CRNAS performing TEE

[militarymd]

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My old friend, military md. ....... I am still not sure what side you are on but I do enjoy the banter. I would like to know if your group would hire/allow a CRNA to do TEE for your cases (unsupervised of course)? Would you allow a non fellowship trained anesthesiologist to do it?

Our group:

1) do not employ crna's for anything.
2) as it stands......non fellowship trained anesthesiologists do TEE's across the country.

3) and we don't hire fmg's.

 

[dhb]

Noyac...I plan on getting sh it faced...not just buzzed.

I've heard Asian's are poor ETOH metabolizers

 

[militarymd]

I've heard Asian's are poor ETOH metabolizers

sounds like a challenge😉

 

[ProRealDoc]

Wow what a cast of caracters in this post 🙂 just wanted to add myself

I believe TEE is just like any other technical aspect it can be learned but it's the reasoning behind is and how you manage the information that it gives you that's important.

Anybody that drops a probe for 1 year in the heart room will be able to perform a basic exam.

if all you know how to do after a year is a basic exam something must be wrong with you.

 

[Consigliere]

Our group:

1) do not employ crna's for anything.
2) as it stands......non fellowship trained anesthesiologists do TEE's across the country.

3) and we don't hire fmg's.

I ESPECIALLY like #3

 

[Converge]

CRNA shoves the tube down the patients throat and aims it the right direction. Cardiologist/CT surgeon interprets the test. Enjoy your CT fellowship.

 

[mille125]

Our group:

1) do not employ crna's for anything (YOU ARE SMART)
2) as it stands......non fellowship trained anesthesiologists do TEE's across the country.(YES AND THIS IS WHY CRNA'S FEEL THAT THEY CAN DO IT TOO. I DONT AGREE BUT THIS IS THEIR MINDSET. THE SAME IS TRUE IN PAIN MGMT. CRNA'S TRIED TO GET INDEPENDENT PRACTICE FOR PAIN MGMT IN LOUISIANA.)

3) and we don't hire fmg's (ALSO SMART)

 

[SleepIsGood]

MilMD

I know what you get of on here. YOu come in here and you like creating controversy and saying things that are outlandish and then saying you are calling a 'spade a spade'.

For those of us that have known you for a while, we know that's your attention gathering method.

The reality is that the pendulum is swinging the otherway. Unlike what you would lead people to believe, private practice anesthesiologists are NOT embracing CRNAs. Quite the contrary.

Also....if I'm not sitting on a stool and i'm not supervising, then what am I doing? It's called WORKING.

 

[militarymd]

Sleep...

actually if you listen to yourself....it is VERY amusing.

1) you claim SUPERIORITY in training..skills...etc...
2) then in the same breath you get all threatened by your competition.

If 1) were so true (and i'm not arguing that), then you shouldn't feel 2)

Number 1 and 2 together in the same individual suggests.....perhaps an........insecurity/inferiority complex....look it up in dsmIV...or is it V or VI now.

MilMD

I know what you get of on here. YOu come in here and you like creating controversy and saying things that are outlandish and then saying you are calling a 'spade a spade'.

For those of us that have known you for a while, we know that's your attention gathering method.

The reality is that the pendulum is swinging the otherway. Unlike what you would lead people to believe, private practice anesthesiologists are NOT embracing CRNAs. Quite the contrary.

Also....if I'm not sitting on a stool and i'm not supervising, then what am I doing? It's called WORKING.

Answer please.

 

[militarymd]

MilMD

I know what you get of on here. YOu come in here and you like creating controversy and saying things that are outlandish and then saying you are calling a 'spade a spade'.

For those of us that have known you for a while, we know that's your attention gathering method.

The reality is that the pendulum is swinging the otherway. Unlike what you would lead people to believe, private practice anesthesiologists are NOT embracing CRNAs. Quite the contrary.

Also....if I'm not sitting on a stool and i'm not supervising, then what am I doing? It's called WORKING.

give me a fu cking break......What ARE YOU DOING? if you aren't sitting on a stool or supervising....

I KNOW you ARE NOT attending in the ICU like I CAN.

 

[mille125]

MilMD

I know what you get of on here. YOu come in here and you like creating controversy and saying things that are outlandish and then saying you are calling a 'spade a spade'.

