It's that time to take the SEE again?

Yes, It is. SELF-Evaluation examination (SEE) consists of 160 questions in professional and legal aspects (13%), anatomy/physiology/pathophysiology (29%), Pharmacology (25%), Basic principles (14%), and Advanced principles of anesthesia (19%). Here is the breakdown of the content area from nbcrna:

These categories are scaled score that ranges from 300-600 points. As you can see, anatomy and pharmacology yields the highest percent, which means more questions are in these categories. Many people focused more on these two categories. Not many people realized that even though other categories are low yield in terms of number of questions, the percent of correct answers makes a big difference on your scaled score. In contrast, if you miss more questions, your scaled score will drop significantly. So when you study, make sure you cover the categories.

Results: Statistically speaking, SEE exam taken the 2^nd year yields lower score compared to previous year. One main reason is that most 1^st year takers are more fresh from the didactic standpoint. 

Generally speaking, scoring above 400 or higher is a good indicator for passing the NCE. The question that I always hear” what’s the national average?” Well, here it is. According to the table above, total cumulative score of 400 yields at 58.5%. That means you scored 58.5% percent better than everyone else in the country. That percent seems a little too high if it really correlates with the NCE. Valley anesthesia stated that Over 90% of 1^st time takers passes the NCE exam. If it is really over 90%, cumulative score in the SEE exam should be lower than 400 points as an indicator for passing the board. Of course, you want to score the highest for confidence purposes. 

Study tips:

Use the content area as your guide. You may use valley memory master, prodigy or APEX, Core concepts and many others to tackle these subjects. Happy studying!!!

D

When Endoscopy Cases aren’t Quick

It has been three months since I started working as a CRNA and “I m loving it!” However, good days, bad days, so-so days are there just like any other profession. Being able to practice independently has allowed me to finally use the drugs how I learned they were meant to be used. Going out of the box is a little unnerving even though I have been practicing in my scope of practice and using well researched techniques. General anesthesia is a little more forgiving in my attempts to ensure best use of anesthetic agents and adjunct pharmacology. On the other hand, Monitored-Anesthesia Care (MAC) doesn’t allow that luxury. I remember as a student I used to be think, pushing propofol for a five minute case is not bad at all.  That all changed during clinicals when I realized that my five minutes are not five minutes for the surgeons and their understanding of MAC is simply that it is a general anesthesia without the “tube”. So, now that I am in a place where endoscopy cases can last anywhere from 30 minutes to hour and a half long, I have been challenged more than once intraoperatively. Whenever a MAC anesthetic is used, it is important to acknowledge the fine line that exists between maintaining an unassisted airway and adequate sedation. So no surprise that for the first day I was re-introduced to endoscopy, either my patients were too awake and fighting or too sedated and apneic. And starting off with an embarrassing case where the patient gags, coughs, desaturate doesn’t help your reputation as the new guy. Luckily for me, I am at a place where anesthesia providers (I will leave it at that) are known to use physical restraints to hold patients during endoscopy cases. 

After trying out a few things, here are a few tips to bring back smooth, calm endoscopy day. (Like we all know every patient is different and there are thousands of ways to"skin a cat".)

       1)     To numb them or not? Entry of EGD scope can sometimes be traumatic and lead to the patient gagging and coughing. So I was always curious to see if numbing their oropharynx with hurricane sprays or lidocaine mists would make it less stimulating. I started off with using a 2% lidocaine gel in the back of their throat and asking them to gargle. That was too much or too thick to gargle so I soon converted to using a mist of 4% lido from the LTA kits. Now I haven’t personally tasted it but noticing patients’ facial expressions, I could tell that both tasted NASTY! And that taste would last a while making them cough as I rolled them to endoscopy suites. A bit counterproductive. Another issue with numbing was its timing. It was easy to administer it either too early or too late. Surgeon didn’t come in the room right away and it was gone! Using it also caused the patient to salivate more thus increasing their risk of aspiration. Now I don’t use numbing agents at all and just request the surgeons to go slow with the initial entry while I give the patient a jaw thrust. So far I have had positive outcomes with this technique.

