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  1. jwk

    CRNA: We are the Answer - WTF????

    Please - my AA profession is happy as is - no "merging" is necessary or desirable.
  2. jwk

    Viva sight

    99% of the time our chest surgeons want to do a bronchoscopy anyway. So we're using a bronchoscope regardless, and I'm sure the DLETT with a camera in it is more expensive than just the plain old DLETT. Not sure what this device would add to our practice given that fact.
  3. jwk

    It’s not MAC

    That's TMI ;)
  4. jwk

    Labor epidural follow up

    We do "labor epidural rounds" q4hr - pre-templated note in the EMR.
  5. jwk

    Awareness under General Anesthesia

    Thanks to our old Emory friend for that lovely 1/1000 study quite a few years back. It was suggested in a Letter to the Editor one of the journals or the ASA Newsletter that if this anesthesiologist's incidence of awareness was truly that high that he might want to consider a better anesthetic...
  6. jwk

    Pure "Nurse-Run" Clinic Opens at Augusta University

    For instance, many chronic conditions such as diabetes are often accompanied by another, such as heart disease, Brown said. WOW! Who knew???
  7. jwk

    constant high risk cases

    Our Own Safety - Anesthesia Patient Safety Foundation Burnout is real. Everyone needs to find a way to decompress or reset, even those of us that have been doing this for decades.
  8. jwk

    AANA Dispute with APSF

    I wonder if the APSF will remove their CRNA members from their board, or if the CRNA members will resign on principle.
  9. jwk

    Fellow Kansas Physician Anesthesiologists

    Not gonna happen. The entire AA profession has been centered around the ACT concept for 50 years. That fundamental concept is not going to change.
  10. jwk

    AANA Dispute with APSF

    Works for me! We've had a number of RNs go through several of the different AA programs.
  11. jwk

    AANA Dispute with APSF

    They want to offer us the "opportunity" to become CRNAs and work independently and in all 50 states. Only four more years of school to do what I'm doing now. Conservative estimate of $1 million in tuition costs and lost income. Wow, what a deal!
  12. jwk

    AANA Dispute with APSF

    They claim the AA to CRNA bridge program exists and that AAs are going through it. I'm still calling BS until I see hard proof, and I haven't seen it yet.
  13. jwk

    AANA Dispute with APSF

    We're trying :) The first Wisconsin class just finished, IU's first class is in their second year, and there are new programs in the discussion phase. One of the best tools my group has from a recruiting standpoint is our AA student rotations. We have 10 or more students at any given time...
  14. jwk

    AANA Dispute with APSF

    They make a lot of noise, but they're but, especially in an area with limited options, they're not going to uproot their families just to be pissy. However - there are PLENTY of groups that have talked about hiring AAs and the CRNAs threatened to leave, and the group totally caved - like the...
  15. jwk

    Fellow Kansas Physician Anesthesiologists

    The CRNAs are certainly much more vocal and obnoxious about it now, and the independent practice crap is pushed from Day 1 in their programs, especially the DNP. However, the smaller-town and private medical office "independent" CRNA has quietly been around for many decades.
  16. jwk

    Fellow Kansas Physician Anesthesiologists

    The blackmail thing is out there, but leaving a job just to make a political statement is not as common as the CRNAs would like you to believe, particularly in smaller markets where leaving a job means leaving town and uprooting a family. In any event, , if one has the capability, toxic...
  17. jwk

    Fellow Kansas Physician Anesthesiologists

    Nearly 50 years in - hasn't happened.
  18. jwk

    AAFP being proactive at defining ‘provider’

    Here's the ASA statement... Statement on the Anesthesia Care Team | American Society of Anesthesiologists (ASA)
  19. jwk

    advice for early attending when supervising

    Just a couple thoughts... If your CRNAs need micromanagement, then you might give some thought to hiring better quality CRNAs - or perhaps try some CAAs. Our group typically runs 3:1 or sometimes 4:1, depending on pt. acuity. It can be done, and it can be done well, and it can be done within...
  20. jwk

    Dr Miami....

    Wonder how he'd feel if the DNP-ARNP-NP-C-ACLS-EMT next door to him hung out a shingle for liposuction?
  21. jwk

    Honest question, why do you guys keep training CRNAs?

