darne20

Two weeks after an uneventful T&A as an adult, I returned to my job as an airline pilot (weekend hospital pharmacist); while approaching an internatinal airport I felt my nose dripping...didn't realize that I had been bleeding and dripping down my throat (tasted funny) for quite some time...I didn't even feel my necktie and shirt soaked in blood until I turned to my First Officer and saw the horrified look on her face. It looked like I had been shot. No big deal, we landed (cockpit door closed so as not to scare the passangers).....I then started to barf up blood clots the size of golf balls and it was totally gross. I grabbed a big paper cup to catch the blood and deplaned. I continued to swallow and barf up blotted blood for hours before we could find a doc to do an anterior pack and I ended up as an inpatient overnight. Totally gross since it was me.

I'm not a nurse, actually an airline pilot and every other weekend hospital pharmacist..........last weekend, I was the pharmacist-in-charge (whatever that means, and one of our pharmacist's (a Ph.D candidate, not a PharmD.) dispensed MS contin 100mg tabs instead of the 30mg tags ordered to a nursing home and they gave a bunch of them (via NG tube) to a resident..Somehow we caught the error (a few minutes AFTER the nursing home had administered the 100mg tablets).....I called and told them of the error and a fast-thinking nurse used a Toomey syringe to suck the incorrent tabs right back out, undissolved....thank God for that nurse! my hands were shaking on the phone and I probably needed new underwear (sorry, I'm 55 and flying an Airbus is less stressful that healthcare)..............keep med errors to a minimum, but they happen,,,,,,,,,,,I probably have made far more than I know... I was a patient and got sent home with a hickman catheter for IV antibiotics (spinal infection)....I kept working and was discharged with heparin 10,000units/ml (sub-Q) heparin rather than the 100 unit/ml lock flush that I was supposed to use. The VNA made a mistake....consequences? none....i told the nurse who made the error to forget it; the vials of heparin look similar and she won;t do it again..I'm still glad she was my nurse, med error or not..don;t be too hard on yourself and administrators: seek to minimize the errors, but don;t hurt anyone's career...we are all human

The word "hazing" caught my eye. My undergraduate training was at West Point (long ago) and hazing was an art form there. Physical and mental. It was phased out in the 1970's because it was mean-spirited and degrading. Why anyone would tolerate hazing in a CRNA program, I do not know. Up until recently, I thought CRNA's were nurses posing as MDA's with a very watered-down education; I always wanted an MDA for my own surgeries. I now understand that the CRNA's have an important role in anesthesia. My suggestion to any medical professional who is being hazed: notify the authorities. It's illegal. If anyone hazed the CRNA doing my case, I would offer to apply my size 10 combat boot to the offending person's butt.

Thanks for the info; I tried max doses of oral benzo's, but it didn't help. I don't do IV sedation, although the MRA facility offered it. My pain was so bad, I just had the exam. When I got there, they had a CRNA and sedation ready. I didn't want amnesia from benzos (Versed) and told them that I would try the MRA without anything. I guess that I'm a control freak. When I offered to pay cash for the CRNA (since whe was called in to do nothing), she declined to accept my payment. When I freaked out before the MIrI even started, the nurse told me to relax and "I will get you though this" Yeah, right! But she was right. Te CRNA covered my face with a wet washcloth and after I went into the tube, she held my foot (sticking out from the machine) and kept reassuring me.. and kept reminding me that she had a syringe full of a sedative in case things got crazy. Having someone there and reassuring me made all the difference!

