scale) came and spoke about Precedex. Amongst his lecture was an open heart, who woke up from surgery and promptly walked out of the room on his hemodynamic drips and precedex infusing when prompted by voice. (A pic is worth a 1000 words). He also mentioned that he has used it for involved surgery as the sole anesthetic without the need for supplemental ventilation. It is like clonidine, but is much more alpha 2 specific. I have noticed lability with a loading dose, and a lot of people shy away from boluses; however, the first clinical trials are starting for neuraxial use, which are promising.

End tidal is the most accurate method; however, the dialed in will be more easily defended in a lawsuit. An example is an end tidal of 2.5 and the patient's CO drops from 5.0 to 1.2. You want to lighten the anesthetic immediatly, but because of the diminished uptake of agent, your end tidal never changes. If you charted dialed in then you would note that you turned agent down signifigantly. It may not be the most accurate, but is a more accurate record of what you are acctually doing and is easier to defend without going into FA and FI, solubility coefficients, and physiology.

ENOUGH! Here is the answer you are looking for. . . it is acceptable to use a stipend and default on it. It really is alright because you worked hard becoming a CRNA. People have done it before under extrenuating circumstances, or just for their personal gain. It is something that one can do. It is a possibility, so you are correct. Now some personal advice . . . don't do it for the wrong reasons because of the following: morals, values, professionalism, integrity, and good faith.

Of the four interviews I went to, one asked clinical questions. That one gave you a piece of paper with values on it and asked, "what is happening based on these values and what are you going to do about it?"

I did attempt to look it up, and was surprised to find limited literature on the subject. What a great thesis project!

I did attempt to look it up, and was surprised to find limited literature on the subject. What a great thesis project!

I second this. It is a primary reason I usually choose an oral airway vs nasal airway, as I have seen this numerous times. The population, a young athletic male, is especially predisposed due to wild wake ups and strength. In my experience, CPAP or reintubation with PP are essential.