Apex Anesthesia Review Course

I have recently been approached to give my opinion on a new SRNA board review website Apex Anesthesia Review (www.apexanesthesia.com) that is available now. Before I begin, in a  recent comment, it was mentioned that they feel "A Student CRNA blog" introduces a lot of new "products". I am not sure if they were saying its a good thing or bad. The information presented about the mentioned courses are  mainly introduction to the products without any promotion or rejection of their effectiveness. Everyone has different learning styles so the idea of me discussing these is to allow an insight into the courses that can help you all determine if they meet your learning needs or not. Regardless, I wanted to start off by saying that the products that I discuss on my blog do not provide me with any monetary compensation. In fact, I look for terms that allow me to keep a neutral, unbiased stand towards the product. Thanks to the developers of Apex Anesthesia Review Course, Kevin Baker CRNA and Daniel Frasca CRNA, DNAP, I have had the opportunity to personally browse their website courses and get an insight on how it works.

Apex Anesthesia Review is an online SRNA review course that provides students with a comprehensive review including multiple tutorials and question banks on topics tested on NBCRNA board exam. The topics are divided into 9 units along with review exams and national certification practice exams. Student subscriptions allow unlimited access to all these courses from your computers and tablets. Smartphones may also be used to access review exams and full length practice board exams. Student course progress is tracked and communicated between all compatible platform allowing easy transition from computer to ipad. The courses are created with in-depth details of the anesthesia topics and are supported by necessary diagrams and illustrations. Questions have been formatted similar to the NBCRNA boards such as multiple selection, drag and drop, illustration questions, and calculations. Apex courses are stored in the cloud and are updated without the need for students to get software update.

Pricing is based on a subscription model and a group rates are available for groups larger than 10. Students are also able to contact the CRNAs who created this program for personalized help if needed. According to the developers, they currently have a 100% pass rate. However, if a student fails, they provide help to create a customized plan and also provide a full refund if the student can't pass the boards after 3 attempts.
Browsing through Apex website, there were some things that I think SRNAs will definitely benefit from and some I had to think over a bit. Initially,from a student's perspective, I was worried about it not being available offline. However, I ended up favoring this change once I compared it with downloadable review programs. It allows students to access courses from almost anywhere and on any device since there is no program to download. All you do is login and pick up where you left off. Another tool that I really like is the "index" section which provides a straight forward, to the point list of very specific topics that are easily accessible with just a click.

Overall, Apex anesthesia seems to be a well organized and to-the-point review course website for SRNAs (and CRNAs in the near future). Hopefully my  brief introduction to the website provides all anesthesia folks with enough information to see if Apex anesthesia is the way for you to study for your boards and earn those four letters behind your name...C.R.N.A.

Feel free to help out fellow SRNAs by commenting below if you would like to share your personal experience with the Apex course. Also, you can contact this developers at this link if you have any more specific questions. http://www.apexanesthesia.com/contact_apex/

If this has been helpful, please be sure to "Like" us on Facebook! 

Thanks again for reading!

Part 1: Trauma Case Management

Hi all,
Hopefully everyone is having a great start to 2015. It has been a long time since I have had the opportunity to blog. A lot of good and bad has happened in my personal and professional life over these 4 months. I have finally learned how to utilize all the good from these experiences and make myself better for the future.
I still enjoy working independently and would never settle for anything less professionally. However, there have been some situations that made me realize that there are times when you just need an extra pair of hands and a fresh, fully-caffeinated brain.
This is especially true when you get a middle of the night call for a bad trauma case that is too unstable to be transported to a larger facility. That is when your mind needs to be fresh and running full force. I got caught off guard in similar scenario recently that really tested my knowledge of managing these complex cases. Even though, the trauma committee seemed impressed on the whole OR team's performance, there are always things that can be learned from such cases. So, I wanted to talk about what we need to consider dealing with these cases.

Preoperative
When the patient comes from emergency room in an unstable condition, it is sometimes difficult to assimilate all the information that is being reported off to you (if you get a report at all). There are some key details that should never be overlooked and are definitely important to know in order to manage a trauma.

