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.

:rotfl: Good program! Live close to KUMC, not that bad. All didactic up front. Clinicals at Bryan etc have lots of regional and little competition for cases. Good luck!

This is not an answer out of a book, but the way that I would explain the low diastolic: the increased systolic is a result of increasing inotropic contraction of the heart to increase pressure thus also increasing pvr (like aortic regurg). The decreased diastolic is a result of shifting the diastolic pressure-volume curve right by increasing left ventricular volume and/or elasticity. Another component to this triad is bradycardia as well, which further potentiates the formentioned physio.

i feel i was taken out of context, and paraphrased what i was conotating was that this board has already addressed this issue many times and that its detrimental to the board when a large porportion of the discussions have to deal with this over and over again. scan and read past posts. cleaning up feces is part of the profession and it can be discussed. i would just like to think that a person wanting to pursue a profession would have a different mindset, and not focus on money and feces.

in continuation . . . i really don't see the point in bringing this to subject. the link does not work? i have read it many times without fault, as have many others. can we please not talk about poop anymore on this board, because it is really detrimental to this whole concept of a professional board. i'd like to think we are past the whole anal/oral fixation thing.

personally, i have a prob when the first remark is about money. the next is when somone complains about poop; so for that i give an F-, and tell the person better luck next year.

Thank you for the advice. I really hope to gain a better understanding of the issue, and the book seems like a great place to start.

loisane, In reply to your post when AA legislation is introduced in my state . . . Part of being a professional is being an active member in your organization. There is nothing wrong with debate, just how it is done ie misinfo, generalizations, paranoia . . .. ASA/AANA do well to their respective professions, so to ignore it is not an option as a participating member. I plan to participate. Now to support or oppose . . . ? I would oppose because: 1) the shortage can be averted by increasing enrollment in est. SRNA/residency programs by a number of different options. 2) although MDA's believe that CRNA's believe that AA's do not justify their practice with their educational backgrounds; the AA as I understand it has little health care experience at all. I have tremendous respect for those who complete medical school. I also respect nursing school and the tough critical care arenas where CRNA's gain exposure, experience, critical thinking, as well as encompassing all the aspects of health care. 3) it adds a third providor that if there were not a shortage, would be a nonfactor 4) AA is a valid alternative, albeit it were not more than a strategic lobbying effort which evades the real issue which is clear and defined roles for both providors implored in a variety of clinical settings. There is a middle ground, but I do not think it is AA's. If you allow AA's, it increases the rift between MDA's and CRNA's. AANA continues to push harder for expanded roles to offset shadowed roles by AA's. ASA cont to push harder to limit CRNA and promote AA's until the point where they are strong enough to establish their own professional organization: AAAEE (anesthesia assistants against everyone else). The misfocus of the debate will perpetuate and cloud the issue, until the only people who suffer are the ones like me who try to make sense of it all! Just my $0.02.

This is my first post; however, I have browsed this forum for about a year, as I start a program this week. One of the most disturbing issues to me is the fight between MDA's and CRNA's. I do not look forward to animosity in the clinical arena. In the words of Rodney King, "can't we all just get along?" I think both sides have valid arguments, but I have observed that most of the disagreement is based on misinfo, generalizations, assumptions, and paranoia. While I admit I'm green and that this is merely a subjective conversation post, I had been envisioning a more altruistic anesthesiasociety. Please don't critic this post, just take it for what it is: a roast of both PROFESSIONS.