gooseafrn

Roxann, I am assuming that you are talking about a combination continuous femoral nerve block and sciatic nerve block for knee arthroplasty. The catheter, however, blocks the nerves of the anterior thigh, most of the knee, and the skin on the medial aspect of the lower leg. This catheter has basically nothing to do with the foot. Most people will place this catheter in combination with a sciatic nerve block. The sciatic nerve provides movement and sensation to the foot, except for the saphenous nerve on the medial aspect of lower leg/foot, which is a branch of the femoral nerve. The sciatic nerve block usually lasts up to 24 hours. These blocks are great for intra and postoperative pain management. The pain fibers are blocked prior to surgical stimulation which is a good thing, less pain intra and postop equals less sympathetic stimulation for the patient (pain = HTN, ^ cardiac O2 demand, nausea, stress/anxiety), less opioids used means less opioid related side effects (urinary retention, n/v, resp. depression, etc) both intraop and postop, along with other benefits. It might be a good idea to get together with a member of the anesthesia dept. and talk about the benefits/risks and how you should be assessing the patients with these blocks. Eric

We do something pretty similar. We use a website called "Medatrax". It has pull down lists for everything and keeps track of everything. It's nice because we can enter everything on our palm version and hotsynch it whenever we get the chance. I just wanted to see if we are getting close to the average number of cases as most programs. I hit 815 yesterday with about 3 1/2 months left (last clinical day is Nov. 16). I have a trauma rotation for August-good experience but a lot less cases than the normal month. Thanks for the reply. Goose

I'm curious to know how many cases most people have/expect to get by graduation. Are most of you pushed to get more numbers, or better cases? Just curious. Goose

I've got about 6 months of clinical left, so I'm certainly no expert. But, I usually ask the monitoring tech what is the most relaxation they can deal with, and keep in communication with them during the case to make sure that their monitoring is adequate. Some want just TIVA, so I use propofol and remi, or maybe some precedex. At other times, muscle relaxation down to 2 twithces is fine with them, so you can get away with less agent. I like neuro. Just keep up with where you are in the case (stimulation d/t entry into the cranium, dura, etc), watch the positioning (exp. for the long cases), and find out if your surgeon has any preferences. I hope this helps. Eric

Ramoro, I'm finishing up my 2nd year in the USAF CRNA program. The primary site for phase 1 is USUHS in Bethesda, Md. However, the AF does send 2-3 people a year to the Army program in San Antonio. As far as the VA, I believe they have a slot or 2 at the Army program, also. We have AF, a couple army, a good bit of navy, and a couple of public health slots at USUHS. This is the primary program for the USAF. The AF requires all applicants to have a minimum of 2 years at their current duty station, in addition to time in grade requirements, professional military education requirements, among others. The AF does not allow for direct accesssion into the CRNA program. However, it is possible to make the CRNA program your first assignment in the army, as long as you meet their list of requirements. I hope that this helps. Eric

I just finished up my first 2 months of my pediatric rotation. I used Halothane quite a bit and really liked it. As soon as the heart rate started to drop, the patient was deep enough and it was time to dial it back. It was great for mask cases like nasal lacrimal duct repair, or nasal probing where you would need to remove the mask for a couple of minutes, since it 's solubility will cause it to stay around a while. I was able to do a few inductions with Iso also. It worked really well on kids that had enough pre-med on board to be very cooperative. Just had to titrate it very slowly, but it worked nicely. I would not say that Iso is preferred with adults. However, I really like to use it with low flows. Goose

Sigma, I'm in a front loaded program and just finished my first 2 1/2 weeks of clinical. Yep, I feel like a complete idiot most of the time. It's tough being with different staff everyday and trying to get used to the way they do things. Lots of anxiety everyday. Tons of pimping. But, you will be doing anesthesia and it's a great feeling. I did 3 ped's mask inductions my first day, an interscalene block my second day, and have 22 total cases so far. I have to admit that there is no better feeling than doing post-op rounds on someone that was really anxious pre-op or worried about hx of N/V, and having them thank you because they feel great. Try to keep a positive attitude no matter how you feel inside. goose

30andconfused, There is nothing wrong with advancing your education to make more money. But, don't say that none of us would go this route to make the same money. I just finished up my first year of a front loaded military program, and hope to train over the next 18 months to graduate and make the same captain's pay as a CRNA as I have made as an ICU and ER nurse in the USAF. Yeah, if I want to get out after paying back the 5 years I owe the USAF for school, I can make better money. But that is not what it's about for me and alot of other people. I am gauranteed to get deployed to an unknown location w/in 4-5 months of graduating, provide anesthesia for dedicated young men and women who do a harder job than any of us will do for a lot LESS money. I might get a bonus after I pay back my 5 years, but it is not gauranteed. Just realize that you don't know everyone's motivation. It does not bother me that you are doing this for the money, but don't discount the fact that many of us are not doing it for the money. Thanks. Goose

Well, I did not really study anything. My finals were on a Friday and I took the exam 5 days later. I looked over some old notes, but can't really say that I studied. I got my scores today. I'm pretty disappointed with my scores in a couple of areas, pleased in a couple of others. But having said that, I'm not really sure what is a good or bad score is on this test. Oh well, I'm sure my clinical site director will let me know when I report in a couple weeks. Goose

Thanks for the reply. My program is frontloaded, and I have done great in the program. We also get a lot of simulator time. I felt really good going into the SEE, but it sucked. Hopefully I did do better than I think I did. I guess I'll see in about 1-2 more weeks. I start my clinical phase on June 5th. Looking forward to it, but also pretty nervous. Thanks again. Goose

Well, I finished up the first year of my front loaded program last Friday and took the SEE yesterday. I finished the year strong and I felt really good going into it. I came out of there feeling like I had never taken a science or anesthesia class! Do any of you have experience with it? How long will it take to get my grade? I've got about 1 week before I move to Ohio for the 18 month clinical phase of my program. I hate to think that my clinical site instructors first opinion of me will be formed by my SEE grade. Anyway, just had to vent. Goose

Finishing up 1st year at the Uniformed Services University of the Health Sciences (USUHS). I will be heading out to Wright Patterson AFB in Dayton, OH in May to start phase II. Hardest part is not being able to spend alot of time with my 5 yr. old daughter and soon to be 3 yr. old son. Luckily, my wife is great and 110% supportive. -I'm a little partial to Black and Tan and Crown Royal (when I have enough money) -Best part of the program: Our advanced medical pharmacology class that we take with the medical students this semester - the SRNA's are blowing them out of the water! Goose

Congratulations. I've been in the USAF for about 6 years and am currently in the CRNA program at USUHS in Bethesda,Md. You need to stay on top of your recruiter. Alot of recruiters are great, but they are also busy. Get a list of questions together, take them to him or her and get direct answers. I would have missed my officer training date if I had not insisted that my recruiter get me some answers to some questions that I had. Anyway, good luck. Goose

I am in my first year at the Uniformed University in Md. I came from the ICU at Keesler AFB in Biloxi, MS. and am supposed to be going back in May to start clinicals. We have several students that are currently there for clinicals. As of right now, we don't know where people are going to be going for clinicals. The program directors are working pretty hard to figure things out.