BigDave

No, This is not movement related to hypoxia/delerium. I do the same thing maybe 10 patients/week. I (and 3 other CRNAs/2 MDAs) are having the same issues since starting this system last week. Nothing has changed in my technique except that my patients are desaturating all the time now??

Our hospital started using the Smart Capnoline nasal cannula for endoscopy cases. http://www.oridion.com/eng/products/sampling-lines/filterline/non-intubated/smart-capno-line.asp Today I was having a hell of a time with oxygen desaturations. I had one guy (400 lbs mind you) that was grabbing stuff and talking with a real sat of 55%. I've never seen such a thing! The patients are desating, despite having little anesthesia on board (as evidenced by grabbing and eyes open). I've received no training on this stuff, but the nurses there said that the cannula will only flow 5L/min max. Is anyone else using this and having issues? Thanks!

If you are talking about big Miller, I think that is a bit much pre-school. Not to mention the $300 it will hurt you. Baby Miller (Basics by Stoelting/Miller) is good. I read that one before school and was miles ahead of my classmates.

I have it. Mary was the program director at Duke, but now is starting up the program at Ashville. A couple of my faculty wrote chapters in it. Some of the tables in the book are very concise and detailed. They worked well in careplans.

We use Medatrax at UNCC and had to pay for it. $147 total for 29 months. I track cases on my PDA (Dell X-50), but do evaluations on the PC. We are not doing careplans through them. Here is the invoice for the case tracking portion: Medatrax Case Records Period of invoice: 8/23/04 - 12/31/07 Fee Rate w/evaluations: $ 4.00 per month # of Months: 29 # of months adjusted to 24 Sub total $ 96.00

Maybe that is why Baxter gave us the book/DVD set for free!

An ex co-worker of mine interviewed there a couple of years ago and actually asked about the lack of central line experience during the interview. They kinda got ticked off at him for asking...he went to a Texas program--since they did not accept him after that!

I think you nailed it here. It would be a financial disincentive for an attending to go 2:1 except for the teaching rules--that fortunately did not change this year. But, yes there are politics too. When I was in San Antonio, there were NO CRNAs except in government (military & VA) hospitals. I don't think there has ever been a difference in liability...'cept an MDA telling the surgeon "ya know if you don't have an ologist on the case, the bad stuff will fall on you. You really need me in the room to protect you."

Congrats NCGIRL!!!! Can I rub you for luck??

I worked NICU for a little while. Fun work, high stress. I guess being challenged in your work is the most important determinate here. As an ICU nurse, I had seen about everything. I'd come to work, go on autopilot, cuss at a couple of residents, go home... I was making $100k as it was. For a 46 YO to get poor, go into debt for 2 1/2 years and come out...well it isn't all about the money!

As someone that spent 9 years in the ICU and 2 as a NP... Yes, I am glad that I will never work there again. If I flunk out of CRNA school, I'll leave the medical profession completely. It wasn't taking care of patinets (even code browns) that bothered me. It was being placed in demeaning roles by arrogant MDs (that were obviously in it "for the money") and by demanding family members that constantly displayed personal agendas that interfered with quality patient care for their loved ones. As a NP, life was better, but it was a grind working primary care and keeping on schedule...especially when patients brought "the list." Also, Americans have lost the ability to do self-care. They come in with a "headache." You ask "did you try Tylenol or something?" They say "no, did not think of that--but could you write me a sick note for work?" For those of you that think CRNAs are in it to get rich, maybe you should do more research. Did you know that CRNAs have one of the highest job satisfaction rating of all professions? Are treated as a valued member of the patient care team? (rather than a hand maiden for the docs). Have the only "functional" organization in nursing for their profession (AANA). And so on...

Good idea! I have several beers that I call favorites. Right now I'm going through a batch of homebrewed red ale that I cooked up over the holidays. When I buy, first rule is nothing in a can. I like anything from Sam Adams, New Belgium (Fat Tire, Blue Paddle, Loft), Sierra Nevada... I'm in the second semester at UNCC now. The first semester was a snooze, but we are actually getting busy this semester. I have a test at noon and should be studying right now, but... I've learned a lot from this forum. It is good to hear others perspective.