• How much fluid has the patient received?- This can get out of hand very quickly in even well managed trauma cases. The transition from administering crystalloids to blood can easily get delayed further compromising patient outcome. A poorly resuscitated patient will also be poorly responsive to vasopressors. If blood transfusions have been started it is important to note if they were type and cross matched to avoid compatibility related reaction.
• Does the patient have adequate venous access? A trauma patient going to the OR should have at least 2 IV lines (if not a central line) regardless of how severe the trauma is. Things can change quickly so preparation is key.
• Is there an arterial line? This is especially helpful if the patient is expected to have massive transfusions. ABGs and continuous hemodynamic monitoring will be needed.
• What were the recent lab values? Electrolytes and blood count should be evaluated. 
• Radiology reports: Cervical spine stability must be maintained with a  C collar especially if radiology reports were not cleared. Placement of ETT should also be confirmed.
• Degree of trauma: Talk to the surgical team to get their view on how severe the trauma is. It might seem common sense but sometimes even the most important information tends to get lost in translation.

Preoperative Setup

• Hotline with blood tubing, arterial line setup, vasopressors such as phenylepherine drip, ephedrine and vasopressin (1u/ml), level 1 rapid infusor, bair hugger, central line kit with CVP monitoring set up.

Intraoperative
It can be a daunting task to prioritize things for a trauma case. Everything seems important and it may be difficult to organize appropriately in such a high stress time. Fluid and blood administration takes high priority for me (generally, depends on the case). If the patient is very unstable it may not be appropriate to hold off on making incision. However, if the patient is hemodynamically stable it may be wise to get properly set up with vasopressor drips, bair hugger, arterial line etc. Patient may lose significant amount of blood on incision depending on the degree of trauma. Resuscitation may be difficult especially if the patient is already fluid depleted.
Another important factor to consider is temperature. Hypothermia can severely increase trauma related mortality and is unfortunately, ends up being last thing on the to-do list. Use of hotline, air humidivent, and bair hugger should all be incorporated soon after patient arrive to the OR.
Massive transfusion is bound to cause severe electrolyte imbalances that could lead to possibly fatal outcomes such as arrhythmias, and vasodilation. Therefore, correcting abnormal laboratory values such as potassium, calcium, magnesium, and arterial blood gases should not be delayed. Hyperkalemia is often noted with massive transfusion so EKG changes should be noted carefully.


I have been researching this topic to ensure that I don't miss anything but even remembering all the details and writing it for the blog is a long tiring process. So, I will continue on this topic in Part 2 to follow.

An Insight into CRNA Career

Hi everyone,

It’s been a while since I blogged but it has been even longer since graduation. Today it’s a year mark since graduation and it has been a great one. There have been so many things I learned and improved. I agree completely with what my preceptors told me during clinicals that “real learning begins when you are on your own”. That leads me to the topic for today, independence in the profession of Nurse Anesthesia.

If you are just considering applying for CRNA School, you might think topic about jobs is a little too far for your interest. However, I think the biggest shock for me not knowing much about the profession was realizing that there is such a vast range of independence allowed in this profession based on where you work. I am not talking about doing certain types of cases but the scope of practice you will be “allowed” as a Nurse Anesthetist. It may be a little difficult to grasp since as RNs we are all expected to be efficient in everything (and often more) than our defined scope of practice. The scope of practice for Nurse Anesthetists has unfortunately been distorted by American Society of Anesthesiologists (ASA).  So for us this means that even though skills such as placing central lines, administering neuraxial anesthesia or regional analgesia are under our scope of practice, we have to sort through multiples jobs to find a place that “allows” us practice with such independence. I have realized that the real depressing issue is that we have allowed that to happen.

I consider myself lucky to have attended a school that had clinical sites all over the nation. This allowed me to experience vast array of settings that CRNAs practice in today. These included completely supervised CRNAs practices, MDA/CRNA groups without supervision and CRNA only practices. I get goose bumps thinking about places like a clinical site that I attended where CRNAs are highly supervised by MDAs and often treated as second class to anesthesiologists. That is mostly not the norm and I have seen practices where the relationship is harmonious. My goal with this is to have you consider that if you are looking forward to a completely independent unsupervised CRNA career, you might have to sacrifice a few “must haves” on your list until we have a stronger professional organization that restricts these limitations. These may include you having to move into a rural area, work in setting where you have to take significant call days, and possibly lesser pay. So, before you make that decision of attending a school, be sure you know what clinical experience they offer. In addition, have a clear insight of the things that are important to you in your CRNA career. I HIGHLY recommend focusing your clinical time to prepare yourselves for an independent practice. It might even be worthwhile to make those tough sacrifices to better yourself as an independent practitioner during the early years of your career.  Before I get off the soap box, I do want to mention that I work in a rural area in a CRNA/MDA model with 100% independence and practice every skill I learned during school and I wouldn’t give up this freedom for anything.