I'm a clinical pharmacist (weekends), a reserve Air Forse officer and an airline pilot by profession. Many have asked me to pee tp prove my innocence. Recently, the hospital where I have worked (part-time) for 25 years "requested" a random durg test for everyone inclusing me. I told the MRO that I would submit a sample if she )an MD) helt the cup in her teeth...sorry to be graphic.....so I assumed i was fired. I have Harrington rods in my back and take an occasional benzo/naco if needed. Bottom line: if you have a script, no problem. You do not have to release any medical info (why you are taking the rx or how often) for employment.........give your prescriber a letter to release that you are on a drug, nothing more.......................oh, and my situation was resolved; the doc who prescribed my drugs had a hissy fit and told the hospital that captain x was on drug Y and thats all you are going to get...................I don't want to work with druggies, but this testing nonesense is really nonesense

I'm hoping to get some help here. I'm 54, an airline pilot, and a former clinical pharmacist (who has received great answers here)..I was NEVER claustrophobic; I spent many happy years in the confines of a fighter cockpit and actually felt safe in confined spaces. 30 years and 2 wars later, I freaked out like a lunitic during a recent attempt at a spinal MRI; needs to be the closed type...I'm 5'10. 160 and in great health......I totally freaked out and could not do the test..triedthe wet towel over my face, 3 martinis beforehand and it only got worse. any suggestions? I feel like an idiot,,,,,,,,,,

I wanted to reply to this old thread because I just got back from having my second ulnar nerve/trans CTR done and this time I was able to have the CRNA/MDA, no sedation, Bier Block only issues settled in advance. For the first operation, the MDA had a total hissy-fit when I told him that I didn't want sedation or GA and put this on the consent (my experience is that a verbal agreement means little); so my surgeon suggested skipping the MDA and going with the CRNA. Unlike the MDA, the CRNA had read my chart in advance and knew what I wanted and didn't want (sedation makes these procedures intolerable for me)......and we didn't have to argue about it, which would have raised my BP and made the block less effective. I though that the procedure went well; the CRNA mentioned that I must be uncomfortable since I was all sweaty, but that was by choice. In the RR, the surgeon ordered Toradol and before I could object, the CRNA said quite loudly: "no, he's not kidding about his allergies; the last time he got Toradol he ended up in the ER with a GI bleed and got IV H2-blockers"....I like that CRNA;I'm sending her a letter of appreciation, at least, even though she thinks that I'm nuts for declining the sedation.

thanks-redfaced and sweating was an accurate description, but the pain was preferable to getting so-called "conscious sedation" that I didn't consent to. Some patients like propofol; I hate it. I did my Ph.D. thesis on propofol, so I know a little about it...it's the creepiest most dysphoric sensation that I can imagine.........administered by someone whom you trust is one thing; when they try to administer a drug that you do not consent to-that's another...................

thanks for the info-redface and sweating (SOAKED)

Thanks TXCRNA-Due to a cancellation I was able to get the surgery done this morningn and I did go with the status qood (good suggestion). The only rough spot was when I reminded them that this was supposed to be a Bier Block without sedation (because of a really horrible previous experience with C/S); they basically ignored this until just before the surgery then mentioned as I was entering the O.R. that this may or may not be what they were going to do despite our previous discussion. That is until I mentioned I specified on the consent no sedation or GA bier block only; this resulted in a brief heated exchange (the MD who agreed to the no sedation part was not present)...to prevent cancelling the surgery, the anesthesiologist agreed to do the block without sedation but added that if I declined sedation that I couldn't get any painkiller (I agreed but it seemed a little one-sided to me)...after talking to my surgeon the anesthesiologist departed never to return (not sure why he left, but the CRNA said that the no sedation/no painkiller ultimatum was stupid) and she and the surgeon did the case (32 minutes). The bier block worked fairly well, but my heightened BP from the "preop discussion" prevented the block from being as effective as it could have been, but the surgery did get done. So the CRNA was an effective patient advocate (she offered fentanyl when I was less stoic about the cuff pain, but I survived without it). The anesthesiologist was not. When I have to have the other arm done, I'm asking for the same CRNA if possible. My only criticism is that despite resolving the sedation days in advance, the anesthesiologist tries a "power play" 5 minutes before surgery to change my mind. Fortunately I had 2 things on my side: I specified no sedation on the consent and a CRNA who had no problem with standing up to an anesthesiologist who was clearly trying to ignore my wishes. There is nothing like having a real patient advocate on your side and the CRNA was clearly mine.

