Happy Halothane

It really depends on the loan support you need. For most, they take out 2 tiers of loans every semester. The total can be well over 100k. Mine was 130k. First Tier: Stafford @ 6.8%. Secondary was Private @variable, but most do a Grad+ @ 8%. Federal student loan interest rates are very high, despite all other loan rates. Regardless of what you do... DO NOT CONSOLIDATE!!!!! All it does in average in your interest rates, and create one massive loan that you'll never feel will be surmountable. The best way is to set all loans on autopay, and tackle the highest interest one first. Pyramid effect. I paid my loans off in less than 2 years, but with the support of a secondary income. So is it worth it??? The job market is extremely tight right now. High debt without a definite job placement??? Tough one. If anesthesia is something you really want...something you'll excel at...then go for it. If you're doing it for the money, look elsewhere. There's a better return on investment in many, many other fields. Best of luck, Happy

Go for Stafford 1st. Both Subsidized and Unsubsidized. Research the loan companies and look for the best deals: 0.5% off with automatic payments, etc. For the secondary loan each semester: compare Private variables vs Grad Plus. Grad Plus doesn't require credit worthiness, but will have a higher fixed interest rate than Stafford. Additionally, Grad Plus loans will generally hit you with an origination fee (3%) that gets tacked onto the principle. Example, with a $20,000 2-part loan, there will be a $600 fee...so you'll be accruing interest on $20,600 during the deferment period. Private loans may have variable rates, but are extremely competitive against each other, and generally don't have origination fees. The interest rate is generally lower 3%-5%, but has the possibility to increase later down the road. I opted for the private loan after the first year. The interest was 3% vs 7.5% grad+, plus no 3% origination fee. Additionally, the company paid me back 2% after graduation. It's my low priority loan based on interest rate, but has the potential to become a higher priority if the interest rate increases. Also, some information on consolidating loans after school: If you decide to consolidate your government loans (stafford, Grad+), the moment you do so enters you into repayment. In other words, your grace period is up. It does NOT save you money. It averages the balances/interest rates of your loans, and rounds up. Additionally, most loans offer a 0.5% interest rate deduction with automatic draft...a benefit may lose if you consolidate. It may help organize your loans for you...but in the world of BillPay and auto debit, what's the difference? The feeling of paying off a loan is rewarding and motivating. I took the approach of paying off the highest interest loan first, then re-applying that money into the next highest interest loan. Hope this helps!

Trying to decide between Prodigy and Core Concepts for a test simulator. It looks like Prodigy offers up to 700 questions, on a downloaded software...for $185. Core Concepts has up to 3 - 125 question online exams...for $100. But it seems that the exams are 1 time options, with review of results for 2-3 wks after. Any feedback from recent users?

Instruction is done remotely in many circumstances, and at various satellite locations. Perhaps 50% of didactics were taught out of Miami. The sessions were usually recorded, for replay later (1 benefit of online instruction). There will always be connectivity issues, a drawback definitely. Just like anything else, you get what you put into it: clinically and in didactics. Barry will help you learn anesthesia, but the student is the one ultimately responsible for putting forth the effort. Its a very long road. Don't do it for the money, especially with healthcare reform on the table. Do it because you want to learn more and find a rewarding career.

By far, I believe Morgan/Mikhail will be your best resource. It focuses on important concepts, and is very well organized. Miller and Barash are move involved, and excellent resources...but very difficult to swallow until you have a solid foundation. Basics of Anesthesia, by Stoetling (Baby Miller), is a great starter book. However, it misses many advanced concepts that Morgan/Mikhail includes. Anesthesia for Surgical Procedures by Jaffe is a great resource once you get more clinically involved. There are other texts that may benefit you...Nagelhout and Stoetling's "Anesthesia for Co-existing disease". In "Board-Stiff...Preparing for Anesthesia Orals"....the author stated that you'd be better off reading Basics of Anesthesia twice than incompletely reading other books. Along that thought process, I feel that Morgan/Mikhail (if read several times) will be your best time investment. Keep in mind that it also has incompleteness which will require supplemental material. For Handbooks, I recommend Ezekial. Very small, lightweight, and great information. However, it's poor binder quality makes it very non-durable. Hope this helps. Happy

Full Time work, absolutely must be put aside. These programs are heavily didactic in the front part, and heavily clinical after that (50+hrs/week). Any free time should be spent with friends/family. If you approach it like a full-time job itself, it's not that bad. I've kept a very part-time job as a medic, but only in between semesters...and sporadic at that. It allows for a change of scenery, and a decent time to study.

