sandman1

Yes......it can be done. As much as it still sucks getting up at 5am everyday..... I AM getting about 7 hours sleep before clinical no matter what. During CRNA school, especially during clinical, i recommend setting a goal for yourself to go to bed at a certain time every night and stick to it. Lack of sleep will show in your performance. Staying up all night doing careplans will hurt you more than help. Plenty of people have graduated with subobtimal careplans( you'll find they are always suboptimal no matter how much work you put into them...there's always something that can be added as long as it's fewer pages than MILLER. LOL!) but very few get by with poor performance. During didactic I never pulled an all nighter either but believe me, my time awake was spent very wisely with very few wasted moments. It would, of course be more difficult with kids.

I agree. They are hardly worth putting in the same sentence. Compare? kiddie slope vs. black diamond, 5k versus a marathon, life versus no life (literally),......you get the picture. I like the straw and fire hose analogy as well!!

DFK....... If you have an art line that is "not working", clotting, damping, etc....... don't use it and go with the cuff. It' s not that hard of a decision. Just document that it is flawed. If you have been educated properly on monitoring BP with an art line then you know how to test for over/underdampening, proper waveform, zeroing, at what level to place it, etc. If you recognize a good waveform and all of the above checks out then you HAVE to go with the Art line pressure whether you like what it is reading or not. There is no better measure of blood pressure than art line. Just make sure you don't get caught up with the folks who just decide their art line sucks for no other reason than it is different from the cuff and they like the cuff reading better. If you can prove that the art line is off and you can't fix it then there is no problem as long as you document

Am interested in hearing about your experience with this combination for a MAC case. What ratios tend to work the best? Thanks. I've been using 10mg propofol/1mg Ketamine.

Correct. It is only a proposal and it doesn't look like it will happen by then, if at all. First, you can go to the AANA website and find their position statement regarding this matter. Currently they do not support this action. Interestingly, the ASA is causing a stink about this proposal as it would enable CRNA's to be called "doctor". What the ASA doesn't realize is, the AACN is the one proposing this, not AANA.

Those are still 2003 rankings. The process doesn't have anything to do with true quality of education. It IS very political and also based on things like the degrees the faculty have, how many texts they've published, # of simulators, # of faculty, # of students, etc. The #1 school is the one that lets you in and is right for your needs. My school is not on that list ( think it's 20 something) but I can guarantee you that I am and will be every bit as good as any SRNA that graduates from VCU, which IS a great school I'm sure. It's all about what you put into it.

Thank you everyone for your well thought out and researched responses. Just to clarify,(as the title of this thread is "IM ATropine dose for peds emergency") I, nor anyone else on this board thinks that IM ATropine is a PRIMARY route for emergency for anyone. As I indicated, earlier in the thread, I am only asking in the case of the emergency of laryngospasm, or an emergency with No IV. I know IO proves better, etc but you better believe that if I have an IM dose of Atropine ready with no IV and I need it that I will give it a split second BEFORE I try to start an IV or IO, regardless of the unpredictible onset, etc. With that being said, I was wondering what an appropriate IM dose of ATropine might be if I had to give it. Thank you for the Nagelhout reference of .03mg/kg. I'll look for that one. Anyone see anything else besides .02 and .03? Many people in the clinical area still tell me .04 and even .05!

Thanks for your reply. I just wonder because at most facilities that I have been to, most anesthesia providers want you to draw up an IV AND IM dose of Succs and atropine for pediatric cases. The Succs is obviously to break laryngospasm in the unfortunate case of having no IV (during PE tubes, etc). The atropine to counteract the Succs adverse effects or to use in an extreme situation not corrected with a little O2, I guess. Nothing happened. It's just confusing when you have people(not just one person) telling you to draw up Succs and ATropine with the IM dose being double the IV for both drugs yet I can only confirm the IM dose of Succs in the texts. All I can find regarding Atropine is .02mg/kg IM which is the same as IV.

What is the consensus on the IM Atropine dose for peds? As a student, I have had people tell me everything from .02mg/kg to .05mg/kg. I can only find references for .01 and .02, however. Can anyone provide a REFERENCE that states the IM Atropine dose for peds is anything different than the standard IV dose? Thanks.

Turn off the vent, close the APL valve, turn up the gas flow, squeeze the bag until you reach your predetermined pressure (40 is a nice number) and hold it.

Come on guys. I KNOW the MAJORITY of you believes that colloids are to replace blood at 2:1. I'm trying to find the source of this because EVERY text that I read says 1:1. Where does this 2:1 come from? (Maybe it's in an older version of Barash, Miller, etc?) It's frustrating to be in clinical and get reprimanded/corrected on something that you can quote right out of 5 textbooks but you're still wrong anyway........ It's almost like "that's the way it always has been and that's the way it will stay regardless of what the current versions of the top 5 most respected anesthesia texts say." Thanks in advance.

Why is it that EVERY text I read says that blood is to be replaced with crystalloid at 3:1 and colloid at 1:1, but yet 90% of all anesthetists and MDA's I ask say that blood is replaced at 2:1 by colloids? Blood replacement aside.....(hypothetically, so don't say "I wouldn't replace it with colloid!)if you calculate that you are 1000cc's behind and you only had colloid to give, would you feel satisfied that you were back even if you gave 300ish of colloid or 500cc colloid? For those that say it is indeed 2:1, please provide me with a reference because I can't find it. Thanks!

Suit or at the very least, conservative coat and tie. What you wear is representative to the interviewers as to how important the interview is to you. I've seen good candidates not get accepted because of their casual attire.

There are also rare cases in which the spinal needle is not advanced far enough and only the tip of the needle is in the Subarachnoid space. In such a case, some drug is also injected in the subdural space and it only takes a miniscule amount of drug in the subdural space to travel all the way up. This happens almost exclusively with beveled needles.

Methoxyflourane is the most potent agent because it's MAC is.......well, I don't know what the heck it is but it's less than halothane (halothane being .8%ish). It is the most potent agent because it takes the least amt of agent to acheive MAC. Des....well, actually nitrous is the least potent because it, takes the most agent to achieve MAC (104%). So.......if it takes 1.2% forane to achieve MAC but 6% Des to achieve the same effect (also MAC) then forane is the more potent of the two. The least potent agents are also the least soluble in Blood. The most potent agents are the most soluble in blood. As far as the Meyer/overton rule.......that's talking about solubility in OIL. Here the most potent agents are also the most soluble in olive oil while the least potent agents are the least soluble in olive oil. Someone correct me if I'm mixed up here.......