I was wrong to think that I would be better off with the anesthesiologist rather than a CRNA. I just finished separate meetings with the anesthesiologist and the supervising CRNA to determine how to proceed. My surgeon's advice was poor. The anesthesia MD is a mere figurehead; the CRNA's are knowledgeable and a lot more honest.

Thanks for the replies; this is more complicated that I had originally thought. Since the re-do will be elbow/wrist surgery with a Bier Block and the "problems" arose from the "conscious sedation" I'm thinking that I'll just request the procedure without any sedation and that will eliminate the anesthesia issue except for the block. Do CRNA's do Bier Blocks? I have been checking out several facilities; one wants to schedule a CNRA and an anesthesiologist (block and sedation, which I'm now going to skip)..is using 2 providers normal? Thanks.

I have documented med allergies to 2 meds and the CRNA gave me both.....30 years as a hospital pharmacist tells me that this happens; there would have been a difference if I had a MD provider: the CRNA admited that she made the error; I wonder if a physician would have been so forthcoming...still I'm scared of ever having anesthesia again......the MD's that I know have a high opinion of CRNA's; but want a MD doing the anesthesia when THEY have surgery................not sure of what to think of this.

Thanks, that's what I needed to know. I recently had surgery and there was an anesthesia problem; the surgeon suggested that I should make sure that I have a anesthesiologist when we reschedule not a CRNA like we had the first time. I'm guessing that an anesthesiologist could have made the same error that the CRNA made.

Apply for the job and be honest about something that happened in the past. It was a mistake; they happen every day in hospitals and sometimes every hour...making mistakes happens to everyone, it's what you do after a mistake happens that counts. I'm a hospital pharmacist and have hired (dozens) of technicians, pharmacists, an RN or 2, several MBA's and even a lawyer...anybody with any experience has made mistakes, just not everyone has been caught. Firing someone for charting on the wrong chart is just plain wrong-minded; I'm not saying that it wasn't serious, but I think that most employers would listen to your explanation; tell the truth but don't dwell on it. Your biggest handicap is that you haven't worked as a nurse for 8 1/2 years; you might consider taking even a part-time nursing job then apply for a specialized job like L&D. Good luck.

Thanks for the replies. If the surgeon agrees that the anesthesia will be performed by an anesthesia MD (because of patient request), is this a problem if agreed to in advance?

In basic term, can anyone tell me how closely a CNRA has to be supervised by the anesthesia MD in charge; or put another way, is it usual practice to have one anesthesia MD supervising more than one CRNA doing a case at the same time? thanks

I just had a colonoscopy and it probably took a little longer because it was without sedation. The doc who did mine told me that she's in no race to reach the cecum; slow and easy lessens the chance of perforation. The withdrawl time was over 10 minutes; probably because she was so careful and explaining everything to me. I'm sure that the entire exam can be done in 10 minutes, but I would doubt the quality of the exam.

Creo-I think that you are 100% right, if the endoscopist is experienced and willing to take a little extra time, drugs are probably unecessary. My last one was done with a little fentanyl only and afterwards they told me that I didn't really need it. I have to have a repeat exam for another biopsy and the endo doc told me that she's perfectly o.k. with doing it with nothing; but she has done literally thousands of these exams and doesn't do them assembly line style..they take a while and this makes a difference. It's nice not to have to find a driver for the exam and we get to skip the IV, pulse-ox, EKG, oxygen...not that it matters. And my endo doc also says that she only takes a little credit for a comfortable exam; anatomy plays a big role. thanks for the info..