Graduation!

Hi all,

Its finally here! The long, exhausting journey through CRNA school is over...(well if you don't count the boards). I thank you all for following me through this process and I hope to continue updating you all on what I learn from whats to come. Hopefully, this has helped you. Thanks again! :)

Which Program to Choose? (Part 1)

Hello everyone,

Selecting a CRNA program to attend should be a process and not a one day decision. That is the key to remember in picking a program. If you are planning to attend a CRNA school, there are a number of things to keep in mind to ensure you get what you wanted from it. And for that, you must know what you aim to achieve. These are some of the topics to research before settling for a program.
 
1) "I want it easy"
During my schooling, everyday I thought my program was too tough! So I always questioned myself if attending an "easier" school would have been better. One would like to think yes, but would that help ensure a long, safe, CRNA career? Truth is, most likely not! First of all, I highly doubt there really is a CRNA school too easy! Some school may be more laid back about the rules, exams and teaching methods but overall you need to learn the same things in order to practice successfully. So, I say learn, research and understand that if its real tough to get through its most likely to make you good at what you be doing. Also if you are looking for an easy way out, this isn't for you. No pain no gain!

2) "Do I want to travel?"
This is something I would confess to as the primary reason for why I chose the school I went to. It was 20 minutes from home and so I be closer to family and friends etc. Didn't looked beyond that. Again research the school well! Make an appointment with the program director to see if it meets you need. You may think it is close to you but that might be just the didactic portion. Like my program, clinical rotations are all over the nation (which I knew BTW). That might not work for everyone. This might also be a problem when it comes to cost and safety. Do you really know where you be going before hand? Can you request site rotations? Do they pay for your housing and transport? and what kind of experience you be getting at those specific sites? MD directed or independent CRNA practices? Rural areas? These are all good questions to know. Regardless of where you plan to go, I highly suggest you go up there and assess the situation.

3) "How much money I be spending?"
Of course, nothing is done until you ask how much it costs. This a major determining factor for a lot of students decision. Private universities will cost a whole lot more than state. This might be a problem for students with families or someone who would rather not have 100,000 dollar loan. Again, ask your school if they for sure send to out of state clinical sites and if travel and housing is paid for by school. If they school is paying for your housing, is it in a safe area, in the hospital (I have seen call rooms being student housing)  

 (will be continued...Got to study for Boards :) )

Senoritis!

I cannot believe I am saying this already but I have 27 more shifts to go within the next 2 months and I will be officially done with CRNA school! Knowing this fact, I have a severe case of Senoritis. Switching between nights and days is a little tough and my cardiac experience at this last site hasn't been too kind. Now the stress is towards finishing the last bit of careplans left to do and to study, study and study!!
Prodigy and Valley are in the study plan but haven't been too consistent with it because of long shifts and alternating day and night shifts and of course, "senoritis". The nice thing, however is that time is moving closer to my graduation every minute and I cannot wait!!
Time is ticking :)

LMA Placement

I have heard that people have a love and hate relationship with laryngeal mask airways (LMA). Lately, I have been using a lot of LMAs and the more I use them, more I like them. There are a few tricks to remember while placing one to avoid causing trauma even though micro trauma is frequent. There a variety of LMAs that I have seen at the sites I have been. LMA Supreme is my favorite (2nd picture) and has been the easiest to insert for me. However, a problem that can occur with any one of these is catching of the tongue in the opening of LMA as you are inserting it. Some patient's have large oral opening that make it easier to insert but for smaller oral opening it is important to make sure you protect the tongue.

Insertion:

One technique to help with this is to use a 4x4 gauze and hold tongue upward out of the mouth and slide the LMA over it. It can be helpful but hasn't always worked for me. Another technique I have used lately is to go in slightly sideways while inserting. I have found this technique to work better if I use the LMA exactly like its packed, without deflating the cuff. Once you get past the tongue enough, turn it straight again and your patient was saved from getting a frenulectomy.