    We're about 10:1, AA student to SRNA. Just like with the AA students, the nurse anesthesia students are never ever left alone in a room, and they get no regional, block, or central line experience. Ours is strictly an anesthesiologist-led ACT practice - none of this collaborative crap. The...
  22. jwk

    CRNA impact on job market

    There are still a fair number of certificate-only CRNAs out there, but the youngest are approaching 60, so most will be gone in the next 5-7 years.
  23. jwk

    Post op block checks

    I've had both shoulders scoped. First one three years ago with ISB and catheter, pulled at 3 days. Phrenic involvement resolved after adjusting infusion downward 10hrs postop. Last scope was three months ago with Exparel. The motor block + phrenic not fully resolved till about 30 hrs, and...
  24. jwk

    Door opening

    Of course not. :rofl:
  25. jwk

    Door opening

    We studied this years ago when our joint surgeons complained about OR traffic. Roughly 75% of the door openings during the case were related to their sales reps, and the rest to a combination of OR and anesthesia staff.
  26. jwk

    CRNA impact on job market

  27. jwk

    Nurse Anesthesiologist

    Pathetic. But of course there is NO attempt to mislead anyone with this change of title.
  28. jwk

    Anesthesia on drugs

    I think it was a reasonable question until marijuana was on the list.
  29. jwk

    Yearly NYT news story re: awareness under anesthesia...

    IMHO, it's frequently not explained well. And due respect - if you're telling the patient that "MAC carries the risk of awareness", that doesn't help. "Awareness" is not a risk of sedation, certainly not in the way that aspiration, death, etc. are potential risks.
  30. jwk

    OG shortage?

    We rarely add an OG unless the surgeon requests it, and then, it's usually once they're already in and can see the distended stomach. Some of our GYN docs still do a fair number of veress needle techniques, but almost every other surgeon thankfully does an open technique with a Hassan. One of...
  31. jwk

    Call burden as an attending and as related to subspecialty choice

    True 24 hr call is honestly just stupid from a potential liability standpoint. You can bet you will get asked questions about that if you have a bad outcome and the lawyers come calling. Our anesthetist shifts are limited to a max of 16 hrs straight. Our doc night shifts are only 10 hrs...
  32. jwk

    Nurse kills patient by giving vecuronium instead of versed

    Although very sad, I'm impressed that the hospital publicly released a very detailed description of what happened. "The vials of rocuronium and the IV bag that was labeled "fosphenytoin" were reviewed without the error being noticed." That would give me the impression that if a pharmacy tech...
  33. jwk

    MAC vs Miller Blade, hemodynamic response to intubation

    Anyone can ram an ETT in with a straight blade. It takes skill and finesse and less time to do it with a Mac. :) As I recall, JPP could tube a gravid fire ant with a Mac.
  34. jwk

    SC High School football player dies during ACL repair

    I've never had a case personally - nearly 40 years in practice and avg 800-1000 cases/yr. There are regional differences for sure. Also areas with higher incidence as Mr. S noted in his post, with "closer family ties" making it more likely.
  35. jwk

    SC High School football player dies during ACL repair

    We've got MH posters and placards plastered all around the OR suite and in every OR. We call MHAUS for help with case management if we have a suspected incident. And that info is all over the MHAUS website as well.
  36. jwk

    NPO and EGD for food bolus?

    Why does that need to be done in the OR? You can do an RSI in the GI unit with an ambu bag. We have a GI room with a machine, but it's often tied up with ERCP or EBUS. Do an RSI and TIVA with O2 via an ambu bag.
  37. jwk

    GI procedures in ambulatory centers

    Our outpatient criteria hold across the board for all our centers, GI or ambulatory surgery. We don't lower the standard for GI cases. I'd have to check, but I think our BMI cutoff is 50.
  38. jwk

    Case Today

    Agree - this can be done in 10 min at our place as long as everyone is in place and ready to go.
  39. jwk

    New law on pricing transparency: Anesthesia $4900/half hour

    My non-discounted pre-insurance calculated rack rate surgical fee was $20k for a shoulder arthroscopy that took less than 45 minutes.
  40. jwk

    Anyone experience with electronic timecard for your CRNAs?

    We use a scheduling program that has clock in/out functions available. OT and call shift stipends are all tied in with this system. So are all scheduling functions, self-service swaps, PTO time, etc. We have done everything over the years from writing time in a book to "overtime cards" and...