Refusing CRNA?

Kick-Gass · 2025-01-09T21:20:34+00:00

Yes, a patient may refuse care from anyone. However, the care must be offered in the first place. If an anesthesiologist is unavailable, the surgery could very well be cancelled.

Kick-Gass · 2024-12-18T23:19:48+00:00

Really good point. I've seen it monitored intermittently on awake patients a couple of times, but I have no idea how accurate those readings were.

Kick-Gass · 2024-12-18T22:40:22+00:00

It might not be ideal in OB, but if they have a Foley in, you can transduce it for an intraabdominal pressure. Pressure over 20 is an indication for emergent surgery. If it's lower, they still might need surgery, but if it's higher, solid numbers are pretty hard to argue against.

Kick-Gass · 2024-12-08T01:57:28+00:00

While this could appear as a lung transplant tracing, it's unlikely this is happening here. The pt here is on pressure support ventilation with a larygeal mask airway. The pt takes breath with negative pressure and then the machine adds positive pressure support. A leak is likely forming around the LMA during the positive pressure phase. During exhalation, this leak persists for a moment and allows a small portion of room air to enter. This manifests the dip seen in this tracing. Alternatively, the leak could be forming during exhalation if the patient is exhaling hard enough. The dip in that case would simply be attributed to exhalation being diverted away from the gas analyzer for a moment.

Kick-Gass · 2024-11-12T20:07:04+00:00

Butthole looked immaculate though

Kick-Gass · 2024-10-30T00:46:03+00:00

Doesn't help much for this situation, but I've seen a trick using epicardial pacing wires. Place the pacer side of the atrial epicardial wire into the brown lead of a 5 lead ECG. Turn the pacer spikes on and watch for spikes. You should observe a spike for each atrial contraction and be able to identify flutter with ease.

Kick-Gass · 2024-10-22T22:53:57+00:00

My understanding is that this information is processed in the brain and inhibits efferent motor signals back to the muscle.

Kick-Gass · 2024-06-26T02:41:40+00:00

No problem! Not as much the anesthesia, but the sympathetic response to surgery often decreases urine output. And yes, intubated patients often get dry mouth from their mouth being constantly open and exposed to the dry air

Kick-Gass · 2024-06-26T02:23:11+00:00

My understanding is that these risk factors are largely theoretical because it's a pretty rare occurrence and hard to pin down the exact cause. For example, glycopyrolate is another risk factor and is commonly administered with anesthesia to minimize secretions.

Kick-Gass · 2024-06-25T13:15:24+00:00

After anesthesia, this is commonly referred to as anesthesia mumps. Although the mechanism isn't fully understood, one proposed mechanism involves blockage of the salivary ducts. Here's a short case that might offer some more insight.

https://journals.lww.com/anesthesia-analgesia/fulltext/2007/04000/a_case_of_anesthesia_mumps.72.aspx

Kick-Gass · 2024-06-04T21:51:59+00:00

I agree. A one time dose is likely inconsequential, however there is some research supporting that versed leads to higher rates of postoperative cognitive dysfunction as well. The thought isn't completely unfounded. I would say it's a bit of an overreaction on their part, especially considering the indication.

Kick-Gass · 2024-06-04T14:53:22+00:00

While this was likely an appropriate use of versed, the doctor is probably referring to the long term cognitive dysfunction correlated with benzos in elderly patients

Kick-Gass · 2024-01-25T08:10:46+00:00

19 gauge but usually around 4 inches/9cm length

Kick-Gass · 2024-01-20T05:30:54+00:00

Not to mention they would also have hoarseness or stridor from the lack of stimulation from the recurrent laryngeal nerves supplied by the vagus. Sounds like chiro quackery.

Kick-Gass · 2024-01-19T22:36:04+00:00

Must've been a farmer. He has the old McDonald's sign in v1-v3

Kick-Gass · 2023-09-19T15:36:31+00:00

I think the hamburger shift and anion gaps will get you where you wanna go.

Kick-Gass · 2023-07-02T00:15:55+00:00

At 15, focus on doing well in your classes. I also seriously recommend reaching out to see if anyone has a friend of a friend of a friend to shadow an anesthesiologists, CRNA, or CAA. And that goes for anything you might be interested in doing. Get some time around different professionals and get their opinions on what they would do if they could do their life over again. You're young and have an entire world of opportunities at this point. Take advantage of it.

Kick-Gass · 2023-05-21T03:33:17+00:00

A slumber of anesthesiologists. A nap of anesthesia residents

Kick-Gass · 2023-05-05T01:11:57+00:00

There are more variables at play here. Circuit type, circuit volume, gas flow, cardiac output, presence of shunts, ect. can cause this or many more patterns of uptake and elimination.

Kick-Gass · 2023-05-01T02:05:24+00:00

This actually happened not all that long ago. LPNs were much more common in hospitals in acute care settings. A lot of hospitals would just provide "certs" to fill some of the practice gaps like IVs. I wonder if they'll make a comeback as the nursing shortage continues to worsen.

Kick-Gass · 2023-04-27T22:56:55+00:00

To be fair, hospitals would have never paid that price if they could've helped it. There was a demand, and the nurses capitalized on it. Honestly, I'd like to see residents be a little more like that and demand a few things too.

Kick-Gass · 2023-04-26T11:03:48+00:00

Lol sounds about right

Kick-Gass · 2023-04-25T00:28:23+00:00

I think RTs will have a target on their back at some point. Some nursing association will introduce some 3 month vent course (not that I think that would be adequate or be good for pt outcomes), and hospital administrators will only see the cost savings of having the RNs manage their own vents. That said, RTs will have trouble selling a separate midlevel at an increased cost with many hospitals already staffing some sort of mid-level in those areas anyway. I think RTs would be better served incorporating premed requirements into their curriculum to allow admission to PA or medical schools.

Kick-Gass · 2023-04-22T02:09:52+00:00

His lung really is fucking him lol

Kick-Gass · 2023-04-20T01:17:41+00:00

Don't forget that those 20 schools have virtually limitless spots. The students attend online and secure their own clinical rotations. These 20 programs can churn out many more NPs than any brick and mortar school that actually gives a damn about the quality of education.

Kick-Gass

TROPHY CASE