Cuff air:
This is another thing to experiment with while inserting LMAs. I always go back and forth between deflating the cuff completely or adding in more air before insertion. The problem I have with deflating cuff completely is that its tip will almost always tend to bend on its itself and be a reason for some major struggle. So, based on my experience with them, a little bit of air always makes it easier. Now I just inflate it enough where there are no wrinkles or dips in the cuff and its worked quite well.

Anesthesia depth:
This is what makes us different from any random person trying to shove a mask down people's mouth. Figuring out how deep you need to have the patient prior to inserting the LMA may need a lot of practice especially if you like your patient to start breathing spontaneously immediately after insertion. Well, I have noticed that there is a very fine line between you having the patient too deep that they won't breath or them biting your finger when you are trying to make sure LMA's tip doesn't bend or worse...bronchospasm. Style points for putting the LMA in without patient coughing or gagging and then them breathing. However, I think its safer to give enough to have them go apneic and support their breathing until necessary either manually or with PS <20 on the vent. So, do give them the needed propofol dose! Use of opioids can also ease insertion but their administration should be very well timed. This is especially true if you are using fentanyl. There have been times when I am just a little bit delayed in pushing that fentanyl and then had to deal with them being way too comfortable to breath. Give fentanyl first thing as the patient enters the room. Sometimes, if a young, healthy person, I will even give it with the versed in preop and then bring to the OR.

Extubation:
This is one step of using LMA that I haven't seen many variations of. Almost all of the CRNAs or MDAs I worked with remove this without deflating the cuff. This prevents secretions from falling off the cuff and possibly be a reason for laryngospasm or bronchospasm.

Thats been my experience so far with LMAs. Very nice tool to use but if ever question using it in a patient that might possibly be more at risk than benefit from LMA...just intubate!! Better be safe than sorry. Hope you all liked this post. Let me know your experiences or suggestions.


Be sure to Comment, "Like" ,Subscribe, "Follow"  & Recommend for more useful info! Thanks!

US- Guided Femoral Nerve Block

Hi everyone,

Hope everyone is having great holidays!! It's been busy at the new site I have been for the past month. Even though I only do about 4 cases a day unlike 7-8 at the last site, there is still a lot of running around. In all this busy work, I have had some great opportunities to learn how to place femoral nerve blocks using ultrasound (US). Still no where near being an expert at using the US, I have learned to get through it using a few resources like NYSORA website and RKU compact app. The site I am uses a lot of these continuous fem blocks (in conjuction with spinals and TIVA) for post op knee surgeries. So I decided to write a little bit about how I have been taught to place one. I also attached a video for the visual. 

Preoperative :

1) Ensure correct patient and the location of surgery. Check for allergies

2) Check consent. Only absolute contraindication for regional block is patient refusal

3) Equipment: Continuous FNB Tray (2-4mm stimulating needle), dermabond if available, EKG pad for nerve stimulator, sterile gloves. Medications to include Versed and Fentanyl, monitors ( spo2), Ropivacaine 0.5% = 30ml (or similar alternative), another RN or CRNA for assistance. Emergency equipment

4) Inform patient about the procedure. 

Procedure: 

5) Connect monitors, give versed and fentanyl as appropriate. Expose groin/ inguinal area on correct side

6) Don sterile gloves after opening Kit.

7) Prep site with chloroprep as place drape. Prepare local 1% Lidocaine and open femoral Catheter and place it on the sterile portion of drape for easy access.

8) Drop end of the extension cord for assistant to connect and flush stimulating needle with local anesthetic. Do the same to connect nerve stimulator at turn on at 2mA

9) Set up US probe by adding lubricant in the sterile sleeve provided and covering the unsterile probe with sterile sleeve with the help of assisting RN.

10) Place remaining sterile lube at site and orient self to US. Make sure the probe side on your end and on the US screen are matching to avoid confusion.
11) Identify anatomy in the inguinal region. Vein, artery, nerve (medial to lateral). Vein is more compressible when pressure is applied with the probe. Also, identify the two fascias, fascia lata and fascia iliaca that present as white lines under US. Two distinctive "pops" must be observed as these fascias are penetrated.
12) Once structures have been identified, nerve stimulating needle is inserted at 2 mA and patellar "snap" is identified. The bevel of the needle should be facing towards the patients head to ease guiding the catheter. A medial sartorius twitch may by corrected by repositioning the stimulating needle more lateral. Negative aspiration for blood is confirmed as needle is moved. Patellar "snap" should be present up to 0.5 mA of voltage. If still present under 0.2 mA then the needle should be withdrawn slightly as it may be too close to the nerve bundle.

