icurn96

Lortab is a combination of acetaminophen and hydrocodone (a partial opioid receptor agonist.) Hydrocodone, in the same class as codeine, supresses the cough reflex by stimulating a specific receptor sub-type, possibly sigma receptors. This is an effect of most opiods like morphine, fentanyl, etc. Partial opioid agonists do so at lower doses than needed for analgesia. If you are having laryngospasms s/p trach, I'm assuming you are having boughts of excessive coughing which is why the Lortab is working for you, and probably helping with any pain and soreness. Hope this helps.

And speaking of chilling out...I really debated even taking the time to respond to this statement. I think it's really funny how you first attacked my humble solutions so hastily without even reading the the whole thread. When you realized you made a mistake you then lashed out and attacked my writing style. Sounds passive aggressive to me. Please, it's unnecessary. I'm all for freedom of speech & expression of opinions but let's keep this professional. Note to self, BarbPick: read and pay attention before you throw around insults and serious terms like "rape" and we won't even have to have these silly exchanges. That's all I have to say.

Good advice, mommyof2girls! We have usually done TurboTax before and plan on doing it this year, too. I hope it's comprehensive enough to find all the extra little deductions you're talking about...and charities and donations are very beneficial. Maybe my prayers for a bountiful refund will be answered!!

Sis123, I think I can explain why the use of benzo's is so favorable, specifically Versed. When someone is going to be anesthetized for surgery, there are 3 basic components to achieve: amnesia, analgesia/areflexia to pain, and muscle relaxation often with paralytics. So by using a combination of agents, you achieve balanced anesthesia. Benzo's contribute a major component of sedation, hypnosis, and amnesia (which most patients focus on...the desire to be asleep, unaware, and not remember the unpleasant experience of surgery.) As you may know, ativan and valium are other benzo's that tend to hang around long which may hinder waking the patient up. Versed is so widely used from this class of drugs because of its extremely short 1/2 life and duration of action. It's use pre-op is to help the patient relax, go to sleep and facilitate the next step which would be induction during which an ETT is placed and airway is secured. I hope this helps a little. I am so sorry to hear about the experience you described. I am a second semester CRNA student and I find what happened appauling. I hope your acquaitance follows YogaCRNA's good advice.

A friend who is an accountant recently told me to be sure and check with my financial services dept at school and request the 1098T form to show that I am currently paying tuition. She said when you are in school as a FTstudent, you automatically qualify for a $1000 credit which can only help!! Also, I'm not sure if you are a homeowner who itemizes, but if you are paying interest and drop down to only one income, wouldn't that work in your favor? At least these are my hopes for this year (my first tax season in school) I'm praying for a HUGE refund :) Maybe others can add their experience!

Again, BarbPick, nowhere did I mention administering Versed or any other benzodiazepine at all. The question at hand is how to handle Tenesma's situation with alternative options. If you will take the time to re-read mine and Tenesmas's post, maybe this will clear up the confusion. You must be referencing Sis123's initial post. I'm addressing a little different situation. Anyhow, if I were referring to Sis123, she stated the patient refused Versed, but was willing to accept another drug, hypothetically propofol. I am 100% in agreement with upholding patient rights and protecting patient safety...essentially that is what beneficence, nonmaleficence, and informed consent means...clearly the antithesis of "rape."

No means no to what??? In Tenesmas situation, the patient stated they had a BZD allergy meaning further evaluation and red flag giving benzodiazepines. Propofol, the last time I looked, is NOT a benzodiazepine. And as I extensively discussed, the patient would have been INFORMED of the decision and a discussion would have taken place in the pre-op holding area. The word "rape" is a little inappropriate. My suggestion to "head straight for the propofol" was merely a suggestion as an alternative agent...NOT violate the patients wishes. Please read my preceding post again.

Tenesma, You are right. This is an interesting thread. I've looked after more than my fair share of fearful, agitated, restless, anxious, demented, and psychotic patients in the unit. But this is like apples and oranges, as they say. Realistically, the surgery setting is often very different from ICU. These patients are typically just plain scared to give up control and put their life in our hands...very understandable. From my limited perspective as a student, they are USUALLY still rational and maintain reasonable cognitive function. I'm not sure what the details are of your patient scenario (whether this was an elective outpatient procedure or an inpatient with comorbid issues having surgery.) Nonetheless, if I were in similar shoes (I'm on track to be in December, 2005) I would take 5 or 10 min more of my time in pre-op to do some teaching with the patient and a family member if present. You know, the whole therapeutic conversation "You seem a little anxious and restless and I'd like to give you something to help take the edge off and make you feel more comfortable. We need to discuss together how we can calm you down...etc, etc, etc." So many times I am amazed at the reactions I get from patients just by showing a touch of genuine compassion...it establishes trust and a sense of comfort that often (not always) makes a huge difference. It's a shame the original poster didn't have this courtesy. It sounds like your patient was one of the many who don't realize the normal expected side effects so they assume they have allergies. They need to be informed. I know you probably know all of this. Trite as it may sound, this is our duty to address psychosocial needs and involve the patient in choices rather than being paternalistic and going against their wishes much like the original poster described. It was wrong for this Anesthesiologist to attempt to deceive the patient...obviously the patient remembered the incident (anterograde not retrograde, right?) When this approach fails, can you go to plan B and head straight for either a narcotic opiod to calm them down or a light conscious sedation dose of propofol prior to inducing them? (assuming they were cooperative enough to establish IV access) Although not as optimal as BZD's, propofol does have some amnestic effects. I don't know if propofol would be used like this very often. If not, I'd notify the surgeon about the delay and evaluate my PO & IM options, as long as the patient consented Benevolence, nonmaleficence, and informed consent are essential. I may be way off track but I'd like to hear your response!

