WAREAGLE

My technique was not the problem. Their was a CRNA with me in both instances & yes there are patients in which an LMA does not work as you would like it to. I have heard many CRNAs say that have had some patients they could not get good air exchange and ventilate well with an LMA & so they intubated them. Maybe it was the placement & maybe not, but you have to figure out quickly what's going on & change what your doing. Sometimes that means intubating instead of using the LMA. Earlier I was not talking about the fasttrack & intubating thru it in an emergency. My whole point was that you have to be prepared because each patient is different & there will be a time when the method you have selected will not work-even an LMA is not fullproof.

I really like the glidescope, but for new students it has good & bad sides. It is great to view the airway anatomy, but like you all have mentioned a little hard to manipulate the tube for intubation. Also, when you are first starting out & trying to get the feel of not rocking but lifting up & forward it can throw you off a little. Just putting out this info for new students to keep in mind. It is an awesome addition for difficult airways & cervical precautions.

I am sure there is a lot more to this case than the information provided. It is easy to say what went wrong & what should have been done if you are looking at it retrospectively. I am only a student & have already had instances when LMAs just would not work & I had to intubate the patient. I have also had times when attempting to exchange tubes during certain surgeries failed & a fastrack LMA had to be used (which worked). The fact of the matter is that losing an airway is a true, possible reality for ANY anesthesia provider. I am curious has to why a nasal tube was selected for this surgery. There are instances when a student is present & is allowed to practice different techniques on patients when they think it is safe to do so. I am not saying this is why, just a thought.

You need to read the policies set forth by the board of nursing in your state & also your individual hospital policy. Remember, even if for some reason your hospital allows you to push/use something you still need to check with the BON in your state. CYA always!!!!!!

I know what you are saying- you know what you would do if you were a crna already or even an rn that is employed there, but then you don't want to make waves when you are the student. Grin & move on!!

I understand what you are saying in regards to individual people will react differently, but as a whole, and I am pretty sure most would agree with me the nursing field shows more patient compassion day in and day out. That opinion comes from years of experience & I have travel nursed -it is the same everywhere I have been. There are always exceptions to the rules. BTW, I would have cleaned the patient up regardless of what the nurses said-they do not dictate your individual patient care!!!

I agree both types can be compansionate or non-compasionate , but all in all CRNAs has a whole are more attentive to the patients emotional needs and are more comforting. That is a huge part of what a nurse brings into any area of healthcare.

An anesthesiologist is a doctor that has specialized in anesthesia. A nurse anesthetist or CRNA for short (certified registered nurse anesthetist) is a registered nurse that worked in a critical care area for at least 1 year (usually much more) before returning to school for 2+ years for specialty training in anesthesia. CRNAs are masters prepared. (except for older ones that trained prior to a masters degree requirement.) Both anesthesiologist and CRNAs are very educated and capable of delivering quality anesthesia care. The main difference in my opinion is that CRNAs bring compassion and a human touch into the anesthesia setting.

They should just throw those mannequins out the windows!! They are nothing like intubating a person in my opinion. Laryngoscopy takes some strength, but it is much more about technique. Once you start getting the technique down you will find it requires less strength than you think. I am only in my 4th mth of clinicals & I can tell a huge difference now. good luck!!

CONGRATS!!!:Melody:

I have only been using the miller. I am waiting to try the mac after I feel I am proficient with the miller. I have gotten my intubations easily & then there are days I couldn't get one no matter what. The two biggest pieces of advice that have helped me (other than the lift forward & up!!) are #1)Go into the mouth with a focus on the tonsilar pilar then as you get there sweep your tongue over bringing your blade toward the left. This gets you in the right spot in most people to at least see the epiglottis. #2)Once you see the epiglottis & lift it up (if using a miller) get your hand up there on the patients trachea & move it around for yourself. This has been the single most successful tip for me. Usually I find the chords very easily. The thing is getting over the idea that your right hand has to hold the mouth open or tilt the head. Just an idea of what has helped me-maybe it will help you!! good luck & don't get frustrated--we all have those days!! PS--I wish I had a dollar for everytime someone says "don't rock, you're rocking!!! I think sometimes they feel they just need to say something!!!

We lived in Helena, Al & it is a nice area. Pelham is in that direction as well. The housing costs are rapidly going up so even 15-30 mins away can be costly. We loved helena, but the traffic during rush hour is still bad. Not as bad as Hwy 280-it is the worst so stay away! But, any area you live in right outside of bham will be hard to get anywhere fast 7-8 am & 5-6 pm. It took me 20 min to get to work in the morning at 630 & anywhere from 45-90 min to get home in 5 oclock traffic. Anyway, everthing is out of sight right downtown & immediately surrounding. Try Fultondale-they were building some nice homes from 130-400 thousand & it is right off the interstate north of UAB. Gardendale is also near there. These two are probably the best for price & traffic flow right now. However, Hoover, Helena, & Pelham are pretty nice-Hoover is pricey. They are all south of UAB & you can get downtown by many routes. Trussville is nice, but it is getting expensive as well. You may ask the program director or someone in the program that may be graduating if they want to sell or rent their house or townhome. Hope this helps. Let me know if you have questions about specific areas or neighborhoods that I may can help you with. goodluck!! Jennifer

If you are talking about joining as a crna student then you will not be pulled during school. The army wants you in school & for that to be your only focus. Now after school you must go for a few weeks training & then you are fair game. That is what they told us in a meeting & we have plenty of people that signed up for the reserves.

I am in anesthesia school now, and I worked in the sicu unit @ uab before travel nursing. Any unit @ uab is busy & will give you great experience. I would suggest SICU or Trauma & Burns cuz you will get tons of exposure to vents, gtts, etc. Plus you can work primarily in one unit & pick up in the other units on your days off if you want. good luck!!

AMEN!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! Oh, my favorite: "We woke him up & he said he is in pain! You need to give him some pain medicine now!!":rolleyes: