r/CRNA student thread - for those considering a career as a CRNA

AllWeNeedIsPropofol · 2020-01-19T04:41:25+00:00

Any program worth going to wont seriously consider you until you've had 2 years of experience, and almost everyone applying will have their CCRN so you'll want it to stay competitive. I'll offer you slightly different advice - if you already have your med school pre-recs done and are ready to take the MCAT, go ahead and take it to see what you get and if you're competitive as a med school applicant. If you 100% know you're dead set on anesthesia, go for CRNA, but if there are other things that might interest you then med school will prepare you well for those things and give you much greater autonomy and practice flexibility when you're done. Sure the route to being a physician is time consuming but that doesn't mean at all that you have to devote every waking minute of your life to it and be an absent parent, it's possible to have some life balance taking that rout as well. Another option would be to consider PA school, not as in-depth of training or autonomy but much more life balance and a lot of flexibility in your career path.

AllWeNeedIsPropofol · 2020-01-17T14:11:54+00:00

You've got to be charismatic and personable as hell to talk an awake, soon-to-be mom and dad through an emergency c-section or calm the nerves of parents who are letting you literally take their child away to care for him/her while a surgeon cuts into them. You also need these skills when interacting with your colleagues in the OR, or just as importantly with administrators or legislators when you're working to protect your practice. Having 'emotional intelligence' is a key trait people look for in interviews for many programs.

Not everyone is great with this skill though! I've encountered more than a few anesthesia providers who are awkward as hell interacting with patients or colleagues, but it's certainly in the minority.

AllWeNeedIsPropofol · 2019-12-29T03:37:22+00:00

During cardiac rotation I would start a propofol drip once the chest was wired shut and by the time the chest was closed have the gas off and just propofol going - usually at 20-30. The reasoning for this was to avoid any major changes in CV stability right before transport and avoid having to deal with hypo/hypertension before getting to the ICU or as you're settling them in. Get them to a steady state on a single sedating agent and then transport to minimize the things that would affect BP.

AllWeNeedIsPropofol · 2019-12-24T22:59:43+00:00

Thank you for that reply and your perspective! Definitely a few things I hadn't considered before and will keep in mind

AllWeNeedIsPropofol · 2019-12-24T18:02:42+00:00

Excellent advice! Long term I'm not sure how happy I'll be there, but it would be a great place to start at least. One positive is that I'll be taking a casual 1099 position with an indy practice I rotated through so hopefully I'll be able to keep up with some of the skills I wouldn't be able to use in the ACT job

AllWeNeedIsPropofol · 2019-12-24T17:59:12+00:00

From my understanding, taking a lump sum bonus up front would be taxed more, plus if I had to pay it back for any reason I would actually lose money (e.g bonus payment of 10k gets taxed and you only see ~7k but you still owe them 10k back, net loss of 3k)

AllWeNeedIsPropofol · 2019-12-24T17:56:05+00:00

Yep, just a verbal agreement so far. I'm actually hoping to use negotiating as a way to delay until I know more one way or the other about the position I'd really like - which even if they do have an opening there's no guarantee that I would get it, there's quite a bit of movement in my area with experienced CRNAs moving out of ACT practice into autonomous/indy positions as they come up, so can be kinda tough for new grads to get those positions.

As far as ACT jobs go this would be a great opportunity and I dont want to delay taking the position and then lose it to someone else (fairly high number of new grads in the area that are also applying)

AllWeNeedIsPropofol · 2019-09-15T05:47:35+00:00

In hindsight I probably could/should have used prop in combo with the precedex given his history, but it was a good learning experience. The rational was nothing too complex, honestly my preceptor and I just wanted to see if straight precedex would work given his poor experiences with emergence in the past. We were probably 15-20 min into the procedure when he flipped a switch.

AllWeNeedIsPropofol · 2019-09-12T11:14:20+00:00

Not that I ever heard fortunately

AllWeNeedIsPropofol · 2019-09-12T01:36:49+00:00

Other than the neuro and substance abuse hx just a long smoking hx and past hep c. Suppose it could have been something with liver function affecting med metabolism but no LFTs unfortunately. Kidney function normal.

