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.......

The benefit would be if you successfully complete a retrograde intubation then you have a controlled airway that you can ventilate adequately with. A cric is a temporary fix until you can establish another airway. IT is my understanding that you can't really ventilate through a cric, but it is a way to get large amts of oxygen to the lungs with jet ventilation etc. Someone will be sure to correct my if I am mistaken. In addition, retrograde wire intubation will normally take about 5 minutes(according to Barash) while a cric takes only 15-30 seconds so the cric seems like the way to go (between these two options) in an emergent/hypoxic patient. For that reason, I think retrogrades are MORE OFTEN but not exclusively used in non-emergent situations.

if you want to work in another country, you need to go elsewhere besides the us virgin islands as it is a united states territory.:) i took an assignment at roy lester schneider hospital in st. thomas as an rn for a few months and it was a real eye opener. things were very antiquated.....dangerously so. furthermore, it was even more dangerous because instead of acknowledging their shortcomings, they gave off the impression that they were just as good as anyone else by bragging about their jcaho certification, etc (for the first time ever in 2004!).........and i have no idea how they got that! it made me realize that all the hospitals here in the states have nothing to worry about when jcaho comes! lol! if you go, don't let anything surprise you........ from my experience, i wouldn't be surprised if they were still using copper kettles or open drop ether!

Whatever. Your ignorance and inflammatory remarks are not worth our time....... Have a nice day.

Sorry about your experience however, I refuse to spend any time debating anesthesia with a non-anesthesia provider. We are all happy to educate you but you obviously are emotional, have taken a stance, and aren't going to budge. Furthermore, you haven't any ground to stand on when trying to debate with us regarding this matter. Given your experience, you certainly have the right to a strong opinion regardless of how inaccurate it may be. Maybe some others will oblige and debate you but most of us do not have the time. Good luck to you and I certainly hope you are getting the necessary counseling, etc. My response - 1. I don't think it's a common problem. I think that it probably has an incidence of .1-.2%. 2. I don't think that it's ususally caused by poor practitioners, don't know where you got that one. As I said, I think, in a closed claims analysis, human error may have been #2 after technical problems. Since this database is from people who sued, I assumed it's biased and said so. 3. The only way to prevent it is to use a BIS monitor. It is my personal belief that the BIS, in high risk of awareness cases, can give a provider a tool that helps to reduce the incidence of awareness. I think the numbers that the clinical trials came up with were a 50% reduction in risk, with a p value giving 95% confidence. Personally, I think that with the numbers so low in the trials, that's too optimistic. In the real world maybe what, 25% reduction? For someone trained and comfortable with using it? That's anyone's guess. If I had my say with the booklet, here are some changes I'd suggest: Under 10 things you should know 1. It is quite rare and often fleeting. It it does occur, be sure to tell your provider who can help you deal with any psychological consequences, which can be severe if left untreated. Why I'd make these changes. Awareness is already grossly under-reported. If you don't know you can't help. The original text only gives one side, the experience is fleeting (not always) and not traumatic (how many patients have psychological consequences? A lot) 2. Patients who experience awareness have a wide variety of experiences, from a pleasant, dream type awareness, feelings of pressure, pain, or anxiety. Why I'd make these changes - pain may not be "usual" but it isn't "unusual" either. What, about 30%? Saying that patients don't usually feel pain, and then transitioning into "maybe" pressure, is MISLEADING. 3. Patients who experience awareness, or other disturbing recollections before, during of after treatment should always feel free to discuss them with their providor. Why I'd make these changes - I'm sure that there are a lot of patients who think that have inter-operative awareness who are actually remembering before/after the procedure, but there are also those with awareness. The original text only discusses what true awareness is NOT, leaving it up to the patient to figure things out. I also think that the original text misappropriately discourages the patient to admit awareness. To help show why I think it's skewed, I'll flip things around. I'm not suggesting that a pamphlet has this wording. Awareness can range from an extended, clear recollection of your surgery to a brief awareness of your surroundings. People who have experienced awareness may may think they have had a dream. Such a recollection does not necessariy represent a dream, but may actually be awareness. 5. Awareness can occur for any patient undergoing GA, but is most likely to occur in high risk surgeries..... Why I'd make these changes - Aren't the highest number (not risk) of cases of awareness in healthy patients, who are not in for cardio, trauma or childbirth? When the original text states that awareness can occur in a, b and c, it misleadingly leads the reader to conclude that it can ONLY occur in a, b and c. 9. New brain wave monitoring devices currently are available and may prove... Why I'd make these changes - Saying that monitoring devices are "being tested" makes it sound like they have not been FDA approved, which I think is misleading. (I know that a lot of you hate the BIS, but that's not the point, honesty is) If someone tells me a new cancer drug is being tested, I don't think that it's on the market. If a patient is so freaked out about possible awareness to hunt down a facility that has a monitor, maybe they should have one. And NO - I don't have ANYTHING to do with Aspect. Please stay polite, I'm trying to. Actually, I'm kind of having fun. I know that I have such a different point of view than almost anyone else on this board. Please take my comments as they are intended, not as an attack on personal beliefs but as a patient perspective.