Congrats on starting your anesthesia education...perhaps I can give you a more positive insight on Orlando. Orlando is considered a decent sized metropolitan area. Like any large city, there are wonderful areas and also areas you wouldn't want to be in after dark. Overall, it's a pretty safe city; but it does see daily drama that's publicized because it's not commonplace yet. There are 3 major anesthesia groups inside Orlando, with several more on its outskirts. The largest being JLR, contracted for many of the Florida Hospital/Adventist facilities. Wolverine Anesthesia is contracted to most of the ORMC facilities, including the Level-1 trauma center ORMC. Dr. P.Philips Hospital is with this group. Anesthesiologists of Greater Orlando has 2 ORMC hospitals and several outpatient sites. Winnie Palmer, the mother-baby hospital uses them for their approx 15,000 births annually. Arnold Palmer, the children's hospital, is next door to Winnie Palmer and ORMC. They employ their own anesthesia staff. Orlando is a great place to live...plenty of lakes, close to the beach, and accessible to anywhere in Florida. As an anesthesia provider, you will need to find ways to communicate with spanish/creole speaking patients...in addition to foreigner tourists visiting the attractions. Best of luck to you.

Basic things you need to know: The Stafford Loan will most likely be your primary loan. It's broken down into 2 parts: subsidized and unsubsidizedsubsidized: interest accruing while deferring payment is paid by the government unsubsidized: interest capitalizes (adds) into your principal loan amount [*]it's subsidized amount is based on your EFC (Expected Family Contribution). The more you make, the less subsidized you get. this amount will change while you're in school, because your adjusted gross income will go down. [*]right now, its at 6.5%, and you should be able to find a loan company that doesn't charge origination fees. A Stafford will not likely be sufficient enough to cover your expenses while in school. So a secondary loan, like GRAD+, or a Private Loan comes in. My beef with the GRAD+ was that it was 8.5%, plus origination fees. origination fees: usually 3% of distributed loan amount, that adds into your total loan balance, and accrues interest.Say your annual Grad Plus loan was 20,000. That's another $600 you will pay interest on, and have to pay off eventually. Going to a Private Loan, you will likely be able to find a very low interest, no-fee loan. However, usually the interest rate is variable, based in T-Bill or APR. So it could either be your top priority to pay off at the end of school or the lowest. Regardless, it's lower interest rate and not paying the ridiculous origination fees should be a better choice than GRAD+. Another term: certified. Certified usually means that your school disburses your loan money. It's amount can be restricted based on school decision. However, it almost always has a lower interest rate than non-certified. Keep in mind, that every year the loan companies offer different incentives: lower interest once in repayment, no origination fees, etc. Research every one of the loans. It'll save you tremendous money over the life of your loan. Also, keep in mind that when you finish school, you will probably only be able to deduct 10-98int interest for the first year. http://www.irs.gov/taxtopics/tc456.html Hope this helps. Happy.

Right now, for a secondary loan (after your stafford split), I would recommend a private, certified loan. If you go the grad+ route, it's 8.5% plus 3% added into the principal. Most private loans right now don't require an origination fee, and offer lower interest rates.