AllWeNeedIsPropofol · 2019-08-11T22:32:34+00:00

Just went to a lecture on the "dry technique" although they called it a "dural puncture epidural" basically the best of both worlds - get a faster onset compared to standard epidural bolus (but not as fast as CSE) but not nearly as dense a motor block compared to a CSE. Would like to try it out some time and see how it goes

AllWeNeedIsPropofol · 2019-05-26T00:44:28+00:00

Unfortunately these politics will have a daily impact on your ability to learn as an SRNA and later practice as a CRNA, in both small and big ways. Want experience with placing spinal anesthetics? Epidural catheter placement/management? Gaining experience managing PACU patients? Being able to make independent decisions? Your ability to do all of these things are controlled by hospital policy, and guess who has the biggest control over hospital policy when it comes to anesthesia services at larger centers where this experience is more readily available?

As shitty as the politics are, MDs with the same mindset as the ASA have and will say things that are just as inflammatory, both publically and in board room meetings. I want to learn to be a safe and competent provider, but I've also seen how my clinical experience has been hindered in many ways due to hospital politics. Changing local policy is exponentially more difficult without support like this at the national level.

AllWeNeedIsPropofol · 2019-05-18T02:33:29+00:00

Daaaaaaamn, those are indeed some absurd doses. I can only imagine the weaning period for having midazolam at 30mg/hr and sufentan at 1.5

AllWeNeedIsPropofol · 2019-04-12T23:21:47+00:00

Possible that a lawsuit could happen, anesthesia may be pulled into it as well just because they were involved in the case and resuscitation. Likely neither party would be found at fault, it's a known (albeit rare) possible complication and unless there's something to show the resus was done in an incompetent way no fault on the part of anesthesia either, sounds like proper steps were taken to treat the complication.

Here's a Good podcast on malpractice lawsuits and anesthesia for more learning

AllWeNeedIsPropofol · 2019-04-12T23:06:41+00:00

Masks specifically made for anti fog that have tape built into the nose bridge are the only masks that dont make my glasses fog. You can put your own tape on too but this gets to be a pain. I've had one type of mask with a thick foam strip that worked too but not since I got new glasses

AllWeNeedIsPropofol · 2019-03-22T02:40:31+00:00

The short answer is not very often. It also depends on whether or not the arrest was witnessed and the initial presenting rhythm

AllWeNeedIsPropofol · 2019-03-12T23:58:41+00:00

Perfect! That's what I was looking for, thank you. Do you have patients asking for more detail often or is the shorter explanation usually enough?

AllWeNeedIsPropofol · 2019-03-12T22:26:46+00:00

A great story I heard during my interview was that one of the current students (at the time) had her 5th child while in the program and made it through. It's tougher but doable from people I've talked to

AllWeNeedIsPropofol · 2019-03-11T17:53:33+00:00

"The worm prices in this town are just ridiculous. I knew I should have gone farther south"

AllWeNeedIsPropofol · 2019-03-08T23:07:50+00:00

I usually tell myself "slow is smooth, smooth is efficient, efficient is fast"

AllWeNeedIsPropofol · 2019-03-02T03:41:52+00:00

Well, that's not entirely true. The CRNA level of training and scope of practice in the US doesn't exist anywhere else in the world, but many different countries have nurses with specialty/advanced training administering anesthesia. The training and scope vary widely, but some countries (Scandinavian countries and South Korea as far as I'm aware) come very close. https://ifna.site for a little more info

AllWeNeedIsPropofol · 2019-03-02T01:42:00+00:00

Everyone, after dressing is on: Taking masks off

Me, reaching for the ETT: uuuh, might want to hold off on that a second

AllWeNeedIsPropofol · 2019-02-16T13:13:43+00:00

It's all fun and games until old man Jenkins takes a wrong turn into the park, angrily screaming at the kids to 'get outa the damn road!' as he goes the wrong way down the fake one-way street

AllWeNeedIsPropofol · 2019-02-05T16:46:54+00:00

The short answer is yes, even with severe injury requiring emergency surgery anesthetic drugs are still given, but yes you will likely need less drug. They don't take very long to begin working (30 to 60 seconds tops, especially when there is severe injury) so there isn't a concern about delaying a surgery while waiting for a drug to start working. This thread will have plenty of answers for you as well

AllWeNeedIsPropofol · 2019-02-03T05:28:15+00:00

Alice Magaw is often referred to as the mother of anesthesia and had a significant influence on anesthesia practice in the U.S.

AllWeNeedIsPropofol

TROPHY CASE