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jwk has 32 years experience.


jwk's Latest Activity

  1. jwk

    tumescent anesthesia

    Thanks for making my point. I've done anesthesia for liposuction cases since the procedure was developed more than 3 decades ago. Most go well - but I've also seen the overly aggressive high-volume lipo with tumescent anesthesia where things have not gone well.
  2. jwk

    tumescent anesthesia

    Sorry liponurse - the translation for your post is "lazy surgeon, more interested in money than patient safety". It doesn't matter how rare complications are in your hands. It only takes one and your career is gone. All that's being done here is maximizing the number of patients and $$$ for the surgeon. I'm sure you probably do a fine job - but why on earth would you take that risk?
  3. jwk

    Do crnas deserve that much salary?

    You know as much about AA's as Jasy appears to know about CRNA's, which is ​nothing.
  4. Of course it's sterile. And this isn't exactly rocket science chemistry. Many years ago when I ran a cellsaver service, we wanted to use the larger 3L bags to rinse the red blood cells which were then re-infused. Back then, I had a letter from the manufacturer of our fluid products stating that what was in the 3L bags of NS was exactly the same as what was in the 1L bags or smaller. Whether that's true now or holds or held true for all manufacturers I have no idea. We were also told that anything larger than a 1L bag could not be labeled for IV use - although clearly custom-mixed TPN infusions would be an exception to that.
  5. jwk

    Does it bother CRNA's that MDA's get so much more...?

    My large group has never been subsidized. I know quite a few anesthesiologists what work in rural areas, despite the fact that CRNA's are subsidized by the federal government in critical access hospitals and anesthesiologists are not. Your generalizations are opinions not based in reality.
  6. jwk

    ET tube questions

    This C-collar thing seems to be a common paramedic thing, but it really doesn't do anything to secure a tube. You will not find a single patient in the ICU or OR with c-collar on to keep a tube from being dislodged. Tape it in properly or use a commercial tube-securing device. When you're moving the patient, best to D/C the circuit, but if you can't do that, make sure the person at the head has one hand on the patient's head and the other holding the tube. Tube's don't just come out on their own - they come out because people are careless.
  7. jwk

    Providence hospital 'let's go' of 68 crna's sounds fishy

    My guess is there is a whole other side to this story that has not been talked about - what led the hospital to this point that they decided to move the anesthesia contract to a private company? I'll be the first to say I thought the original offer presented to the CRNA's left much to be desired as far as details. I wouldn't sign a contract either without knowing what I was agreeing to, so from that standpoint, I totally agree with them. But, by their own admission, they pretty much had free rein on the schedule and received a ton of overtime. Anesthesia, whether provided by hospitals or by a private group/management company, is still a business. Even non-profits can't lose money indefinitely. Somebody stepped up and offered the hospital an alternative that saved them money. Whether that's a good move long term or not remains to be seen, but by all accounts, everything has been running fine at these two hospitals since the new group took over. I have no idea if any of the "Michigan68" ended up working with the new group, but if they had no alternative employment options, it would not surprise me if some changed their minds at the last minute and went to work with the new group - they had that option available to them till the last day. For better or worse, and I hope it's not worse since my group was just acquired by a management company, this is the direction anesthesia is headed, at least until bundled payments to the hospitals becomes reality and the hospital controls who gets what piece of the pie for the whole hospitalization. I will thankfully be retired by that point.
  8. jwk

    CRNA Practice in SE Florida

    A $10k difference is nothing, considering there is no state income tax in Florida and the cost of living, for the most part, is substantially less than NY. That being said - the main complaint for years has been that the Florida market is more than flooded with anesthetists. There are jobs to be had, but high supply compared to demand is what is keeping compensation down.
  9. jwk

    Suggamadex passes FDA

    The main question in the US will be the cost. If it's cost-prohibitive, which it's rumored to be, it won't get much use.
  10. I'm sorry - there is no such thing as a rural hospital with 200 beds in Georgia. There is no such thing as a rural hospital in Georgia doing hearts, etc. Any hospital within an hour of Atlanta is IN metro Atlanta. Rural is NOT Lagrange, Rome, Gainesville, or Valdosta. Rural is Blue Ridge, Toccoa. Americus, or Donalsonville.
  11. jwk

    CRNA and patient death

    Like the others indicated - death from anesthesia is extremely rare. Perioperative death due to the patient's presenting condition are much more likely, though also uncommon. Trauma, ruptured aneurysm, fulminant sepsis, and perhaps PE would be among the things we would see most often. Loss of airway, one of the things feared most often in anesthesia, is much less probable than it was even five years ago with the widespread use of video-laryngoscopes. The OP' statement - "I know that a lot of the times the death will fall back on the anesthesia team"- is not reality.
  12. Scary thought. :) Ever hear that old saying about nurses eating their young? You're seeing a classic example in this thread. You're not even a nurse yet, and you're firmly established in a professional career, and yet you're treated as lower than pond scum because you don't bow down at the altar and show what is deemed to be appropriate humility even though you're asking perfectly reasonable questions. And although folks like wtbcrna and others would have you believe that only a tiny fraction of CRNA's are practicing in ACT practices and are not to be considered "true" CRNA's if they are, quite the opposite would be the case. BTW - AA's are not a dying profession, nor a new one. We've been around nearly 45 years now - I know, I know, it pales in comparison to 150 years of CRNA-dom, but then none of the CRNA's here are 150+ years old, so it's not like that makes any difference. Although small in numbers compared to CRNA's, our graduates as well as the number of states in which we practice, grows every year.
  13. jwk

    Internal jugular IV

    Although it's just semantics...an IJ catheter is, by definition, a central venous catheter, whether it's with a 3 inch 18ga catheter or a 9FR introducer and everything in between. Treat it as such. Also, it makes no sense to leave a catheter in the IJ (or other orifice for that matter) for four days if it's not being used or cared for appropriately. There's no reason an RN can't take it out using appropriate technique.
  14. jwk

    UK to USA conversion

    Correct me if I'm wrong, but there is no such thing as a CRNA in the UK. As I recall there are "anesthesia nurses" but their roll is pretty limited.
  15. jwk

    The Lazy, Lackadaisical MDAs

    "Pre-nursing" and you're worried about CRNA vs MD compensation? Seriously?
  16. jwk

    Methegine and migraines

    I think the OP is talking about -triptans, not tristans. Probably the most well known is sumatriptan, or Imitrex. Methergine is an ergot alkaloid, some of which are indeed used in the treatment of migraines (the one I'm most familiar with is Cafergot, which contains caffeine and ergotamine). However, any OB nurse should be familiar with methergine and recognize that this is the drug we use immediately post-partum to help the uterus contract and control post-partum bleeding. Ergot alkaloids are contraindicated in pregnant patients.

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