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          2) How to induce. Being a new grad, it is easy to let yourself think that you are taking too long when the surgeon is waiting for you holding the scope. Truth it, it doesn’t matter. If I need time to do a safe anesthetic then I am taking that time. It is critical to take this time especially in endoscopy cases because a little too much and they go apneic and start desatting as the scope goes in. Slow induction is the key. I would give them just enough initially, for example, 50mg of propofol for a young healthy male, then continue in small squirts. Goal is to keep the patient anesthetized enough to tolerate the scope without going apneic.

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          3)Ketamine is awesome but…. I started using Ketamine for endoscopy solely because it does not depress respirations. However, one of its side effects includes excessive salvation. I thought using a small dose will limit its side effects but that is not true. I had a lot of patients laryngospasm on me as the saliva would collect in their oropharynx. Using 0.2 mg robinul about 3 minutes before the procedure starts greatly decreased this side effect resulting in a smoother anesthetic.

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           4)What I use now. In preop, I administer 1-2mg of Versed and 0.2 mg of Robinul if I am using ketamine or patient has a lot of secretions. Once in the room, I connect the monitors to get a baseline set of vitals and immediately give 25 mg of Ketamine. I follow it with propofol 200mg + 25mg of Ketamine at a slow rate. If it is a colonoscopy, I will also give 25-50mcg of fentanyl as insufflation generally causes pain and causes you to use more propofol. I will push a very small amount of propofol every other or third heartbeat (which I can hear from my monitor) for the remaining case. So far that has been working great for me. Let me know what works for you.

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Being a CRNA

Hi everyone,

Believe it or not a month has gone by since I started my new job as a CRNA. And it has been amazing! It's just a different feeling knowing you are on your own and have the independence of making your own anesthetic plans. I am at a place where both MDAs and CRNAs work independently. So I fly solo but have someone available to bounce ideas off of if needed. It's a small place but I have been doing all kinds of cases on pediatric, obstetric, and general population. I have also been doing regional anesthesia such as inter scalene and femoral nerve blocks using ultrasound. It's been great learning all the new stuff that I read and can apply to better my anesthetic plan without any interference. In addition to that I love my schedule! My usual work week is three days and a night on-call with post call day off.

I know it's been a while since I got to write for you guys but that will be changing shortly as I will have more time. New thing to look forward is a review book for boards so be sure to like, subscribe and comment.

Thanks for reading! 

It is Official!

Hi all,

It is official! I am done with school and done with boards. Officially a CRNA! This was some tough journey and I am so glad it is over. My board preparation was not as efficient as I would have hoped because of some family troubles but it paid off. I had attended Valley Anesthesia review course and had invested in Prodigy program as well. I was asked to take the boards as soon as possible by my future employer so the time I had was limited. I wasn't able to stick to Prodigy's study guides and basically used it to practice "drag and drop", multiple options and "hot spot" questions. My main review source was Valley Anesthesia material. I reviewed the "sweat" book and memory master once each. I didn't feel too good about the exam however, most of the 100 questions I was tested on were from familiar topics. I strongly suggest reviewing Valley anesthesia material multiple times especially memory master.Hope this helps. I will be continuing this blog and be working on writing review questions and material. Thank you all for being with me! :)

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 :) )

Valley Anesthesia Review

What a busy weekend!! Just came back from attending Valley anesthesia and my mind is full of information. Three days to learn important anesthesia topics was a tough job. However, I was highly impressed with how the information was presented. Sometimes it felt like topics were discussed really quick and it was too much to handle. It was nice that they allowed us to voice record so I can re-listen it. I am kind of disappointed that my weekend sleep-in time was lost but I would be really glad if this helps be do good on the SEE and the boards. It was a little expensive I thought (at $750 + Hotel + Flight cost) but if it works, its better than paying for boards twice. When you sign up for the review course, they send a review book (sweat book) for you to study through prior to coming to the actual course. I be honest that I didn't even get a chance to open it before the actual course review. I highly suggest you try to do that! It was nice seeing all of my SRNA friends after a while and the new ones I met. So, good luck to everyone on the exams and let me know how you feel this review helped.

Boards and Job Search?