With all due respect, I too am extremely sorry for what you have gone through but am going to have to disagree with your opinions on the pamphlet. All information in that pamphlet is accurate and can be found in any anesthesia text. As stated earlier, it is difficult to put that kind of information in lay persons terms, so considering the amount of research you have no doubt done after your experience, the brochure may seem insufficient to YOU, but not to the general public. The purpose of the brochure is for both patient education AND to allay anxiety. That is actually the purpose of most patient education. Countless studies show that educated patients have reduced preop anxiety levels and require less preoperative sedation. Again, sorry for whatever horrible experience you had but please know that this is accurate information and just because your experience was different from what the brochure says doesn't mean it's full of lies. The brochure describes the usual circumstances, not the exceptions. My take on the BIS?........ I think the BIS is dangerous. First off, it is a depth of anesthesia monitor, not an awareness monitor. Most, if not all, studies brag about how much money was saved by monitoring with the BIS because of LESS anesthetic consumption but can never prove less awareness with any statistical significance. Logic makes you wonder how if LESS anesthesia is being given, how can that prevent awareness at the same time? I do not care what a BIS monitor says.......it's ALL about the patient.

I can definitely see your point. One of my concerns is, if you get in just remember you still have to take an even bigger, more consequential test when you graduate. Test material is not similiar obviously but it's my understanding that testing conditions, format etc are similar so you might consider it good practice taking the GRE?? Just a suggestion. .........oh yeah, let's not forget to mention the fact that if you DO take it and get an acceptable score, you will then have about 85% more options for CRNA school. Don't limit yourself if you truly want to to.

8 years experience as an RN. 1 in med/surg 7 in various ICU's. Spent 3 of those seven traveling, including the last 3 (a common question is does it matter if your most recent experience is traveling). Cumulative college and BSN GPA-- 3.32. GRE 720 quant and 530 verbal for total of 1250. Skipped the writing section because the school I was aiming for didn't require it.......luckily I got in on the first try. I say if you can get your foot in the door for an interview, it is ALL in your hands at that point. Your experience and stats get you the interview. My guess is, most everyone is on equal footing once you get to that point. Impress them , be humble,show them respect,and make them like you and your in. Look too cocky, nonchalant, miss easy questions, or just plain don't interview well and your out.

I have heard that the Valley Review is definitely worth the money spent. Just wondering if it is worth it to get the supplementary "MemoryMaster" flash cards or book or if the materials you get with registration suffice. Has anyone purchased these things?

I won't say none but my guess is VERY FEW. If your goal is CRNA school it would be unwise to not make the move to an ICU before you apply.

I will have to look up that study evaluate it. Not saying it's bogus but one thing you'll learn when doing the research aspect of your education is that one can make research say anything you want and you have to read the details VERY carefully as to methodology. I'm particularly interested to see how they dealt with the fact that there are 32000 CRNA's and I don't know how many AA's but my guess is very SIGNIFICANTLY less. (Someone help me out here.....how many?). I'm also interested in their sampling methods. I currently have no research (not that I've looked) to back up what I say.....I'm just stating what seems obvious. With the two different backgrounds of AA's and CRNA's, they cannot be on TRUE equal footing coming out. Maybe the difference is too subtle to quantify. Maybe it's a difference in critical thinking and ability to evaluate the big picture. You can train a monkey to do almost anything but that doesn't mean they fully understand what's going on. I'm also just really surprised that pompous MDA's would even consider backing a profession that does the same thing as them with no med school, no med background and only two years or so of education. It seems almost insulting to them.......(not that i'm concerned). The only reason they do is because of their complete control of them and the money it helps them to make. THAT is where the post you quoted earlier from SDN comes into play. If they did not govern everything about the profession of AA's, I can guarantee you all the sudden MDA's would consider them unsafe to practice.