CRNA School...are you Ready to Apply?

You now feel ready to take that big step towards progressing your nursing career. You have always wanted to be a CRNA or have recently started researching this field. What do you need to know in order to figure out if it is the optimum time for you to apply? Here are some things you must address before applying.

1) Are you really ready? Nurse anesthesia program is a highly demanding program that requires total commitment and dedication. And this process begins way before the school actually starts. It begins when you decide to apply. Everyone else applying along with you is your competition. If you GPA is not where you feel comfortable applying, don't apply. Work to be at your best academic and professional standing before applying. Not only that, even before making that decision to start applying for school, thoroughly assess your readiness to be able to make all the necessary sacrifices. Are you willing to move for school? Are you financially ready? Have you researched enough to determine that it is for you? Are you willing to quit work for school if needed? Do you have the requirements (GRE, CCRN etc) met? All these questions should be thought out prior to you submitting that application.

2) Is your family ready? If you go in single like I did, you may think I can skip this step. However, I would suggest you still give it a thought. You friends, parents, siblings or whoever is important to you may not understand the significant change they are going to see when you are actually in the program. It is important to discuss the changes they can expect to see in you during school. Less time at home with the family, eating out, no vacation time, emotional turmoils, traveling for clinical rotations, along with many others are common issues observed in Student Nurse Anesthetists. Your family or significant other has to be on the same page as you before you apply because even if you may not agree, your family will be sacrificing a whole lot more than you to get you through a CRNA school. Do they know you won't be able to work? Are they going to survive without your income? Can they tolerate time away from you if needed? Are they willing to move with you if needed? These are all important discussions to have before you decide its time.

3) Is this profession really for you? Great pay and "chill" job is what I kept hearing about this profession before I applied. As I got to know more about it, like every other profession this isn't for everyone. You are doing yourself and your future patients a disservice if you are doing it just for money. It is a very stressful and at times, unpredictable profession. This may not be for you, if you are the one who likes to talk to your patient and enjoy following up with patient progress throughout their hospitalization.CRNA profession has an ever going battle for their role in the anesthesia world against anesthesia assistants and anesthesiologist. This can limit the availability of job that you envisioned when you decided to be a CRNA. Like me, you may have to move to a rural area in order to find your dream job. So, you may have to continue sacrificing longer than just the duration of the your schooling. Be sure you find a CRNA (specifically a CRNA) to shadow to get an idea of how their day goes. This can give you some idea on what to expect.


Look forward for additional CRNA school related considerations. Hope this was helpful. Be sure to Like, Subscribe and Follow.

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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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 :)

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. 

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.


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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!

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Daily life of SRNA

Hi all,
I have been asked by many prospective SRNA on how daily life schedule is as a SRNA. So, I decided to write a little run down of questions that everyone wonders about school. I have my parents and sisters helping me with homely stuff so, I have not much to worry about at home yet (until I head to clinicals).

1) What is your sleep schedule like?
I am one of those who loves to sleep. First two quarters I got up right away and was ready to go on with my day. However, this quarter is a different story. I am always trying to stretch it out. My weekdays have classes starting at 8 everyday and I live 20 minutes away. So, I get up between 5-6 am. And as far as going to sleep, I try to aim for midnight but that is hardly the case. For me it usually ends up being 4 hours of sleep, that is either 1-5 or 2-6. I usually catch up a bit on weekends by sleeping in a little but even weekends are short on time.

2) How many hours do you study a day?
Leaving the daily slacking, low motivation hours, and eating etc. It ends up being about 8-10 hours of study time for me besides class time. And of course, that varies a bit everyday when  I have longer class days or lab.

3) How do you try and stay focused?
I have my days where I really don't want to study but when I think of 10 people who came as far as interviewing and didn't get accepted, I feel lucky and buckle down! Still for me, internet is the biggest distraction. I have all the notes on my laptop so I will always start browsing while studying at times. To help me with this, I use this google chrome widget called strict pomodoro to set study timer. This thing really helped me by blocking me from going on things like facebook, yahoo, twitter etc.

4) How hard is it for families?
Like I mentioned previously, I get a lot of help from my family. I think it would be harder having kids and trying to do this, but then, I have like 10 classmates who do just fine with young kids. You just have to make them understand that you are doing this for them and time goes by real fast.

I hope this helps answer some question
To listen to more of my responses be sure to subscribe for my interview, Be sure to click >>
How To Be A Nurse Anesthetist

P.S: Be sure to "Like" and subscribe!

