gaspassah

from what i understand the dnp will be awarded primarily due to the amount of clinical hours most crna programs are completing. many are just a few hours shy, probably just end up doing a couple months more in clinical, with a few extra classes.

i have given it bolus by mixing in the standard fashion then drawing some in a 10 cc syringe to give by 1 ml increments. i will also free flow cardene on regular iv tubing if the patient has an art line. i use it alot for intracranial interventional radiology stuff, aneurysms and the like. it is a very safe drug and has a relatively fast half life. doesnt stick around for very long. d

if doing motor evoked potentials mep's you shouldnt use nmba, the tech is supposed to monitor for the quality of the twitch, not just is there one, it's kinda like measuring tof ratio for us. sseps, some say you can use nmbas some say you cant, usually 1/2 mac with agent and propofol gtt, or straight tiva. we do tiva at my intitution. prop and remi g

i think they are fine, ive used them in the past. only thing is make sure your emergency drugs are in an open drawer for easy access.

dont forget that although halothane was used for many years and was a good agent, it sensitizes the heart to catacholamines. if you give local with epi, you can get vtach vfib rather easily. this is one main reason it fell out of favor. d

it's a great block, i too learned it at the navy when training at kaiser. however noone knows what it is here in miss and trying to get them to learn or try it is like beating your head against the wall. it's much easier than an interscalene imho. d

where i did my anesthesia peds training they didnt want you to use sux on kids for spasms. their treatment was major positive pressure and time, as hypoxia has a muscle relaxant property when it gets low enough. the few i had to handle would usually break around a sat of 72%. you may need to treat with atropine but not always. secondly, kids are very parasympathetically invervated so if you do choose to use sux always give atropine with it or you may get significant bradycardia.

2. OR warm and QUIET during induction and wake-up. this is a biggie for me, and the scrubs banging instrument trays all over the place on the metal carts doesnt help either.

suzanne, i was wondering if you had evidence to support this statement. as a practicing crna i have been under the impression that crna's can work independantly in all 50 states. the only restriction to practice being hospital policy, not state nursing law.

never fear!! underdog is here!! for those of you old enough to remember that cartoon, i would reply to this but we already talked about this one, what's up underdogdude? anymore issues in recovery? d

i dont normally use defasicualting doses. i read somewhere that nmb can cause myalgia just as using sux can, and just surgery can cause it. i also like to see some twitching, just another way to know when the pat is ready. during the end of my training and now that i have been out about a year, i have been using narcs more heavily (i get to make more of the decisions now :) i have found in your normal ((whatever normal is really) just not elderly or infirm)) i give 5 ccs of fent before prop and lma placement and find that the patients return to spontaneous breathing in about 5 min. this is for cases as short as 45min to 1 hour, i dont titrate anymore in and they usually awake really smooth and comfortable. if you are familiar with the dose response curve, this is what i base this technique on. i do roughly the same thing for longer cases with a tube, i just give larger doses of fent.

i first concider the use of an lma to be no different than using a mask. the risks are the same as the airway is not protected. therefore my use of the lma is for spontaneously breathing patients. i never use nmb for lma, we have an attending that will put proseal lma's in trauma pts, put them in prone cases etc. when i am staffing his room, we have had words on this practice, i tell him to get another crna cause i wont do it. the point of this story is if you are just starting in anesthesia, these are the times when you begin to develop your own practice and decide how you will practice in the future. you will hear alot of anecdotal evidence that is hardly ever backed up with hard science. if it sounds fishy and smells fishy it probably is fishy. now more directly to the point, nmb agents should not be needed for lma insertion, you can intubate patients if they are deep enough without nmb. give some prop and mask with sevo.

i dont usually use much more than about 5 mg versed titrated. i usually do the transtracheal nerve block with superior laryngeal nerve block and lido 4% nebs/

in the OR cric... in the field, have someone do a chest compression and intubate the bubble. d

i do about 1/2 to 2/3 of my work as a peds crna. there are no specialty schools per se. there are specialty rotations at about every school for peds tho. i think to be a peds crna, work somewhere with a peds hospital, or one that does a rather large peds service. most ppl don't like peds and anywhere you pony up to do peds they will train you and or get you the experience. d