qanik1

"just for the record, patient response after propophol is no different than any other drug. It is based on the amount given." You signed CRNA but I hope not with that above statement. Perhaps you should go back and revisit some of those pharm books we had to use during school. Maybe age, weight, fluid status, circ time, biotransformation, metabloism and a few hundred other factors might play a role. The majority of the post are regarding the use of propofol with CS. Go open up your Miller and reread the definition of CS from the ASA and AANA- " a medically controlled state of consciousness in which all protective reflexes are retained- the patient retains the ability to maintain their airway can can respond appropriately to stimulation or verbal commands such as open your eyes, tell me your name and squeeze my hand" -doesn't seem to vague to me. I am not trying to put down propofol- I use it everyday to induce my patients. I am not trying to prevent it from the ICU or ED. WHat I am pointing out is that when your patient needs airway assistance or is unresponsive during the CS proceudre you are no longer doing CS. You are the one who said lets face it who doesn't know how to use a nasal or oral airway or bag somone- My point is made. If you had to do any of those listed you weren't doing CS. ANd whether the order is written or your BON says you can use it or your CS protocol calls for it if something happens you will be held liable. Go and look up the conscious sedation litigation regardless of what drug was used. If the patient needed assistance or ws unresponsive at anytime during the CS procedure with a porr outcome it was and open and shut case. Qanik

I will state it this way. After you have pushed the propofol, How many of your patients can respond to your questions appropriately verbally and can squeeze your hand and follow commands? If they can't you have gone beyond conscious sedation and are now in deep sedation or anesthesia. If you have a bad outcome you will be found liable. In the majority of ED settings there are certainly people that can manage the airway- but remember if you had to intubate or bag or even do a jaw thrust you have gone beyond the definition of CS. If you chip a tooth intubating, the patient gets some air in the belly and vomits during mask ventilation, larygospasms during suction etc etc. you have no legal footing. Also remember there are plenty of small ED's I have been to in my flight career where the ED doc is a family practice guy with no airway skills. Or the outpatient lab with no one trained in advanced airway. If your going to use it you had better have your **** together and be prepared for the legal outcome should something go wrong. Respectfully, Qanik

I think some good points have been made in several previous post. I would like to add my experience with both. Having been a paramedic for 19 years and a nurse for 16 the last 12 as a flight nurse I have had to perform only 4 crichs- thankfully. 3 were helmetless motorcyle drivers that ended up with severe mandible trauma and the 4th was a burn that was 35 minutes old upon our arrival. At my program we don't perform needle crichs as early on in the program they had no success as blood and vomit ended up occluding the catheters so we go straight to surgical crichs placing 6.0 shileys. All went well- in fact they left one of them in for three days before going to a trach. I have tried the retrograde only once. I was unable to get the wire out the mouth. I should say again it was a trauma with teeth and vomit and everything else in his stomach pouring out everywhere. I aborted the procedure and performed a crich. I should say that I am in my last year of CRNA school and have noticed a tremendous difference in the thought process of the two fields. I have been fortunate to have had some wonderful CRNA' s and Docs teaching me. I have been taught so many tricks and back up tools and plans with regard to meds and equipment. The one thing I can't get over is the ego of some of the docs at certain facilities with regard to failed or difficult airways. I just can't believe the number of failed attempts at laryngoscopy that just go on and on and on. No bother trying to ventilate with a mask-Then another doc will try and try. Then the fiber optic is pulled out and useless because they have trashed the airway. Then they are screaming for ENT- all the while with the ASA difficult airway chart staring at them on the wall. As I sit in the corner as I am "only a student" I can't help but think why don't they bag the patient and move on to a back up plan. Respectfully, Qanik

Hey I guess we are taking opposite routes. I have been a flight RN and medic for 10 years and just completed my first year in CRNA school. I would say with your prehospital background and the fact that you must of had critical care experience to get into CRNA school plus your time as a CRNA you would be a prime candidate for any program. I would not think you would need anything else except to apply. I actually am a item writer for the CFRN exam - it is not that difficult. Some programs like you to have it. Where are you located as I sit in the National ASTNA board and know many people from many programs and could give you some ideas. I plan to continue to fly once I graduate CRNA school in a part time manner. Any other questions give a shout Qanik