The Ultimate Guide to CRNA Career

Hi all,
So, I am at the verge of finishing my 3rd quarter and am getting a tinge of excitement and nervousness brewing in me for rotations already. Actually I can't wait to really see all of my learned knowledge being applied!
Anyways, a month or so ago, I was interviewed by a now a fellow SRNA Andria about things to know about getting in to CRNA program. I was asked stuff like how was the interview like, how much experience I had before, what hardships to get it etc. Well, she has organized all that and a lot more from other resources for anyone who is interested in knowing more about the awesome CRNA profession. Here' the link to all that you need to know about getting into and surviving CRNA school. Hope it helps :)

Click here for: The Ultimate Guide To A CRNA Career

My Upcoming Goals...if

Hi everyone, I am here after my Principles of Anesthesia Exam and want to start off with saying that I don't know if I be able to survive this quarter. It was the toughest exam yet! And unfortunately, I only get 2 exams a quarter... but then, thinking positively, if I do make it, I be heading to Texas for clinicals in the near future!! So, excited! My school sends people to a variety of different states so I don't know comparatively, how mine is going to be. I have heard good things, so as long as I get good experience, I am happy!

I wanted to share what I plan on doing before I head to clinicals. I am trying to set up either an iphone/android app with all necessary meds, doses, cart-set up, and other clinical tips, or add other pages to my blog for everyone to see. I am going to do this myself but if anyone is knowledgeable about such things let me know.

I am also sharing questions now for everyone to answer on facebook from different topics every so often. So, be sure to "Like" and learn! Let me know if thats a good, bad or you don't care idea. Hope you are having a less stressful 2012 than me!

Peace.

PS: Follow the "Like" Facebook link to the right >>>>to keep up with the questions or if you just want to ask me something. 

Question Bank Example: Regional Anesthesia

First of all, Happy 2012  Everyone!

Its been a busy start for me and I am already paying for enjoying Christmas and New Years. Test next Wednesday and Friday and haven't even gone through the lectures once!! Studying hours and hours!
Plus, it seems like stupid Care plans are meant to be stuck with nurses FOREVER! Like always, they are unnecessary stress, if I don't have enough from the upcoming test.

Anyways, I wanted to share my upcoming plan of making a question bank for the various topics. So, just have a few examples of some I made for my coming exam.
Although they are very similar in style, they are NOT from any of my exams. They are 100% original, hand made by me :) Hope they help.

Here are couple of them...you can leave your answers in the comment section. I will post rationales and reference for them soon. Please let me know if this is something that will help so I don't waste anyone time with these :) Thanks!


A patient accidently receives spinal dose Bupivacaine intravascularly. What would be the first symptom? 

a)      Ventricular Fibrillation

b)      Circumoral numbness

c)       Seizures

d)      A flutter

A patient is being prepped for spinal anesthesia in sitting position. Which of the following steps is inaccurate? 

a)      Vitals are assessed supine and sitting position

b)      The intercristal line identified on iliac crest for needle insertion at L3-L4.

c)       Betadine is applied to site and left on for 1 minute

d)      Clean the iodine solution with alcohol before inserting needle. 

Great Reference Book!

Wanted to mention another great reference that I found. It is called Pocket Anesthesia by Richard D. Urman and Jesse M. Ehrenfeld. It isn't really pocket size but has basically all I have heard during school in to-the-point style format. It has pretty good rating on Amazon as well. And Amazon also lets you look into it before buying. Its a good book for quick reference and appears well worth taking along to Clinical rotations. Let me know if you like it too.

Here's a link to buy it: Pocket Anesthesia (Pocket Notebook Series)

Breathless Quarter 3!

Its the first week back into 3rd quarter and I m swarmed with stuff to do already! Had to stay up till 1:30 in a very frustrating mood, trying to finish a couple of DQs for Research class...took me 6 HOURS! I not only had to think about what to write with my sleep deprived mind, but also had to figure out AMA format (took me half an hour to figure out how to put a superscript; by the way, its shift + Ctrl + = ).

Well as you might have noticed, its busy as ever this quarter. Never did I feel such time crunch this early in a quarter. Classes are now starting 8 am Monday to Friday which really makes it hard to stay up late and then get up so early. And the fear of sleeping in too late has kept me from falling asleep anyways.

Reading, Reading, Reading is my agenda this time since getting the B+ I got last quarter was quite tough in principles of anesthesia. But have high hopes this time as reading is long but easier to comprehend so far. First day I was scheduled for Spinal and epidural lab, which was awesome!! Although, more stories about residency has started another nervous feeling in me for fun that is yet to come. Believe it or not, heard one of the students getting "hit" by a preceptor.

Anyways, ups and downs, I m still cruising. Will be by soon again...hopefully :s
Peace!

Break Time!