Good luck! I worked on airplanes for 15 years (avionics) before I even started on nursing. I'm 46 and in school now. I figure I'll have at least 20 good working years left in me after I finish CRNA school.

Although money is always nice (especially after racking up loans), I think the vast majority of CRNAs actually enjoy the work. As in nursing, there are a variety of practice setting that can fit your style. As far as having ICU experience, we had a hemodynamics lecture yesterday. The first thing the instructor said was "you should already know xxx so I'm not going to cover that." At the end, she said "I'm teaching you neuromuscular blocking drugs in two weeks. I have a lot to cover, so if you are not up to speed, you'll have to read ahead." There isn't time to teach nursing school in CRNA school. The first day of class our director responded to my question that the most valuable thing we teach is clinical judgement. I consider that a direct advancement of skills learned in the ICU.

jwk, from your perspective, how did this statement sit with you? "anesthesiologist assistants or nurse anesthetists, who are trained in many of the technical aspects of anesthesia delivery, but not the medical aspects of anesthesia care."

I could feel that one coming!!

The role of the anesthesiologist in the operating room is to: 1) provide continual medical assessment of the patient; 2) monitor and control the patient's vital life functions -- heart rate and rhythm, breathing, blood pressure, body temperature and body fluid balance; and 3) control the patient's pain and level of unconsciousness to make conditions ideal for a safe and successful surgery. Funny, that doesn't explain a "medical model" at all. A good ICU nurse can do most of this quite well without "the education, skills and training" of your friendly MDA.

I really see no advantage. I'm letting my NP certification expire this September. Anything that gets in the way of moving patients through the system is detremental to the bottom line. Seriously, why pay a CRNA to do tasks that a NP or PA can do for less $$. It seems nice to see the "big picture" and to have that follow-up capability (did my patients have PONV/pain post-op), but from a patient safety standpoint, you can't stay competent in both fields for very long.

Nitecap, I can smell you from here!

That's cool dude, just joshing with you :)

What the.... Watch those "basic nursing skills." They might trip you up on that CRNA board!!

PS has an excellent lecture on PONV on Audio-Digest. It's funny that he and TJ are both Carolina settlers. Droperidol is supposed to be as good or better than anything, and lots of folks think that the "black box" was unwarranted, but if you croak someone with a dysrhythmia you might as well give your house keys to their family. (BTW SW says hi. He had a nickname for you "Naynay." Do I need to punch him for you?)

Decadron is only good if given in advance (with induction). Some knifesmiths do not like it for its theoretical impact on wound healing. Routine use of antiemetics is not warranted in all patients, just in increased risk folks (girls, non-smokers?, hx of PONV, opioid use...and type of surgery: lap gyn, boobs, shoulder, strabismus, etc). Most researchers in this field (TJ Gan, C Apfel, P Scuderi) speak in terms of number needed to treat (NNT). Most useful agents are 4-5, so out of every 5 people, 1 had a positive effect...20% Effective tx include: TIVA with propofol, avoid N2O, have good pain control (but don't give too much narcs??). Then the agents: Dec, Zofran and other HT3s, Droperidol (which we can't give any more), maybe Phenergan. Scop works as well, but needs to be given well in advance. Some other approaches include: give lots of fluids intraop (maybe good for PONV but bad for other issues?), increased oxygen (studies inconclusive). BTW, everyone says that Reglan=placebo.

I would give the propofol back if he is agitated and pulling at the tube.

thanks! sw is s nice guy. i'll see him at chem/physics final tomorrw. i drive about 15 miles to the hospital and about the same to uncc (although i am done out there). that is about 30 minutes driving with traffic. i too record lectures, listen to audio-digest anesthesia topics, or just rock the stereo and drive too fast!