Quarter 3 has come to an end and as only two more remain, thoughts about being ready for SEE and boards are making me a little nervous. Reviews using Prodigy anesthesia have made me realize how much I have forgotten from the didactic portion of my school (almost all of it!). Slow and steady study review has begun. Homework is also more focused towards studying for boards which is a big relief! Careplans are still on the to-do list (basically since the first quarter). It looks like all this is going to end like it started...stressful! I am ready for it to be over though. I realized how close I am to finishing when I heard my classmates talking about job hunting. My thoughts about job hunting are scattered all over the place.I am not sure where I want to work, what I need to look for in a place I want to work and everything else that matters. To feel like I did something about it, I updated my CV today to be ready for the time I be needing a job. Then I think am I doing this too early? I haven't even thought about the SEE or more importantly the boards. Would I be able to pass them, would I make it through the last two quarters? I guess we will see. 

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.

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New Challenges at Home

Hello all,
Its been nice moving back home for clinicals this quarter. No more paying rent while I have a house, no more daily fast food stops, no more worries for at least 3 more months...one would think. Even though all thats been great, moving to a new clinical site does bring a lot of worries and challenges. New people, new place, new ways of doing anesthesia. So, I am not surprised that I had a stumbling first week. The last site I was at, I didn't get a chance to extubate my patients in the room, which is like saying I only did 50% of anesthesia. Coming to a site that does extubation in the room has been some task. Lowering the anesthesia by approximating when the surgery is going to end to allow patient to wake up with the last suture in is one heck of a challenge. On top of that, new charting, preop and post op routines and CRNA preferences have been hard to remember. While I was hardly ever tested at my previous site, my first week here consisted of multiple questions on medication dosages, regional anatomy and EKGs...some of which I didn't have a clue about. And therefore, here I sit on my chair at home, doing my homework early so I can brush up on these topics for Monday. Hopefully it will be helpful for later. Well...time to get back at it! Be back soon...hopefully

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End of Clinical Quarter II

Hi there dear readers,
I am happy to say that another break is here as I have finished my second clinical quarter. Now another place to move to for my next rotation. That brings in new fears, new challenges, new people...new everything. I really don't enjoy having to start everything all over again but am a little excited too. Even though, I am nervous, I do feel really lucky to have had my first experience at a wonderful site with a huge number of cases. Hopefully this continues and I can get really comfortable (especially with peds) before I graduate. Before that...a week and a half to enjoy at home after a long drive back.

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.

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Considerations: Laminectomy

Here are few tips to consider for a Neuroskeletal case. (Laminectomy, Fusion etc) It is not complete but has few tips that may be helpful as a quick review.

Preoperative

1) Assess patient's baseline pain status. Ask if patient is feeling any numbness, tingling or pain to  a certain area and document.

2) If patient is undergoing a cervical fusion or laminectomy. It is very important to make sure patient does not have limited neck extension. Some limitation in neck movement would most likely be seen which may make it a difficult intubation

3) Assess patient's baseline vision status. Lying prone for extended period of time can lead to vision impairment or loss. Even though our goal is to keep pressure off of the eye using a prone pillow, vision loss may occur.

Intraoperative

Induction: For intubation, it is ideal to use fiberoptic to limit extension of neck as all laryngoscopies cause some degree of neck extension. Fast-track LMA can be use to aid in intubation but LMA placement may increase pressure on spinal cord.

Agents: Prior to induction, check to see if neuromonitoring will be performed.
If motor evoked potentials are used, long acting muscle relaxants cannot be used.
If SSEP are being monitored, TIVA may be the best choice. Muscle relaxants may actually help by limiting artifact. Propofol/Remifentanyl drip may provide for best results from SSEP monitoring. Barbiturates are known to increase latency and decrease amplitude; magnesium and alpha 2 antagonists also decrease amplitude.

Propofol, narcotics, midazolam, droperidol, clonidine and precedex result in minimal SSEP changes.

On the other hand, Ketamine and Etomidate both are known to increase amplitude.

Volatile anesthetics will also cause dose dependent increase in latency and decrease in amplitude. N20 is worse than other volatile agents.

Positioning: Prone pillow should be used and pressure points must be assessed frequently. No pressure should be placed on the eyes. Ensure that tubing and monitoring leads are not leaving pressure on patient's body. Maintain proper alignment during transfer and it is safe to disconnect the ETT from the circuit and the monitors for transfer to avoid accidental extubation.

Prior to incision: If no paralytics are used, be sure patient is adequately narcotized for pain to avoid moving with stimulation. BIS monitoring is a good tool is use along with other monitors to ensure adequate depth of anesthesia.

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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.

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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!

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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!

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