http://www.nurse-anesthesia.org/ This forum is designed to act as an outlet for blowing off steam. Get out all yor frustrations about the Politics of Anesthesia to how your spouse left the gas tank empty! en Fri, 24 May 2013 05:25:18 GMT vBulletin 60 http://www.nurse-anesthesia.org/images/styles/BlueDemon/misc/rss.png http://www.nurse-anesthesia.org/ http://www.nurse-anesthesia.org/showthread.php/16726-A-first-for-me?goto=newpost Wed, 22 May 2013 21:37:51 GMT So today I'm doing GYN. 3 out of 6 patients scheduled are RN's. My third patient, who happens to be an RN, very friendly, gets taken back to OR post versed push. She's on the table, strapped in, VS taken, pre O2, getting ready to push my drugs and place LMA... all of a sudden I hear a loud "pop" and I'm soaked from crotch to feet. The patient is soaked on face, head, L shoulder area. I'm like WTF and look and see the pressure bag for scope has burst. Now the patient looks up with same expression and starts laughing as everyone in the room now is. The floor is flooded by me, towels laid down, pt dried, new gown, then goes to sleep. I'm thinking she probably won't remember this thanks to 2mg versed. Short surgery, wakes up beautifully, before I move her over to bed I ask her "what's the last thing you remember". She's says "I don't know". Then I ask "do you know why you're a little wet". Then she laughs and says "yes!! Something burst!!"

Lesson learned...be careful what you say or do to/about patient when you think they're under influence of versed. ]]> Passing Gas BigMAC - Army http://www.nurse-anesthesia.org/showthread.php/16726-A-first-for-me http://www.nurse-anesthesia.org/showthread.php/16725-School-forum-password?goto=newpost Wed, 22 May 2013 20:33:52 GMT How do you get a password for individual crna school forum How do you get a password for individual crna school forum ]]> Passing Gas jfromtn http://www.nurse-anesthesia.org/showthread.php/16725-School-forum-password http://www.nurse-anesthesia.org/showthread.php/16720-New-Morgan-amp-Mikhail?goto=newpost Mon, 20 May 2013 11:32:30 GMT Just received a copy, will give my opinion on it in a few days. :) Sent from my GT-N8013 using Tapatalk HD Just received a copy, will give my opinion on it in a few days.

:)

Sent from my GT-N8013 using Tapatalk HD ]]> Passing Gas armygas http://www.nurse-anesthesia.org/showthread.php/16720-New-Morgan-amp-Mikhail http://www.nurse-anesthesia.org/showthread.php/16707-quot-ASA-Doctors-and-nurses-are-simply-not-one-and-the-same-quot?goto=newpost Fri, 17 May 2013 02:30:09 GMT "A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.

Recently, discussion about health care has reached a fever pitch, between changes in policy, adjustments to scope of practice and a multitude of other medical issues. As health care providers, it is our duty to provide the highest level of medical care to all patients to safeguard their health. We are the catalysts for change and we need to recognize practices and beliefs that are potentially harmful to those we’ve vowed to protect.

Some argue nurses and physicians are equally qualified and should be allowed to practice within the same capacity. That is unequivocally false. Rather than draw battle lines between the two disciplines, we should harness the differences and find a way to work cooperatively in the best interest of patients. The physician-led care team approach to medicine is the most logical and safe choice.

Arguments about the appropriateness and benefits of the physician-led care model occur daily in the specialty of anesthesiology. Nurse anesthetists would like to practice anesthesia care without the guidance and supervision of a physician anesthesiologist, citing comparable education and training to that of medical or osteopathic doctors.

This is a dangerous misconception. They simply are not the same.

There is no substitute for the rigorous and thorough education of medical school. After four years of undergraduate training, physician anesthesiologists complete four years of medical school and four years of post-doctoral internship and residency. Many nurses only have two to three years of post-graduate training. Physician anesthesiologists have 10,000 to 14,000 hours of clinical training, compared to the 1,000 to 2,500 hours completed by nurse anesthetists.

The education and training of nurse anesthetists and physician anesthesiologists are not comparable.. Physician anesthesiologists evaluate and supervise the medical care of patients before, during and after surgery. While nurses provide routine support, physicians’ advanced training can make the difference between life and death when critical medical decisions need to be made and seconds count to ensure optimal patient outcomes.