Let's put closure to this: No accredited program should accept an applicant without the required experience....working during your anesthesia education is usually frowned upon, as it would be very detrimental and distracting to the education process of the program. I am a huge fan of the AANA...and I have been supporting them financially for several years, as they've supported us in maintaining our profession. It is not demeaning to the AANA that I suggest future CRNAs have a strong clinical background before learning anesthesia. To remain competitive, all of us need to be remain highly proficient in our anesthetic practices. With a future demand in nurse anesthetists, you've likely noticed many more programs being available to train SRNAs. My concern is that with the retirement of experienced clinicians and influx of new graduates, we need to uphold the integrity and clinical expertise of our profession. Mammoth and Insomniac, I'm sure you were both well prepared entering your program...and learned very quickly that the learning curve was very steep. The people that get behind usually never catch up. I, and the 39,000 CRNAs depend on you and your colleagues to keep our profession strong. High training and expertise = respect and job security..so you can understand my "peeve" about those wishing to take short-cuts. 3 things make a successful SRNA: Drive, Aptitude, and solid clinical experiences. Past clinical experiences are absolutely critical, because you are now expected to be an expert in the care of that patient. You only have 2.5 years to learn anesthesia, as there is no time built in to learn basic nursing care. We are not a "minimum" kind of profession.

Your advocacy of "minimum" may have a different tone for other readers. The point is quality and diversity. The fewer experiences you have overall, the more you will rely on your attending...this applies to you as an SRNA as well. Most of us agree that a CV-ICU prepares an RN extremely well for anesthesia education. If you were able to attain this 1 year critical care experience, thats fantastic. However, most intensive cardiovascular units will not allow a new RN, or even a med-surg RN to touch their patients...you usually need to work your way in from another unit. This is because they don't have the time to teach you the basics...the patients are just too sick. The same applies for anesthesia education. Nurse anesthesia is nursing, and it is critical care. There is no time during the program to teach basics. With a solid background, success then becomes achievable only to those with the drive to keep up. There are 3 main reasons people fail out of an anesthesia program: personal issues, academics, and poor clinical performance. You can make a definite correlation to clinical performance and previous work experience.

I personally have never met an RN that could conquer "drips, hemodynamics, vents and codes" in 1 year's time. You'll probably have mastered anesthesia by the time you're done with school too. ICU/Critical care provides a foundation for learning anesthesia. A diverse foundation helps put pieces together in an unfamiliar environment. If an SRNA has never recovered a fresh heart, or an unstable trauma...how are they going to be proficient at keeping them alive when you are the Intesivist? Aggresive CVICUs and Surgical ICUs consider 1 year as "new"...you don't routinely see the really unstable patients, let alone know how be proficient. Anesthesia is critical care. Every case, you put the patient into a critical care state. ICU is as redundant as you make it. Anesthesia can be treated the same way...turn on the gas, give some ephedrine vs neo, wake them up. Repeat. Life can be redundant too, if you want it to be. I personally don't want someone providing anesthesia on my family if they are the "minimum" kind of person. I would also be embarrassed to admit lack of experience, let alone be someone that proselytizes it.

Standardized tests are obsolete in many facets. Why do undergraduate programs require the ACT or SAT for entry? Why does National Merit base its reward on the PSAT? Why does the NCAA require a minimum SAT/ACT score? The fact is, besides GPA and the degree of difficulty of your baccalaureate degree, we need another tool to assess your competency. Your degree assesses the ability to complete a program. Your GPA dictates your focus. Your GRE helps assess aptitude....how quickly you can learn things. Most graduate programs (not just anesthesia) require a minimum 1000-1050. Many anesthesia programs will allow a score in the 900s, but only with a balancing act of your GPA, clinical experience, and interview results.

Josh, did you thoroughly read the comment above? "With the decentralization of the delivery of anesthesia, it is very difficult to maintain the supervision ratios with any efficiency." The reality is that CRNA's do not need to rely on anethesiologists. AA's do require their presence. There are different levels of ACT. Cost-effectiveness and safety depends on the surgical acuity and caseload of the anesthesia group. This doesn't mean that a well-trained AA wouldn't be able to administer great anesthetic technique. However, if AA's were that much more cost-effective than CRNA's, there would be a higher demand than there currently is.

