Focker

I think I used THAM once in the ICU, not seen it used yet in my time as a CRNA. My understanding of THAM was that, like you said, it is like a bicarb gtt, but it doesn't metabolize back into CO2. If you give bicarb to anyone on an end tidal CO2 monitor, you will see just how much bicarb converts into CO2 by the spike in etco2. In the big picture, bicarb is a short term solution for base deficit that in the long run can actually contribute to acidosis. The theoretical benefit of Tham is that it shifts the bodies pH back toward 7.4 without CO2 as a biproduct (*I think). At one point I could do equations with avagadro's number and find how much co2 was contained in an amp of bicarb and stuff like that, but no longer. Anyway, this is just off the top of my head, so if I'm wrong, please correct me.

50" plasma, snowboard trip to Utah

Haha, I love your use of terminology redcell, I'm going to incorporate that into my practice (CRNAs love when you tell them that). But on a serious note, I didn't hear anything new about sugamadex, as far as I was hearing, it was doing great in trials, you have a link or something that says why the FDA boogered it?

I don't personally know of anyone who has failed after only 100 questions, but for sure it has happened, though I doubt its a common occurrence. I felt the same way you did after taking just a 100 questions, all my classmates I've talked to said the same thing too. You expect it to be like a lot of the other tests you've taken, where if you study for 2 months, you will go in and nail every question. But I think because of the computer adaptive nature of the test, the more prepared you are, the tougher the test will be. A lot of very well prepared SRNAs walk out of that thing wondering if they passed or not, me included. I cannot understand why they won't tell you immediately whether you passed or failed when the computer shuts off at 100. Obviously the computer knows for sure that you don't need 70 more questions, it should be easy enough to let the person know why so that they don't suffer through the next few weeks just wondering how they did.

If you think all 81 chapters are pertinent, the only way you could break that much material down is to set a reading schedule over the next 2 months and stick with it. 2 months = 60 days = 1.3 chapters every single day. If you stick with it, only 1 or 2 chapters every day shouldn't be too hard, you might even be able to get ahead of schedule and spend more time on the tough parts. Thats how you have to break down study material for the boards, otherwise it would seem like an insurmountable volume of material.

For me, the actual course itself wasn't much help, not really worth the cost. But the materials, sweat book and memory master, are definitely helpful. You could definitely get by without the class.

I just finished taking the CCNA examination after like two months of studying valley nonstop. It cut off at 100, so that should be a good thing. maybe:no: I am not going to get into specific questions because I would like them to not bar me for life, but I went through most of the test without feeling like I for sure knew the answer to the questions. More often than not, I could reasonably eliminate all but two, but there were so many that I could have gone either way on. Its probably a good thing when you feel confused during the test as maybe that means they keep giving you the hard ones. But during the test, it doesn't feel like that, you feel like you keep getting questions wrong. I took valley to study for the test, and I know for sure that it helped, since it gave me a guideline to structure my studying around. I am now in the column of test-takers who can say that nothing on the actual test resembled the valley questions I studied, though some covered the same topics of course. Now I have about a month to do with whatever I please before I start working, strange feeling.

Haha, the interviews at case western for next year just got a little more interesting

Dude, you have a masters degree. I think that nullifies your undergrad grade struggles. It shows you've matured. If you do as well in the ABSN program that you get into as you did for your master's degree, you'll be golden.

I'd go ahead and take it, besides the fact that it can only help you get into anesthesia school, your current employer should pay for you to take it, and there may be a pay raise for completing it. Just study the questions from a review book and take a few practice tests, you know most of the stuff anyway, its not that bad. When a school is looking at an application, they will look at the overall picture, if you have a weakness (lower GPA, lower GRE, etc.) think of the CCRN as something to balance that out. More than anything, schools want to see that you are serious about getting in, even if you dont have a weakness, taking the CCRN, shadowing, taking classes ahead of time, saving up money, etc. shows that you are really committed. I was able to participate in my school's interview process this year and you would be surprised what some people bring to the table (or more specifically, don't bring to the table).

