KPHIL71

The most commonly used reversal drug is Neostigmine. Neostigmine is not a direct competitive antagonist. A competitive antagonist is a drug that competes for a binding site. Neostigmine does not compete at the specific site of action and is therefore by definition not a direct competitive antagonist. Neostigmine (reversal agent) is a reversable acetylcholinesterase inhibitor. Acetylcholinesterase is an enzyme which breaks down acetylcholine at the neuromuscular junction. So if you block enough acetylcholinesterases, acetylcholine will flood the neuromuscluar junction and out-compete paralytic for available binding sites. First if your patient has 4/4 twitches then only ~75% of their Nm receptors are blocked. What in hell does this mean? Without getting into too much detail it means that your patient can initiate their own breaths and they may be able to move. So when I'm emerging someone and if they have met all my extubation criteria without reversal I will extubate. The reasons for not administering reversal are many. Remember. . . neostigmine is a drug. All drugs have potential negative side effects. The problem with neostigmine it isn't selective. It has cholinergic effects at both the Nm junction (intended target) and also in the heart (uninteded target) and in the lungs (unintended target). Most of the time we give reversal coupled with an antcholinergic drug like glycopyrrulate or atropine to counter the bradycardic effects. Unfortunately in pts with reactive airway disease such as COPD or asthma, reversal agents can cause increased secretions (bad) and bronchospasms (really bad). Well that is all I got right now. Have to get back to my DNP online classes. thanks

I think its a good idea to be a bedside nurse for at least two years after graduation. I graduated with my BSN and went straight to the ICU. I've been there for four years and am still learning everyday. I start a CRNA program in 6 weeks and think I am making the right decision based on my research and my specific opportunity. I myself have always enjoyed procedures (conscious sedations for intubations, endoscopy, etc). I also have a strong chemistry background so anesthesia seems like the right fit. I shadowed with 3 differing groups and really got to know what the the job market was like for each city or town I would practice.

I'm a VA employee SICU RN. I was fortunate enough to get into the USAGPAN. Not only is my school payed for but I will also be pulling a nice salary while in school. When I'm done I owe the VA 3 years at a very competitive CRNA starting salary. So in the end I think its a pretty good deal. Free CRNA school + current nursing salary while in school + Job waiting for me when I'm done.

Well it looks like you will definately know where you are going for the next three years. I'll be right there with you. I've spent quite a bit of time in texas. San Antonio isn't half bad. Austin is real close and Texans in general are sweet people. I have no idea what memphis is like. Tennessee seems pretty cool. Lots of great music in memphis if you like Blues. Kent

All great responses. Most superficial veins roll fairly easily with the older patient population. A Site Rite can be very beneficial in this population. Not only does it provide really nice US imaging but it allows you to access deeper and larger veins. These veins rarely role being they are stabalized better by the surrounding tissue. It may take a while to gain the prerequisite dexterity involved with having both hands occupied, but once you do, it becomes fairly routine.

Hi there, I'm in your same shoes. I agree that it has been a long process and I too have worked pretty hard. We are both very fortunate to have this great opportunity. I'm looking forward to the next stage of my life and career very much. You can pm me any time you like. thanks Kent

Oh wow! Thats news to me. Thanks! Are you guys still heading to Augusta?? thanks kent

4 are taken each year.

Hi everyone, I recently was accepted to the USAGPAN VA employee component for summer of 2013. I was just offered sponsorship by my home VA in Denver. Woohoo!! I'm excited that I will be returning to Denver after my 3 years of training. Can anyone comment on the exact start date? thanks! KPHIL71