13) When patellar "snap" has been identified and a good view of the needle is seen on the US, 5 cc increments of local anesthetic are injected with periodic checks for negative aspiration.
14) Correct placement of local anesthetic can also be confirmed with the US. Once injected, the needle should be held stable and injecting catheter should be disconnected so that the catheter can be threaded.
15) Correct marking for the catheter may vary but is generally placed at the 15 mark. The catheter cap is applied and it can then be secured with a tegaderm dressing.

Be sure to Comment, "Like" ,Subscribe, "Follow"  & Recommend for more useful info! Thanks!

Considerations: CABG On-Pump

I have had the opportunity to work with a couple of MDAs on a few CABG cases. Here are some of the things they thought were good to know when doing such cases. These are just somethings I wrote down during the case. Please let me know if you have something to add or correct.







Preoperative

• Be sure to give assessment of patient's respiratory status just as much as his cardiac status. A patient with severe CAD is generally going to be a smoker or have significant history of it. There decreased FRC may be enough to cause issues while intubation and result in a very bad situation.
• Include there activity level. They generally won't be able to climb a flight of stairs without getting short of breath. That again will help direct your decision on how you want to induce the patient.
• Diabetes. If they have history of diabetes, if may be that they have never had chest pain. So thoroughly assess the EKG.

Induction

• First thing to do when the patient comes to the OR table is start Preoxygenating! It is literally going to be the factor that can determine if patient survives the induction
• Give appropriate dose of versed. If can help keep the patient calm and is good because it is not a respiratory depressant.
• Start a radial arterial line. Use lidocaine infiltration to limit stress on patient.
• Induce with Etomidate, Lidocaine, Succinylcholine and most importantly Fentanyl (or other rapid onset opioids)
• Make the first view the best view! 
• Direct laryngoscopy is highly stimulation and repeated attempts can be detrimental. So, if you think you might need a glidescope...use it the first time!
• A BIS monitor is also helpful to have on before induction, and when you push the induction meds wait for it to go to the appropriate range (40-60) before DL.

Management

• Monitors: Central line, a femoral arterial line, PA catheter
• Drips:
• Amicar: 1g/hr=50ml/hr after 5g bolus
• Propofol (if TIVA)
• Nitroglycerin: 200mcg/ml concentration
• Levophed: 8mg/250ml concentration
• Epinephrine: 2mg/250ml concentration
• One of the most stimulating time period during surgery is during STERNOTOMY!
• So, plan ahead and give Fentanyl (large doses)
• Another thing before sternotomy is that you will need to drop the lungs to avoid puncture.
• Bypass
• Before bypass, you need to make sure the ACT is above 400. Heparin dose is usually 300 units/kg. Cardiac perfusionists may give additional doses if needed to keep ACT >400
• We gave solumedrol 1g immediately before going on bypass to help limit the inflammatory process
• During aortic cannulation, it is very important to ensure that the BP is low, or dissection of the aorta can occur.
• The perfusionists will generally check ACTs every 30 minutes
• Also mannitol to scavenge oxygen free radicals
• Lidocaine dose before cross clamp is off
• If hyperkalemia is seen, calcium chloride may also be given.
• After bypass, blood glucose are usually elevated because insulin is not as effective in cold temperatures
• Some patients may also need platelets, FFPs, and cryos. Consumptive coagulopathy may occur (generally is seen after surgery is over)
• Protamine: ONLY given AFTER patient is off bypass. If you give it before, all of patient's blood in the pump will clot and patient will not make it.
• Give it slow and watch for protamine reaction (increased PA pressure, decreased BP)
• If platelets are used. Do not infuse them through the fluid warmer as they may clump.

Be sure to Comment, "Like" ,Subscribe, "Follow"  & Recommend for more useful info! Thanks!

Spinal Anesthesia

Lately, I have forced myself to overcome my fear of leaving the somewhat comfortable zone of general anesthesia and head to other types of anesthesia such as neuraxial. I have had a chance to work in OB for a couple of days now and feel better about administering spinals and epidurals even with such limited experience.

Yesterday, I had a 15 and a half hour day in the OB department. Yes, it was really long! Part of it was sitting in the surgeon lounge waiting for the doctor to come or patient to be prepped, but still...it was too long! Regardless, I had plenty of opportunities to try out spinal anesthesia for C-section.