Thanks for all of the replies to this thread. I just got back from my colonoscopy without sedation, the endo center had no problem with this request and mentioned that an increasing number of patients are requesting this option although they do not advertise it. The endo center that I went to has a CRNA on staff and tries to do most exams with propofol; they explained that although most motivated patients can do the exam without sedation, they encourage it for several reasons: it makes the exam easier to do and more comfortable which means that a patient will be more likely to return for a repeat exam if needed..the endo doc mentioned that she prefered sedation for public relations; if one patient has a really painful exam and remembers it, then they will tell others and a lot of people won't get screened. But she said that if someone asks for an unsedated exam, they will do it. They didn't have a problem when I declined the propofol, but the CRNA asked if I had a problem with fentanyl if needed (I didn't object to pain control). She was super nice and said that analgesics are a good idea because without pain control, the doc will subconsciously rush the exam if she know that the patient is in pain. Made sense to me. What I really liked is how honest she was, she told me that prn means 50-75mcg now and more as needed. No side-effects at all, the exam took a long time, several polyps and biopsies (painless); the CRNA held my hand for the entire time and everyone could not have been nicer. Colonoscopy with analgesic only is a great alternative, for me anyway.

ChronieToo-I couldn't agree with you more. Sedation and analgesia are often used interchangeably, but in fact many people have negative experiences with sedation (especially Versed), but they can have a comfortable procedure with just an analgesic (fentanyl).

I appreciate all of these replies; I had to read them again before I schduled my own exam for friday. This will be at a new freestanding endo facility, when I went in to pick up the rx for the prep, I was surprized that an RN did the informed consent and was frank about the sedation options. She said that most patients do well with versed/fentanyl, but some find it inadequate and the amnesia "creepy". When she noticed that I worked at the local hospital as a clinical pharmacist, she said "you want propofol", and they have a CRNA to give it (no extra charge, a professional courtesy-pretty nice). When I politely declined this, the CRNA came out and told me that sedation-free was fine, but that this might result in an incomplete exam. Her advice was to bring a driver, plan to do the exam without sedation, but let them start an IV and have propofol and fentanyl ready if you ask for it. That's hard to argue with. I did ask the CRNA about the bad press that Versed is getting lately, she mentioned that the endo center was trying to switch to propofol because they had a significant number of patients complain about Versed, and a lot of complaints came from professional people who aren't prone to exaggeration.

It's great to get so much information and personal opinions from people who deal with this issue on a daily basis. So far, a few things are clear to me: 1. Colonoscopy can be done with or without sedation and that's a personal choice that the patient should be offered and discussed beforehand. I can see no reason that the exam can't be done (if requested) with fentanyl only. Some places still use meperidine? (yikes!) 2. There are a significant number of people who have had very bad experiences with Versed (myself and my primary-care doc included) and this can be avoided with proper informed consent (ie: Versed is given to relax and make you forget, not it's just to make you comfy) or by doing the exam without sedation, with painkiller only or with propofol. When it comes to colonoscopy sedation, one size does not seem to fit all. 3. Most patients who receive versed/fentanyl for colonoscopy are satisfied with the procedure. Patients are generally more satisfied with propofol, but it's expensive. 4. Colonoscopy is not a drive-thru procedure and it is not risk-free. 5. Patients who are cared for by nurses who consider alternatives to "what everyone gets" will have a better and safer procedure, even if it takes a little longer. Personally, I find it refreshing that people express so many different opinions and agree to disagree. These are the kinds of nurses whom I hope are present at my next exam.