Competence and equivalence are barely tangible. With the proper training (hearts, trauma), CRNAs provide anesthesia for any form of surgery--and should be just as competent as anesthesiologists. The practice of medicine vs the practice of nursing is not equivalent. All CRNAs are not the same, and neither are all anesthesiologists. What makes the difference in competence is the clinical training and aptitude...the point relevant to this thread. AA's are assistants....very highly trained, but without a proven history of safety and ability. Basically a crash course in anesthesia without the required 4+ years of nursing training/experience. With the proper clinical experiences, a PA-anesthetist could become extremely strong. The difference is, CRNAs can practice on their own (besides the issue revolving in individual states). AA's require an anesthesiologist attending. The ACT is designed for cost-effectiveness and resource availability. Your term "mid-level" is in itself rhetorical. The point to this thread: diverse, advanced clinical experiences provide a solid foundation to learn anesthesia. Without these, you'll be very far behind a steep learning curve, and might never catch up.

Large capacity bladder Humble Demeanor Supportive Family The Drive to succeed, even when discouraged every day. A black pen, along with another one for when you lose the first. Someone else's pen, because you've now lost both of yours. No clipboard, because you'll look stupid holding on to one. A small bag, big enough for your stethoscope, some personal supplies, and something to study during a long case. A PDA, to organize your schedule and put clinical guides, drug references, and a medical dictionary application on. A small handbook, like MGH or Ezekial, because most of you won't bother to learn to use the PDA. Cheap pair of clear lens glasses, to protect yourself from messy irrigation spatter. Coffee. Coffee mints. Coffee pills. Coffee inhaler. A couple alarm clocks, because sometimes you just don't want to get up. (The half-asleep mind can be very manipulative). Books: Baby Miller (Stoetling) and Morgan/Mikhail, for first 2-3 semesters. Another Morgan/Mikhail for 2nd year, because hopefully you've worn out the first copy you owned. Barash, for the last 3 semesters because it won't make any sense until then. An account on half.com, to sell all the books that you will never use. A self-sense of humor...because no one else thinks you should have one. A reliable car (self-explanatory) A laptop with wireless card, printer, and lotssss of paper. Time. Sleep. Patience. And finally....2.5 years of your life (but this is only half the time you've already spent pursuing admission into a NA program.Good luck, and congratulations!

Well if that's the case, don't even bother becoming an RN...and go to AA school....and be the "assistant" all your life. Anesthesia does more than ICU experience...it requires an aptitude to learn totally new and advanced concepts. I personally feel that more than 3 years of a "high acuity" ICU should be the minimum. This is more than to get your foot in the door...its to provide a solid foundation to survive in the program. CRNA's are expected to be every bit as competent as anesthesiologists. I don't care how smart you are...without a strong background, you can't learn in 2.5 years what someone does in 8 years (+ optional fellowship). The 2 years of RN training are meaningless without the clinical application afterwards. When you, or a family member need surgery, would you rather a med-surg nurse...or an ICU nurse stay by your side? Medical surgical nursing provides excellent time management skills, but doesn't prepare you for 1-1 training. Don't lower the bar of standard. It would disparage the profession and compromise the quality of anesthesia care that is currently being applied.

It really depends on the etiology of the pneumothorax. In terms of V/Q, if the lung is collapsing due to a higher intrapleural pressure-- placing the patient in semi-fowlers and trials with affected lung up might facilitate re-expansion of the lung. In cases of pneumonitis/drainage or poor SVO2, placing the affected lung down will allow maximum ventilation and protection of the unaffected lung. Studies have shown that after needle biopsy/intrapleural drainage, there is no difference in post-procedure outcome related to positioning. Generally, to limit exacerbating VQ mismatch, place the patient in mid-high fowler's, and provide frequent 15 deg rotation.

Take out the max that your school will certify. That usually means 2 loans per semester. The stafford is great, especially the subsidized part of it. Fixed 6.5%, with or without interest capitalization. For the secondary loan, I would reconsider the Grad Plus. Its at 8.5%, with few banks offering incentives. Plus, there's a 3% origination fee, that gets tacked on to your principal amount.So if you borrow $50,000 in 2 years, thats $1500 additional that will accrue interest during the loan period. Look into alternative loans. The good ones offer APR + 0-0.5%, without origination fees. APR isn't forecast to increase significantly for at least the next year or 2...so the lower flexible rate should be a safe bet. Save your , but don't struggle financially during school.