Here is a quick run-down on how I was taught and other necessary tidbits.

• A my clinical site, a tech preps your spinal site usually and sets up the tray for you. I managed to do a few myself. The first thing before doing anything is to make sure the patient is connected to the monitors. A baseline set is needed as you will have to keep a close eye on vitals immediately after injecting spinal anesthesia. Be sure to adequately preload the patient with fluids to prevent hypotension and nausea/vomiting related to that. 
• Basic things needed: Duramorph, Spinal Kit (we use Pencan 25g), sterile gloves. 
• The next step is to ensure proper positioning. Inform nurse that the patient needs to be in a "Mad cat" position and it helps demonstrating this to the patient. Ask the patient to drop shoulders forward and push lower back outwards. Another thing that I missed was ensure the patient was not leaning to a side. I was a working with an obese patient and it was hard to tell but I was aiming my spinal needle off centered because she was leaning slightly to one side. It was easy once my preceptor made me realize that.
• Before prep it is good to identify the landmark for L3-L4 interspace. For some reason if you did not get an opportunity to find the landmarks prior to them prepping the site. Use the drape to feel for iliac crest to keep everything sterile. It is also important to follow the spine with one's fingers to make sure it is not off midline as one would notice with scoliosis. 
• Be sure to collect everything before donning sterile glove. I used duramorph so, I had to open and place the unsterile syringe standing upwards on the table so I could draw up having my sterile gloves on without touching. 
• After getting everything ready, palpate for the insertion site again and mark with a little indentation using your thumb nail. 
• Open the glass vials in the spinal kit one at a time to keep things simple. 
• #1: Lidocaine 1 % for infiltration=  3ml
• Infiltrate the insertion site, create a skin wheal and injected at the site. Skin wheal helps identify the site you choose.
• # 2: Bupivacaine 0.75% = 1.6ml and inject 250mcg Duramorph (0.5ml for me). Be sure everything is meant for spinals and is preservative free!
• By the time your spinal meds are drawn up, local infiltration gets a chance to work
• Insert the introducer straight in. Deviate as necessary to avoid bone. 
• Insert the Pencan spinal needle. Feel for pop 1, keep going and then feel for pop # 2.
• After second pop, remove stylet and check for CSF.
• Connect the syringe with medicine and check for clear CSF and aspirate to check for swirl
• Then slowly but steadily inject the medication and pull all the needles out together!
• immediately rest the patient back.
• I have been told that 1.6 can work for everyone under 6 feet as you can make it go higher or lower based on patient's bed positioning.
• And assess level to be a T4.
• If it is too low, trend the patient for sometime and reassess. If patient starts having numbness or tingling to the fingers. Straighten the bed to avoid further increase in spinal. Vice versa.
• Let patient know that it IS OK to feel pressure and touch!
• But NOT OK for pain.

This is it for now...I will keep adding to this as I learn more. Please let me know your experiences and what else I should add.   Be sure to Comment, "Like" ,Subscribe and "Follow"  for more useful info! Thanks!

Month and a Half Later

I know its been forever since I have come by to update you guys. I have missed writing...besides doing other fun things but free time has been very hard to come by these days! 10-12 hours workdays 5 days a week followed by homework over the weekend...exhausting! On the other hand, with a few ups and downs, its going alright till now. I have done a lot more cases including a couple of days of OB where I got to put in a few spinals...kind of nervous doing that but they went fine. My preceptors have been great! I have had an opportunity to see many different techniques including total intravenous techniques where patient's wake up and get extubated in less than 2 minutes after surgery and ask how the surgery went. That was pretty cool to see! Homework is something that kills me! I hate writing care plans with info that means nothing more than written words because we never actually use the plans I write in real life. All that I had learned is slowly fading away and I am trying hard to keep up with reading so I don't lose every bit I learned just last year. Thats all I have for now. I will be back a lot sooner than last time. So, talk to you soon.

PS: If you like this... be sure to Comment, "Like" ,Subscribe and "Follow"  for more useful info! Thanks!