The fact remains: There are substantive differences between physician and non-physician members of an Anesthesia Care Team. These differences have a direct impact on the safety of the patient.

I’ve heard countless stories from my physician anesthesiologist colleagues illustrating the moments where advanced training made a critical difference. Many diagnose underlying and seemingly unrelated health conditions during pre-surgical screenings that, left undetected, would have proved fatal to the patient during their scheduled procedure. Likewise, routine procedures can become decidedly complex, and emergency intervention beyond the scope of non-physician experience and training is imperative to save the life of the patient.

Non-physician health care professionals play an important role on the care team. When their skills are combined with appropriate physician supervision, patients can receive the safest, highest-quality care available. After all, we can’t forget why we’ve dedicated our lives to health care: to keep our patients as safe as possible. Providing care below the gold standard is irresponsible and, frankly, unacceptable.

Kenneth Elmassian is on the American Society of Anesthesiologists’ Committee on Communications and is a member of the ASA board of directors." ]]> Passing Gas 944S http://www.nurse-anesthesia.org/showthread.php/16707-quot-ASA-Doctors-and-nurses-are-simply-not-one-and-the-same-quot http://www.nurse-anesthesia.org/showthread.php/16704-Cesarean-for-twins?goto=newpost Fri, 17 May 2013 00:18:33 GMT Do any of you decrease your spinal dose for cesarean sections for twins? I've read studies that say that you have more cephalad spread. ]]> Passing Gas init2winit http://www.nurse-anesthesia.org/showthread.php/16704-Cesarean-for-twins http://www.nurse-anesthesia.org/showthread.php/16697-ignoring-advanced-directives?goto=newpost Tue, 14 May 2013 20:04:15 GMT It is common practice in the facility that I work, to override a patient's wishes if a family member or significant is against it. For example, if you end up in my ICU and you have a DNR in place, we will honor that DNR as long as you don't have friends or family. If you code and your sister is there, or your mom or spouse and they want us to "do everything", we will code you until the cows come home. If your advanced directives stipulate that you do not want mechanical ventilation, well that's too bad because your cat indicated she can't live without you, so you're getting intubated. What's that? You don't want to have tube feeds and live in a vegetative state? Well you're gonna do both because your kids think "all life is precious".

I know that the facility does it because at the end of the day, a dead person cannot sue you like the living. However I think that this practice is the epitome of unethical and just plain pisses me off. This is a person who thought ahead of time to make their wishes known and trusted both their family and healthcare providers to honor them. I will not participate in a code that I know the patient documented their will against. For you law experts out there, what are the medicolegal implications of purposefully disobeying someone's advanced directives? Have any of you encountered similar situations in your places of work? ]]> Passing Gas The_dude http://www.nurse-anesthesia.org/showthread.php/16697-ignoring-advanced-directives http://www.nurse-anesthesia.org/showthread.php/16694-IM-Anectine?goto=newpost Mon, 13 May 2013 12:50:20 GMT I've been trying to find which muscle (deltoid vs vastus lateralis....) allows for the fastest onset with IM Anectine in the pediatric population. Any recs? ]]> Passing Gas init2winit http://www.nurse-anesthesia.org/showthread.php/16694-IM-Anectine http://www.nurse-anesthesia.org/showthread.php/16693-Hyperkalemia-amp-Sch?goto=newpost Mon, 13 May 2013 12:37:20 GMT The books say that Anectine is contraindicated in patients with K+ levels greater than 5.5. In renal patient with K levels higher than this, is a 1... The books say that Anectine is contraindicated in patients with K+ levels greater than 5.5. In renal patient with K levels higher than this, is a 1 mL dose safe to break a laryngospasm should positive pressure fail to resolve it. I'm getting mixed answers from my coworkers. Anyone want to chime in, of love to hear your thoughts! ]]> Passing Gas init2winit http://www.nurse-anesthesia.org/showthread.php/16693-Hyperkalemia-amp-Sch http://www.nurse-anesthesia.org/showthread.php/16689-Midwestern-University-in-Arizona-Now-doing-rolling-admissions?goto=newpost Sun, 12 May 2013 15:06:50 GMT Hello all The program director at midwestern university in Glendale Arizona wanted to let everyone know her program now has gone from static... Hello all

The program director at midwestern university in Glendale Arizona wanted to let everyone know her program now has gone from static admission deadline periods to rolling admissions. This is good for applicants who want to apply.