Your supervisor must have some office/work hours, even if it may differ from your schedule. Write the letter for her, and present it to her personally. If she approves, then have her sign it. Use hospital letterhead when you print. You need to be aggressive, and complete your application entirely. Good luck.

After you're accepted into a CRNA program, you'll find several options for paying student loans. Most of them are from private group sign-ons, but there are a couple military options available. The best seems to be the ARMY STRAP program. For the STRAP program, the $$ benefit depends on the # of years you commit (4 is ideal); you become a reservist. Your weekend duty can be integrated into your school classtime, and then becomes actual CRNA duty once graduated. Once every 2 years you'll be sent elsewhere for 90days, usually inside the US. I have a couple friends that are participating...they seem really pleased with their selection. The CRNA duty at other facilities can help augment your skills. There is a chance that you can be sent overseas. If you're looking into the Military as an option, be prepared to serve in the Military. It can either be a fantastic opportunity, or 4 years of anxiety for your family. Make sure you go into the OR and shadow the anesthesia team before making up your mind on CRNA. Good luck!

I was fortunate to have my mom as a resource: She's published and developed several SAT/ACT/GRE test prep materials. So I took 2 weeks off work and did a crash course with her and 5 books. What I found is that every book has something to offer, individual of the other. I do remember liking the ARCOT and Kaplan books. Here some key points for you guys: 1) The math is extremely similar to the SAT. Focus on geometry and simple algebrae: 8th-10th grade math. 2) The test writers seems to get kicks on making the answers very easy to deduct to. There is almost always a very simple way to get to the answer. It should be a red flag if you're spending a long time on any question. 3) With that said, the only way to excel at the GRE is to determine your answers FAST...leaving a few precious extra seconds for the ones you can't figure out. 4) Verbal: If you put any effort into this, you'll likely score better than most. It seems that most persons figure they can't develop a dense enough vocabulary in a short time....so take the extra effort where others don't. 5) Analytical: Most programs just look at the GRE score. The analytical displays a subscore, independant of the Math/Verbal. It shows that you can put together cohesive thoughts....but its scoring is not well understood by those in admission panels. Don't blow it off, but don't stress over it too much. Remember: intro paragraph with thesis statement, referencing the upcoming body. Similar conclusion. Simple! 6) Do as many practice tests as you can. It will help with your speed. A superior GRE score can help prove that you have the aptitude to think and learn quickly. It can really help balance a lackluster GPA. Keep in mind that most graduate programs require a GRE > 1000. Good luck.

There's a couple programs that will really help you...I've looked at just about every one available for anesthesia....probably the only one I haven't seen yet was the unbound app. My recommendations: 1) Taber's medical dictionary (easier to use than Stedman's) 2) Soto's Anesthesia drugs (comprehensive pharmacology..anesthesia specific) 3) Clinical anesthesia (Barash), MGH, or Nurse Anesthesia Pocket guide. NA Pocket guide has some great pearls, but lacks comprehensive content that Barash offers. 4) Either a doctor or nurse drug guide, to look up all the weird drugs your patients are on. Epocrates is free, but can only be installed onto the unit...and is a major memory hog. I've found that I use these four application types more than anything else. Isilo is also very useful; its a great application to put your class notes on for studying. Good luck.

I responded earlier....but the post hasn't appeared (hours ago?) In all fairness, I selected that article to help prove a point...for a discussion that cannot be won. There have been numerous studies regarding ESI since then: ESI is commonly practiced, as a result of evidenced-based medicine. This discussion has circumlocuted away from your original question, but that's part of what makes forums interesting. Still, isn't it interesting that medications are being administered in a way not intended by the manufacturer, nor approved by the FDA for that use? I hope our initial responses were able to answer your question. Happy

In all fairness, I selected the article to prove a point...for a discussion that can't be won. There have been countless studies on ESI since then, and the practice of ESI is commonplace--because of evidenced based medicine. I helped evolve the original question into a non sequitur discussion. Still, isn't it interesting....administering a medication in a way not intended by the manufacturer, nor approved by the FDA?? I hope our first 2 responses were helpful to you. Happy