Simply Anesthesia Book

Hi folks,

Here's another great book that was found out as a day-to-day resource for all related to anesthesia. Its called Simply anesthesia and is written using great resources such as "pocket anesthesia" and "clinical anesthesiology". It's focused on the key points written with just enough information and directed straight to the point. It includes topics such as pediatrics, obstetrics, cardiovascular, thoracic, neurology along with many others. Its written by a CRNA who started writing it during school to help her with school. It is also great resource for certification exam. Here's the website where you can check it out and purchase it. It's well worth the money and not as expensive as most other resources out there. Let me know how you like it. www.simplyanesthesia.com

Here's the full table of contents:
ACLS
Anesthesia Basics
Blood & Blood Products
Cardiovascular
Drugs
EKG Basics
General & Abdominal Surgery
Geriatric Anesthesia
Neurosurgery
Obstetrics
Offsite Anesthesia
Orthopedic Surgery
Otolaryngology
Pediatrics
Regional Anesthesia
Urological Surgery
Vascular-Thoracic Surgery

Clinicals Week 2

Two weeks, 64 cases! Its been so much fun along with some scary moments. My preceptors are great and have a variety of techniques and tips to share. I am surprised to say this but the second day of my rotations, I somehow made myself go work with children. Scary at first but then I think I had exaggerated fears about that. Well, now that I am over that fear, I have to work towards throwing myself into neuro and cardiac cases. But for now, I will wait and get used to the routine. So, I have been looking for opportunities to come and write about my experiences.
My clinical site is great! A lot of autonomy, nice people, and variety of cases. So far, I have done laparoscopic surgeries, tonsils and adenoids, knee scopes, shoulder surgeries, back surgeries, pediatrics to name a few. Its just been a whole bunch of stuff that I thought I won't get to do this soon, definitely not the first week. After the first two days, I finally figured out how to intubate using a miller. Its more of a technique than strength so it took me a while. Kids seemed easier to intubate. Even though its only been two weeks, one of my preceptor choose to let me perform induction solo (semi-solo) for a 12 year old's case. It kept me on my toes. Intubation and setting up went fine and then throughout the case, I was hoping nothing goes out of normal. Then, I kept hoping my preceptor will check in on me during emergence. And that didn't happen. So, I rolled the guy to PACU and took a breath of relief. Later, he told me that some people do better when they are not being watched and that he trusted me. I kept quiet but felt like saying "don't ever do that again man! That was some scary shit to deal with!"
Its been busy and tiring so I am not getting much chance to write about here. If you like to follow my fun and exciting days more closely, follow on facebook. Hope everyone is doing good! Be back with more exciting stories soon!

Be sure to Comment, "Like" ,Subscribe and "Follow"  for more useful info! Thanks!

Clinicals

Guess what?! Its time to start working on real people. Twenty hours drive to Texas with an hour and half break was a bad idea but driving on about 150 miles of dead road wasn't comforting either. Anyways, I m here and ready to start in less than a week!
So far studying has been a minimum exactly opposite of what I had in mind. Sleep schedule has been off and air mattress has been too nice to my back. Cooking for self is way harder than I thought. But as far as I have been told this would be nothing compared to what I about to get into. I guess it won't be too long before I figure that out. Anyways, will try to keep in touch and write more often once I get Internet at home.

Succeeding CRNA Interview!

Its that time huh?
You have a CRNA interview but are not sure on how you should proceed?
Even though I have discussed in my previous post what one might expect in an interview, it is hard to really pinpoint on what one might be asked exactly. So, I decided to write a post giving you some tips to consider on what YOU can do during your first (hopefully only) interview at a CRNA school to leave a good impression!

1) Dress code
NO Hawaiian shirts! As clear as it seems, its not. You be surprised what our minds can force us into doing on such big days! This is from personal experience. Don't be the one going in for the interview and being the only one without a suit. Even though, a nice shirt and tie for guys might suffice, I highly suggest buying or renting a nice, professional suit for this. And Yes...even if it is hot outside! Ladies, it is very important to limit exposure. Again, as simple as it sounds, it still happens! CRNA school applicants have a higher set of standards to meet professionally as they are already professionals as nurses and this apply right from the get go.

2) Be Humble
Had 10 years of ICU experience, 5 of ER, 5 of cath lab? Share it in your resume and I can guarantee you they have read it. So, don't flaunt it. You never know it can play for you in the right amount or against you if you promote it too much. When I walked into my first class, I was told by my instructors "leave your nursing background out the door". If you were good at certain things and knew them inside out, it may be of value but keep it with you until you need it.