I was wondering if I could get some general input from GI nurses and or CRNAs who provide procedural conscious sedation and pain control for colonoscopy. Since I get this exam yearly after avoiding extensive cancer surgery, I try to get as many patient who need the exam to get one. An increasing number of people do not want the amnesia/memor loss associated withh Versed (Midazolam) and opt for the exam sedation-free. I am one of them. The question often comes up with patients who do not want sedation: can they just get pain control (fentanyl)? I understand the synergy between the midazolam and the narcotic and understand that the patient be quite are of the exam, but I agree with the patients who have had or heard about negative experiences with Versed (and the number is increasing daily). So, question #1: For colonoscopy in a patient declinig sedation, do you see any reason why they could not just have fentanyl? This option would get a fair number of patients screened who do not want sedation. Recently, a patient told me that the GI lab at our hospital told her: either accept sedation or you won't get anything for pain. Seems a little one-sided to me, but I called to schedule a colonoscopy and was told the same thing. One GI nurse said it might be a way to convince everyone to accept sedation also. If true, this is bad, leading to many not getting the test. question #2 (for CRNAs): For colonoscopy where propofol is given, do you also administer a narcotic (ie fentanyl) or just use propofol? I'm asking because I have noiced an increase in patient dissatifaction with colonoscopy with propofol when fentanyl was not used; and this is important to me since many patients pay extra for it when I suggest propofol. Up until recently, every patient who had colonoscopy with anesthesa coverage (propofol) was satisfied; now I am running into a lot of patients who had propofol and would never consider another exam because of painful memories. And when I review their charts, they are always the ones who got propofol without any narcotic. Thanks in advance for your inpt. I personally would never do the exam with sedation, but I have to keep my personal opinions out of my work, although it is refreshing to run across so many patients who will not accept Versed because of its well-documented, negative reputation (askapatient or versedbusters). Thanks.

Absolutely, but as stated, the doc can decline to do the procedure. I get yearly colonoscopies and after one absolutely horrible experience with Versed (Midazolam), I would never consent to that drug again. The long-term memory loss and the depression has to be experienced to be believed. About 90% of patients have a decent experience with Versed; but 10% do not. Most patients leave the endoscopy suite in a semi-daze and appear to be content; in about 10% the nightmares etc. start later. I used to think that the horror stories about Versed (askapatient.com or versedbusters) were a little exaggerated, but I have never heard of a drug that was so hated to have it's own website. My degree is in clinical pharmacology; I believe that patients who are properly consented beforehand by a nurse (ie: this drug is being given so you will forget the procedure, not: this drug is to make you comfy) will, for the most part, do o.k. with Versed. I was not properly consented, and even though I know a lot about benzodiazepines and GABA-A receptor theory, the creepy amnesia from Versed haunted me for a long time before I figured out what was wrong. Even now, facing painful elbow and wrist surgery on both arms, I'm sure that I will consent only to a Bier Block without any sedation whatsoever. Sure, discuss your options with the GI doc beforehand; any reasonable doc will let you skip Versed, if you need something for pain consider Fentanyl only. But I hate to say it, most GI docs like an amnesic patient and only see the patient immediately after the procedure and the problems start later. My last 2 colonoscopies were with nothing; each time I was ready for them to try to talk me into conscious sedation..when I mentioned problems with Versed, the doc agreed immediately and she told me that they had a lot of patients complain about it and that she would not consent to receiving it herself. I had my latest colonoscopy at the hospital where I work an I made sure that everyone knew my low opinion of Versed and the doc assured me that I would not get it. I was surprized when they had a problem with me declining the IV (I wanted to make sure that there were no screw-ups); the nurse who wanted to start the IV was a CRNA; my doc had called her in so that I could get Propofol instead of Versed. When I declined Propofol, the CRNA told me that there was no extra charge for her services (as a courtesy since my first exam was a disaster and I was given Versed even though it was a listed allergy. She was somewhat disappointed that I no longer trust sedation of any kind; all of this could have been avoided if a nurse was available to do informed consent for the first procedure-never let economics or scheduling remove your professional nursing skills from the process-you are essential to patient safety. Interestingly enough, the CRNA told me that she would also decline Versed and that she almost never uses it. Unfortunately, I doubt that I will ever consent to any type of sedation, no matter ho painful the procedure. And I know better; a bad experience with Versed can do that to you, even if you have a Ph.D. Just make sure that you get real informed consent before and type of mind-altering drugs are administered.