rn29306

Very impressive.

Not that I was there, so don't kill the messenger. I've intubated several 400 'pounders using the Glidescope right off the bat, one of them was a post-op carotid rebleed. I felt in those couple certain circumstances that performing DL would have been just about impossible for anyone to get a straight visual to the cords. The amount of tissue was uttlerly amazing, esp the tongue and depth to the cords. I had a CRNA while I was in school tell me...."Son, do ya think they are gonna be skinny on the inside or something?" While fiber optic would probably have been pretty much useless at this point considering the intubation attempts (and at times like these, you have to be rather forceful) the GS would have been great. Do you guys have a difficult airway cart? If so, consider an intubating LMA...Even if you can't get the best seal for a few minutes, throw a tube down it ASAP. People complain about the price of a GS...but if this man had a hypoxic injury, the 10-14K would have been chump change compared to everyone's payout. Sounds like you guys had a horrible situation and you handled it to the best of your ability. Think about having anesthesia set up a difficult airway cart, either on your floor or you having access to it while they are coming in for something like this next time. Great job!

yeah that too. what i was told anyways. i see i stand corrected. seems to work in the drug induced haze of waking up, but i'll take note of the correction for future use.

I totally agree. Why would you want to compete with residents? Its just asking for trouble and mismanagement. You would serve yourself well during school and later on in life by going to a non-competition school. And before anyone blows up at me that went to a school with residents hold up a minute....Im not downing on your education, but I have plenty of friends that have had things set up on a big case, ready to roll, and here comes the resident and the attending and there you go down the hall to the freaking cysto room. How conducive to learning that must be. Where I went, the students, esp the seniors, did any and everything. And oh how nice it was.

this phrase is accompanied best by a couple good chest rubs: resperdo perfundo means to breathe deep.

Do you dictate the adminstration of propofol? How are you administering the drug, ie: bolus to titration of effect or via pump at a specific mcg/kg/min?

Amidate or its other name etomidate. Any anesthesia reference will give you all you need to know.

Our EP lab, when doing implanted debifs, does their own sedation with EP RNs doing fent / versed CS and the surgeon uses liberal amounts of local in the pocket. For testing and sensing, they call us for the propofol administration and we set up shop (ie, ready to intubate). We stay with patient until they are awake and then we leave. We also do the CV with propofol and are completely set up for those as well.

I know mercer is incredibly competative. I also know the director there. He used to be our assistant director. Everything he has told me has been extremely promising about the program.

Common misnomer about egg allergies and propofol....People see that propofol is made "from eggs" and simply make their own assumptions without further investigating. Straight from Morgan and Mikhail: A history of egg allergy does not necessarily contraindicate the use of propofol because most egg allergies involve a reaction to egg white (egg albumin), while egg lecithin (propofol) is extracted from egg yolk. Oh yeah, Morgan and Mikhail are the authors of an anesthesia text.

You beat me to it. Very nice illustration of ICP and why ketamine was probably the WORST agent to use in this case.

Or perhaps a CRNA.

Take this for what it's worth. Ask around and see if the same thing is being reported. I guy in the class above me said there wasn't much of anything from Valley on the test when he took it last August. A friend of mine took the certification test this spring and same thing. Their sum opinion was that Valley didn't help much. Like I said, take it with a grain of salt, but I have no reason to lie about this. I am just passing on information here. The test changes every couple of years. Perhaps this is one of those times. Back to reading textbooks for the exam....

State boards can be fairly rough, but hospital credentialing agencies are TOUGH. Background investigation by credentialing boards of hospitals makes state board inquiries look like cake. Not saying you can't get credentialed, but you will have much more explaining to them than the state boards. You might have to attend the credentialing meetings and explain your situation.

Read post 95. I responded to it. How in the world are you going to pin bringing up abortion on me? Have you honesly read the previous posters or was it a knee-jerk reaction just because you didn't like my answer? Either way, really doen't matter to me.