Done with quarter 2 and am already enjoying my two weeks break! 1st day off was watching "immortals" with friend and day 2 was shooting all kinds of guns in the open Arizona desert. Now I feel like its time to catch up on all the stuff that I crammed during finals. The stuff that I probably should know. First quarter was supposed to be the hardest but I think 2nd quarter proved that wrong by far.
Had only two test for Principles of Anesthesia and Pharm besides the fact that 80% or more was needed to pass!! Insanity!
But its over and here are some things that helped me survive second quarter.
1) Don't fall behind
Lacking sleep and motivation along with a busy schedule it is very easy to fall behind but one must keep along (I highly doubt there is any way to stay ahead). During orientation, my instructors suggested keeping up with every assigned reading before class and revisit it little by little everyday. I really couldn't last quarter but it definitely would have helped my grades if I did. So, new plans for next quarter. Start early, keep on time and don't procrastinate.

2) Keep distractions away!
When we have to do things that aren't always fun such as studying, it is easy to get distracted by things that wouldn't normally attract you. For example, being on facebook, twitter every 5 minutes, watching stupid videos on youtube etc. Those were huge distractors for me last quarter and surprisingly, I don't care for them much during break! Solution: So, it was finals week and I had three test in 4 days and I couldn't focus, so I decided to block myself from internet for an hour at a time with 10 minute breaks using a google chrome app called "Strict Pomodoro". Worked wonders! P.S. You can figure a way around anything but then you be cheating yourself.

3) Take Breaks
Don't over do it. Be sure to give yourself a set time of break every so often. It makes studying less draining.

Wish you good luck!

Quarter 2 Begins!

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So 10-day vacation is over already! Back in it for more fun. First day seemed a bit chill at first with only 1 hr of simulation lab scheduled, but as soon as I walked in, I felt we were being scared again. Minute to minute precision with charting, looking up stuff that I am apparently supposed to know but don't know (for me that is swan ganz that I hardly worked with as a nurse, crap load of reading and zero motivation. So, now its confirmed, I am back in it. So it was tough...but then there were moments that made me smile. I be soon learning how to intubate (even though they are just sims), central lines, play with anesthesia machines etc. So, I decided to go back at reading which was tough again as I couldn't get in it for the longest time! Sometimes I feel breaks are more of speed bump than relaxing days. It probably would have been better just cruising along continuously...but then I feel its going to be tough either way so why not enjoy a bit. Oh well...I guess "ready or not, here it comes"

Countdown Begins!

Hi guys!
"Pre reading" Disclaimer: Please acknowledge the fact that I am a nurse and my least favorite thing to do is something to do with writing...aka charting. So, this may not be as well put as it probably should be. Either way I will try my best. I know this is something I don't have to do and more than likely will not have time for it at all during school, but I still wanted to do something to remember the hardships we all are going to face in the next two years as a student certified registered nurse anesthetist referred to as SRNA from now on. So, my second goal, (first of course being a good Student) again if that will be the case during school, will be to keep updating this with hopefully valuable and fun information as we progress towards being CRNAs :) Just the thought of that title coming closer and closer being next to my last name gives me chills...I know...being overly optimistic especially when the sleeplessness of nights and periods of study time prolonging way faster than that QT interval with Amiodarone hasn't even begun.
It's the first post and I already have a lot to discuss. I guess, a bit about me? I was born in california but was raised by maternal grandparents in India where I studied till 10th grade in an Army school. Got my first culture shock when I was brought here by my parents to finish high school in Prescott. The most lonely, depressing time of my life. My Queens english vocabulary was a source of plenty of jokes for those two years. At the end of it all, "rubbish" was no longer my favorite word. Initial goal was to go through aeronautical school at Embry Riddle but rumors about job scarcity made me discard that thought early on and pushed me into nursing. Shockingly, I passed the entrance test age 17 and had to be differed due to being a minor (haha...still think its funny) Beginning of it was brutal, and I couldn't see myself in it at all. But somehow, I got through it. Perhaps due to the repeated encouragement to "push" "push" "you can do it" by my parents. The first job as a nurse was merely exciting because of the pay raise from working in a theater for $6.50/ hr to making that much as shift differential. You probably have a bad sense about me but honestly, me as a 20 year old nurse was not thinking of other reasons to do it. Hell continued for the first year as the politics on the med-surg floor was more corrupt than the Indian government (trust me...it was bad). Had to find an escape route and with some confidence and support from my friend Maria, I applied in the only open position at that time...the ICU.
Another shock was to hear I got accepted. And as the time flew by to 6 months, my perspective about nursing took a major yet to me unnoticeable turn for the better. People were really sick and I was given a chance to take part in their recovery with much greater autonomy, instead of being a task manager on the medical surgical floor...
...ok. I looked back on the paper as I am typing and noticed that it has gone beyond a "bit" about me. I will continue with my story with latter posts.
May be we can discuss a bit about you now... I would really like to know what you have gone through to get here so please comment below to tell us about you... Just be cautious of typing confidential info...like no last names and all...or addresses and phone numbers... It may not be that secure. Thanks for reading my blabbering. More coming soon! :)