I'm in the Duke program, maybe a typo or something, but at least one year of ICU experience is definitely required. I don't think a nurse anesthesia program exists that doesn't have that requirement.

I'm letting mine lapse, I don't see the point in keeping it

I know everyone else says you have to have it down before going to school, but I can tell you that I had minimal IV skills when I started CRNA school. Like a few other people have said, my ICU patients had central lines a lot of the time or they came up from ER with IVs, so I didn't do that many iv starts. You have the knowledge to do an IV what you need is practice; in CRNA school, you will suck at first, then when you get more practice/gain more confidence you will be great at them, after about a hundred or so IV starts, noone will ever know you used to suck at them. That said, if you do have the opportunity to get some more practice in before you start school, go ahead and take advantage of it. Starting off a case with a smooth, pain-free IV start in your patient can make your short time with the patient all that much better, it may be the only thing you do for them that they remember.

They are pretty much the same test. I got almost the same score on both, though that is probably more coincidence than anything else since I took them years apart, obviously.

How is it determined that a pt. has had awareness when they have no recall of it? Many of the accounts I hear from pts (a good example is the tkr in one of the above posts) are examples of awareness during a mac case, not general. That could be partially resolved with education and better explanations to the patients about the type of anesthesia they are about to receive.

It seems like you are comparing apples to oranges. How about a comparison for travel RN vs. travel CRNA (locum tenens). I think most responses you will get to your question will cite job fulfillment. Also, it would be tough to make a career out of traveling; I can't imagine traveling around for the entire 30+ years of a nursing career, which is what would have to be done to consistently make that much money as an RN. Most will also say that noone goes into CRNA for just the money. Regardless, I would venture to say that the travel RN that makes more than CRNA is the exception rather than the rule.

Theres a difference between being rude and having a discussion. Feel free to disagree with me and others and share your viewpoints, just try to have some tact.

I am entitled to my opinion, this is a discussion board. Save your grammar corrections and admonitions for someplace else.

what kind of surgery was it? what kind of anesthesia did he have?

Thanks for the extra info. With all the backup of supervisors, etc. it sounds like you were technically ok to withhold the drug. But I still agree with the doctor. Personally, if I were that man, I would want the morphine given to me, in fact, in situations like this I fail to see why euthanasia would be inappropriate. I know it is technically illegal and some are morally opposed, but when you say "do no harm," do you think allowing a man to slowly die over many weeks is less harmful than giving him a pain medicine that may speed his death as a side effect, when death is inevitable with either option? I think it is fairly obvious that not feeding/hydrating him is itself euthanasia, the only difference is it is passive. I would rather be active and be SURE that he was painfree rather than hoping that inside there somewhere he wasn't aware of his situation.

Did the family request it? If the family feels like the pt. is in pain, or if there is any doubt about the comfort of the patient, I don't see how any harm could result from making your best effort to make the pt. comfortable as they die. I probably would have given it.

Hey deepz, not that I disagree with you or anything, but quoting a twenty year old study isn't the greatest support for your argument. Do you know of any more recent statistics? I'm curious what the ratios really are.

pulsus paradoxus? Never heard of it referred to as the arterial cascade pattern though.

Agreed, the Zebra F-301 is the best pen. I only use the zebra now. It has fine point, the ink always flows smoothly, no smudges, metal clip so I don't break it (which always happens with the plastic ones), retractable so no caps to keep track of, refillable, it is available in several colors. Awesome.

I don't know, I think I can sympathize with you Anesthetize. I have a feeling I know what kind of tests/teaching you are dealing with, it can be very frustrating. Poorly written questions just don't do anyone any good, most of the time you just have to try and eliminate the obviously wrong choices and go with your gut. To be honest, I don't think you will ever totally escape poorly written test questions, but I certainly deal with it a lot less often in CRNA school.