3) Know your Experience
This is an add on to the one above. I did say that you will have to change your mindset from being a nurse eventually, but you better know your experience. By that I mean, if you write in your application that you are a neuro nurse, you are putting yourself out there to be tested on anything neuro...yes...anything! 
I do want to make it clear that there will be a lot that you don't know, just be honest and don't make up stuff.

4) Dealing with bad GPA
So you applied disregarding your bad GPA to see what happens and to your surprise you got an interview call (like me). What do you do? Well, the truth is that they saw something in your resume that intrigued them enough to call you. So, DON'T take it lightly! Make your bad look good.
Here's an example
My GPA was a quite low in nursing school, like Bs and Cs (I know...I was shocked too!). That was recovered a to about 3.4 after I got a 4.0 in the BSN (yes...anyone can do that with a BSN!). Even without them mentioning it, I told them that my GPA was low initially but I have worked really hard to improve it so I could make myself eligible for CRNA school. Mention any other extra things like volunteering you did, awards, that your worked two jobs and still got grades etc. Don't beg or stay focused on it, but do give them your perspective.

5) Things to take with you
Most importantly, confidence (just enough...don't overdo!), enthusiasm, smile, along with a pen and notepad. All of them are important but taking a notepad and a good working pen is a must! It shows that you are prepared.
To leave an even better impression, use your notepad and have your questions written out before you go. Again, shows that you are prepared.
And if your questions were answered, look at your notepad at the end of the interview and mention that you had some questions but that they were addressed already.

6) A Good Lasting Impression
At the end of the interview, have the same confidence, energy and smile. Don't look disheartened if you didn't get a question correct. Instead, ask them if they decide not to select your as a candidate for the upcoming class, what can you do to improve yourself? This shows that you are not ready to give up!

A little personal side note: These are the things I made sure I did before my interview and was lucky enough to hear "See you next year" with a pat on my back from a member of the panel as I stood there in the cafeteria line. Its was a wonderful feeling and a sense of relief. Probably doesn't happen often but regardless, your goal is to work hard and not worry about what happens after...because your hard work will pay off!

Hope this helps!
Let me know how it goes.
Good Luck!

**Be sure to "Like" and "Join this Site" your favorite blog to keep updated. ---->


Anesthesia related topics: Soon to come!

Here's a Reason

For all those who are dealing with exhaustion, sleeplessness, low on motivation or even sick like I am. So, if you are wondering if you should do it or not? Or if you should keep doing it or give it. Here's a reason to keep doing what you are doing and NOT quit! Look in the right section. 

Great Anesthesia Apps!

Looking for "Great Anesthesia Apps". Follow the link on top or Click here for the new improved, updated version!

Helpful?
Be Sure to "Like" on Facebook and "Join the Site" for updates!

Certification Review Course

Hi guys,

Just wanted to mention a very popular name in SRNAs, "Prodigy Anesthesia". He's a CRNA who provides review courses for SRNAs and helps them organize a plan for certification exam. I am posting a video and a website link with some info.

Here's a link to there free article archives

http://www.prodigyanesthesia.com/archives.htm

I am also posting this video that shows a demo on how this program works. In addition, there is also a free itunes application called "Paces mini" available. 

56 Days!

56 days to go to rotations!! So this quarter is fluffed up with stuff I honestly don't care about this time but its been going good so far. First exam tomorrow, so really hoping to get a good start. This weekend my class attended the AZANA seminars which was long but interesting. It sort of was a review of what I have learned so far in school. Along with that, I got a chance to hear my seniors present and give tips on different rotation sites. The one thing I my having to put off is reviewing stuff for the upcoming SEE aka self evaluation exam. Another issue thats been worrying me is getting a place to live at my rotation site. Its so hard to pick a place to live at a site where I have never been. Then again, I guess I should make sure I pass this quarter before worrying about rotations. We ll see.

Back to studying! Talk to you soon!

Be sure to "Like it"on facebook. 

Quarter 4

Hi all, its been a while since we have talked. I had one week off and it went by really fast. A trip to the Grand Canyon made it a great break! Its just wonderful. Then again, I have been so out of shape, I couldn't do much there and stayed there only for 4 hours. This quarter has started off a little chill compared to all others (especially 3rd) but may be crap hasn't hit the fan yet. We ll see. I have a couple of presentations coming up along with other things to pile on. Its also time to figure out living arrangements for clinicals and seems like its going to be a big change moving for rotations. But at the end, I am glad to have one more down.