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.

Usually offset by an increase in LES tone. But hey, patients don't often play by the rules or read the same books we do. That'd be too easy - wouldn't it?

so what do you think you become as you exit your mother (whichever way you came out)? do you think this is like that board game where you stop at go, collect a soul, become a human, get your rear end slapped and booya - a live human being is born? who obviously doesn't care about society. a thinking person who chose poorly. you right. killing a fetus is murder. ending the life of a pos person that killed, tortured, or molested an innocent human is not murder.

If the situation were where YOU are the parent and had a son or daughter molested by a sexual predator or say your mother/father/significant other was murdered by some crackhead for $20 I can promise you that the above statement wouldn't be your response.

Time of death is noted for the time at which the MD at the bedside in the ICU completed all brain death trials and subsequent patient failing all the accepted trials. Find the death certificate on these guys after the harvest and you will notice the time is noted at the pronouncement of death (in the unit), which is well before the harvest even begins.

A much better book, similar weight, size and more informative is Handbook of Anesthesiology. Amazon.com has it for less than 20 bucks. Imagine the Mass book condensed... Handbook of Anesthesiology Mark R. Ezekiel MD Current Clinical Strategies Publishing ISBN: 1-929622-49-X This book was bought by the entire class below me after someone in the class looked at my copy. This book and Anesthesia Constellation on my palm got me through my junior year with flying colors. The only downside is the the glue on the binding came apart at the end of my junior year and I purchased a replacement going into my senior year.

I for one have never heard of this and for the life of me can't figure out how 20 mg of anectine is honestly going to make that much difference in LMA insertion. The risk / benefit in this situation doesn't add up. It seems as if you are entertaining all or at least the majority of the risks of anectine administration and recuping little benefit. You are exposing them to the most potent trigger for MH. (Yes, I realize they are about to be exposed to a volatile agent, but anectine is still the most potent.) Also, you have to consider the possibility of pseudocholinesterase deficiency as well, after failure of regaining respirations, now you have to manage the airway and intubate the patient intra-op. The list goes on and on. People might say statistically, MH and enzyme deficiency are exceedingly rare, but I've had both happen to me while in school. NOT FUN. I've seen alot of knee-jerk practices in anesthesia, but this one seems to take the cake. If a person needs additional deepening of anesthesia after a stick of propofol, either give the patient another dose or breathe them down with sevo after the propofol. That seems to be the safest way. To me, you are just asking for a mishap here. My two cents.

very nice. :rotfl:

Thanks athomas. I appreciate. :bowingpur

Not a knock at existing CRNAs, but we wonder why we even have to go in the first place. The anesthesia group as a whole pitched a vote before signing our contract. ALL the CRNAs voted not to have students. Half the MDs didn't want us either. So there goes the "conductive to learning" atmosphere teaching or instructional sites are supposed to have. Some head honcho in the group thought it would be good for recruitment, although, suprise suprise, no one - not even people who worked there as staff RNs - want to work there as anesthesia providers after graduation. Every student who has gone there, juniors and seniors alike, have welcomed the ending of the required month, even when that means coming back to our main facility and working call / nights. So I don't exactly think it's my attitude here. Call me naive, but I believe there is a great difference in a totally new student showing up for clinicals and a senior student about to graduate, who has to go to a very restrictive, mostly outpatient-based, level 2 or 3 hospital after being given much earned, but also deserved, mostly free reign with decision making / anesthetic plan making at a level 1 trauma hospital. And I'm talking a AAA I did the other day solo: aline, 16 ga IV, subclavain dual lumen codis and epidural cath by yours truly then off to the room and management of duration of case with no CRNA and periodic MD dropping by. And he woke up beautifully. You tell me how doing outpatient hogwash at a facility that doesn't even want me around can relate to this....... Don't get me wrong. I'll go with the standard smile on my face and an open mind. I'm sure I'll learn quite a bit, but the opportunities to learn pale in comparison to our main site, a level 1 adult and peds hospital, doing just about every surgery except transplants and pedi hearts. I do enough outpatient anesthetics within our main system. So what's the point? I'm almost sure they will cancel our contract, too bad it won't be before I graduate. I realize this comes off as slightly snotty and arrogant, but I don't know else to describe it. I think it's one of those situations you just have to know about before anyone starts passing judgement. Here's to the next month passing quickly.

Money issues: Forget it for the duration of school. Money is simply an avenue or vehicle that will get you to your goal. It will be paid off when you get out. Dopamine gtts: I have made exactly two of these gtts in two years. Just remember these three letters: TTE which stands for Titrate To Effect. Relax. Study hard and show up with a willing / learning attitude and you'll be fine.