Bottom line is....if this Anesthesiologist was so bold as to utter the word "midazolam" and push the versed despite the patients wishes, what other illegal and cavalier actions is he/she committing on a daily basis? In my 7+ years of experience, this type of mentality is a pattern. I guarantee they WILL do it again unless actions are taken, legal or not. I 100% agree with YogaCRNA. Letters must be written to the appropriate authority and what a message it will drive home when he realizes he staffed that case for free!!

I agree with aphippen. I, too, am in my second semester in TCU's charter class and I love it!! Definitely the best decision I could have made. I have learned so much already and am thrilled to be in a program with intelligent, supportive professors and experienced directors who know how to generate successful CRNA's. They are laying a foundation of greatness so don't let ANY apprehensive comments you might have heard early on misguide you. In my experience, they like to focus on cardiac and hemodynamics. Review fundamentals of swan values, cardiac anatomy and ACLS drugs. Respiratory is also key so just study these areas as you would for the CCRN. As far as tips for your interview (and this may be applicable to anyone interviewing) be certain you know what you know and you know what you don't know. By this I mean don't try to BS your way through a question. Have confidence in your answers but don't be afraid to tell them if you don't know an answer. They want to see that you're honest, that you handle stress with composure and that you are teachable. A good response would be "I don't know the answer but I can't wait to learn more about it." If you are struggling with a question, they may even prompt you through it to evaluate your critical thinking skills and your ability to reason. Balance your self-confidence with a touch of humility and above all, have a postive attitude. Good Luck! Go Frogs!

During my undergrad, I received Perkins loans as well. The catch was that if you remained employed full-time for 5 consecutive years in an underserved public or county-type facility, you could have the loan completely cancelled at the end of the 5th year. It was a requirement to send in proof of employment signed by a supervisor and stamped with the hospitals seal (done in administration usaully) at the end of each year. That was my experience when I graduated in 1996 and I'm thrilled to say that mine were finally cancelled 2 years ago.....just in time for me to go back to CRNA school and take out MORE LOANS. Oh well, c'est la vie! Check with your financial aid office at your University. They are really knowledgable about the specifics. Best Wishes!

Thank you so much. That is exactly the type of feedback I was hoping to find from CRNA's in the day-to-day clinical setting. I was just hoping to hear either from women who had started their family while working or maybe from those with colleagues who had healthy babies & successful pregnancies. To tell you the truth, our focus right now is just getting me through school with grades to be proud of. The notion of having children is just so on the back burner....I mean the LEAST of my worries right now. But when someone mentioned a scary possibility like birth defects/spontaneous abortions, I felt compelled to pick ya'lls brains. Again, I appreciate the positive words.

Thanks for your feedback, YogaCRNA. Yes, I'm all too familiar with Medline from my undergrad days. I will definitely do some searching there as soon as I can emerge from all these books and tests in the next few weeks. I was just hoping for some general knowledge here in the mean time. I suppose you could say I have respect and appreciation for words of wisdom and experience!

Greetings! I'm a first semester CRNA student with almost 3 months of didactic behind me (767 days left until graduation) Like lots of women, I have made the tough decision to postpone having children until completing this program. I've been married 5 years and have a wonderfully patient husband beyond belief. I was recently informed of (or alarmed by) the implications of anesthesia & waste gases on childbearing, specifically the increased risk of spontaneous abortion and birth defects. Am I being silly by worrying about this? This is the LAST thing my husband and I need to hear regarding this career choice that I am so eagerly anticipating. Hopefully some of you in the field who are much more well-versed than I can reply and tell me that I'm being paranoid. I mean, part of me wants to believe that technology and developments have taken measures to decrease the risks (better biomed checks and balances, better OR ventilation, better anesthesia delivery techniques, etc.) But I can't help but be concerned. Are some agents worse than others? Or is it related to certain trimester exposure? I realize I need to do some research and delve into the fact-finding/statistics, but as you might imagine....not much free time these days for extraneous tasks. Any comments or thoughts?