sc17

You think you know how to bag-mask ventilate, but you don't. Proper mask ventilation can be quite difficult. Most RNs and RTs I see are TERRIBLE at it in the ICU or anywhere. Anesthesia providers are the only people I know who can do this well.

an-es-the-si-ol-o-gy (ns-thz-l-j) n. The medical specialty concerned with the pharmacological, physiological, and clinical basis of anesthesia, including resuscitation, intensive respiratory care, and pain management. MEDICAL specialty -- not nursing.

ANESTHESIOLOGY is the practice of medicine. The term "nurse anesthesiology" is incorrect. You are not a physician and you do not practice anesthesiology. Nurse anesthesia is a more accurate term.

The only reason the surgeon was sued is $$$$$. Regardless of who is really responsible (or supervising) the scumbag lawyers will name anyone involved in the case with deep pockets. If an anesthesiologist had been involved the surgeon still probably would have been named. (It might have been a little easier for him to get his name dropped, though)

mac is all of these things above, but the simplest way of thinking about it is as a standardized measurement of anesthetic gas level, whether you are using sevo, des, iso, etc, or n2o (these agents all have differnet conc at 1 mac) you can express your anesthetic conc as the MAC value.

At my hospital residents finish an internship (could be internal medicine, surgery, or combination of the two and others) then 3 years of anesthesia. Last month of internship is anesthesia paired up with senior resident to learn the ropes. Then resident is in OR doing case with an attending that is 1:2 supervision. During the three years of anesthesia there are ICU, pain, and regioanl rotations as well as several months of OB, CT, peds, neuro, vasc, ent, etc. Yearly research project required.

This attitude is exactly why there are conflicts between anesthesiologists, anesthesiology residents, and CRNA/SRNA. Why are crnas against a bill that would help anesthesiology training programs? The competitive nature of the aana is not beneficial to the crna profession, it only fosters more and more resentment and further increases the divide between the two groups - mds and crnas.

It is obvious from the questions asked that you don't really understand what you are talking about. "There is a higher risk of aspiration with propofol than with a paralytic (from my perspective) when your not an experienced intubator." This is crazy. The point is to use propofol for sedation/hypnosis, and sux for paralysis for intubation. The two are not exclusive and using one without the other (or a different combination of sedative and paralytic)is likely to cause problems either way. The poster seems to think propofol by itself is a substitute for etomidate and sux together or sux by itself. I saw this in our ER when we tubed somebody with propofol and sux and the ER attending said "gee, why did you push the propofol before the sux? I"ve never seen it done that way." We said :Are you f'ing kidding me? One reason for choosing ketamine in this severe asthmatic may be for its bronchodilating properties, so this is appropriate in this situation.

The most common practice of anesthesia in this country is the anesthesia care team where a CRNA and an anesthesiologist work together to provide an anesthetic. In this model the CRNA has variable responsibility, in some places the MD may not be around very much, in others the MD is in the room frequently. The MD is usually associated with 2-4 operating rooms staffed by CRNAs. MD-only anesthesia is also found in many hospitals in the country where anesthesiologists alone practice anesthesia. CRNAs practice alone also in some hospitals in this country although this is less common than the first two models I mentioned. Yoga's post on her practice situation may be a little misleading because this is not how most anesthesia is delivered in this country. She seems to be a very experienced and competent anesthetist capable of solo practice, but not representative of most practice in this country. Alternatively AAs are used in a few locations with MDs in an anesthesia care team model instead of CRNAs. I am not trying to stir up any controversy on the pros/cons of the different models, just stating the facts of anesthesia practice.

This is a very arrogant and uncalled for statement. You may very well be more intelligent than many physicans, but to belittle their education and years of hardwork by crediting it to their parents/upbringing is ridiculous. Most MD's graduate medical school with hundreds of thousands of dollars in debt and work very hard during school and residency - most are in early thirties with huge debt before they start making a real salary. Maybe you could have gone to medical school if you wanted to, but you didn't. It has nothing to do with silver spoons or BMWs, many docs have come from poor backgrounds. Any intelligent person can earn an MD if they work hard enough. In spite of what you believe most physicians respect crna's, other advanced practice nurses, rn's, etc. Some MD's are arrogant egomaniacs but that is the exception rather than the rule. You should also show respect to practitioners with other backgrounds.

for one thing longer caths are easier for ej's and other veins which tend to roll around under the skin. You may have to travel farther under the skin before you actually enter the vein, thus a longer catheter helps you out.

As one of the above posters stated this may have been initial management of a recognized difficult airway. One management strategy is "awake" blind nasal intubation where the patient is kept breathing spontaneously and sedated with versed/fentanyl or ketamine or a combination, the airway is anesthetized topically with lidocaine, a transtracheal block is sometimes done, and afrin is used to reduce bleeding. The tube is advanced slowly while listening for breathing through the tube, as it reaches the cords the patient will almost suck the tube through. This is a blind technique and I've seen many older (and very experienced) providers are more comfortable with this than fiberoptic. I agree that there is more to this story than told by the lawyers.