Good luck all. ]]> Passing Gas ADMIN http://www.nurse-anesthesia.org/showthread.php/16689-Midwestern-University-in-Arizona-Now-doing-rolling-admissions http://www.nurse-anesthesia.org/showthread.php/16688-Question-about-malpractice-tail-coverage?goto=newpost Sat, 11 May 2013 19:00:52 GMT Hey guys.....it's been a LOOOOOONG time. My name is Tracie and I was a member way back when this forum started, as WVUturtle514. Anyhoo, have a quick question. I am in the process of changing jobs and leaving the anesthesia group that I've been with for the past 5 1/2 years. My new employer is saying that my old employer is responsible for picking up my malpractice tail coverage....and my old employer is saying that it's my new employers responsibility. So I let the two of them hash it out, and they've come to the agreement that my new employer will pay for the tail coverage. But now, my new employer is making me sign a year contract (which I was NOT initially required to do), so that if I leave before a year, then I am responsible for the cost of the tail coverage. Is this common practice? Who is typically responsible for picking up the cost of the tail coverage....the old employer, or the new employer? :noidea: ]]> Passing Gas Tray-C MM http://www.nurse-anesthesia.org/showthread.php/16688-Question-about-malpractice-tail-coverage http://www.nurse-anesthesia.org/showthread.php/16675-VA-CRNAs-(AVANA)?goto=newpost Thu, 09 May 2013 01:56:25 GMT Just got back from the AVANA mtg in Portland, Oregon. (Great city BTW) if there are any VA CRNAs looking to connect and get some info PM me. I am the... Just got back from the AVANA mtg in Portland, Oregon. (Great city BTW) if there are any VA CRNAs looking to connect and get some info PM me. I am the new Central Region Director ( covers Ill, In, Ks, Wi, Mn, SD, ND, etc). I can put you in touch with other region directors as well. ]]> Passing Gas nurserebecca http://www.nurse-anesthesia.org/showthread.php/16675-VA-CRNAs-(AVANA) http://www.nurse-anesthesia.org/showthread.php/16674-stupid-question-maybe?goto=newpost Thu, 09 May 2013 01:02:24 GMT today, this conversation took place:

Me (to patient upon emergence): don't rub your eyes, Ginny.

Circ RN: how come you're worried about her, but not when we get up in the morning and rub our own eyes?

Me: patients coming out of anesthesia can't tell how hard they're rubbing. they're not aware of really knowing what they're doing, like rubbing their eyelid upwards and scratching their eyeball. you and I can tell the difference when we wake up. know what I mean?

Circ RN: yea, I hear ya. but I still think you're full of shit.

we all had a little chortle, and rolled off to PACU. good times indeed! ]]> Passing Gas ethernaut http://www.nurse-anesthesia.org/showthread.php/16674-stupid-question-maybe http://www.nurse-anesthesia.org/showthread.php/16670-Should-Prove-interesting-one-way-or-another?goto=newpost Wed, 08 May 2013 22:37:46 GMT http://www.outpatientsurgery.net/news/2013/05/5-No-More-Anesthesia-Providers-in-the-GI-Suite http://www.outpatientsurgery.net/new...n-the-GI-Suite ]]> Passing Gas RAYMAN http://www.nurse-anesthesia.org/showthread.php/16670-Should-Prove-interesting-one-way-or-another http://www.nurse-anesthesia.org/showthread.php/16666-NELRP?goto=newpost Tue, 07 May 2013 22:48:18 GMT Anyone on here ever been awarded the NELRP? I applied this year and am anxiously waiting to see if I get the repayment award. Anyone on here ever been awarded the NELRP? I applied this year and am anxiously waiting to see if I get the repayment award. ]]> Passing Gas trek12 http://www.nurse-anesthesia.org/showthread.php/16666-NELRP http://www.nurse-anesthesia.org/showthread.php/16662-Ketamine-as-an-adjunct?goto=newpost Mon, 06 May 2013 15:25:41 GMT I want to start incorporating ketamine into my practice as part of the multi-modal approach (along with ketorolac, acetaminophen, etc.). Do any if... I want to start incorporating ketamine into my practice as part of the multi-modal approach (along with ketorolac, acetaminophen, etc.). Do any if you commonly do this? Any undesirable PACU side effects w these low doses? Advice? ]]> Passing Gas init2winit http://www.nurse-anesthesia.org/showthread.php/16662-Ketamine-as-an-adjunct