For those of us that have known you for a while, we know that's your attention gathering method.

The reality is that the pendulum is swinging the otherway. Unlike what you would lead people to believe, private practice anesthesiologists are NOT embracing CRNAs. Quite the contrary.

Also....if I'm not sitting on a stool and i'm not supervising, then what am I doing? It's called WORKING.

i agree...we should not categorize the work of an anesthesiologist as "sitting on a stool".....and if that what you think, then you have low self worth

 

[militarymd]

[/B]

i agree...we should not categorize the work of an anesthesiologist as "sitting on a stool".....and if that what you think, then you have low self worth

So, I guess you stand during a case......then you're just stupid.

 

[SleepIsGood]

Dude are you serious?

I didnt answer it because the answer is sooo obvious.

Yes, if you are a board certified anesthesiologist, OF COURSE #1 is true. You should have superior skills. However, #2 doesnt just follow logically.

Why? Politics, and economics. CRNAs know how to persuade legislators and they use the words that ATTENDINGS like yourself supply to them.

You are very reckless. You call your own profession "stool sitters". Dude, you are the problem with anesthesiology. You are probably the type that gives in when a semi-attractive CRNA asks you to show her how to intubate, do a block,ec.

By the way....being an ICU attending is great. However, I'm sure that's not all you do. Why ? Because your funds really come from doing anesthesia. Dont pretend it doesnt.

Again. We know how you like to stir the pot. You typically do a great job. But I think you are becoming more and more transparent. Your sympathetic attitude toward CRNAs and abadonment of our profession are not well received. Can't wait until you are your CRNA harboring group gets ousted by a CRNA group because they are PERCEIVED to be cheaper and more economical.

 

[militarymd]

Dude are you serious?

I didnt answer it because the answer is sooo obvious.

Yes, if you are a board certified anesthesiologist, OF COURSE #1 is true. You should have superior skills. However, #2 doesnt just follow logically.

Why? Politics, and economics. CRNAs know how to persuade legislators and they use the words that ATTENDINGS like yourself supply to them.

You are very reckless. You call your own profession "stool sitters". Dude, you are the problem with anesthesiology. You are probably the type that gives in when a semi-attractive CRNA asks you to show her how to intubate, do a block,ec.

By the way....being an ICU attending is great. However, I'm sure that's not all you do. Why ? Because your funds really come from doing anesthesia. Dont pretend it doesnt.

Again. We know how you like to stir the pot. You typically do a great job. But I think you are becoming more and more transparent. Your sympathetic attitude toward CRNAs and abadonment of our profession are not well received. Can't wait until you are your CRNA harboring group gets ousted by a CRNA group because they are PERCEIVED to be cheaper and more economical.

Yea...but I teach the old fat, ugly ones too....even the gay guys that I really don't want to hang around.

see the cop's h1n1 thread to see why my group is md owned and not crna owned.

If you are so aware of points 1 and 2, then there is no need to be uncivil to other healthcare workers......Uncivil behavior will only ostracize YOU even more, and make YOU even more irrelevant in the coming healthcare system.

If you are truly threatened by the items you listed, then open your wallet....the asapac is ready to accept your donations.

 

[maceo]

...

 

[Noyac]

Our group:

1) do not employ crna's for anything.
2) as it stands......non fellowship trained anesthesiologists do TEE's across the country.

3) and we don't hire fmg's.

Really?

So you accept nurses but not FMG's? What is it about FMG's that makes them inferior? And what makes nurses a better option?

 

[SleepIsGood]

If you are truly threatened by the items you listed, then open your wallet....the asapac is ready to accept your donations.

One thing we agree on.

I've definitely advocated for residents to open their wallets and donate to the ASAPAC. I've put my money where my mouth is. Nevertheless, I think what you are doing...margainlizing our profession to 'warming a stool' is counterproductive to what the ASA is doing....advertising anesthesiology as a MEDICAL specialty.

 

[militarymd]

Really?

So you accept nurses but not FMG's? What is it about FMG's that makes them inferior? And what makes nurses a better option?

actually fmg's are ok....I was just taking a jab at mille..

Nurses are better because they are cheaper.

 

[SleepIsGood]

Nurses are better because they are cheaper.

From the horse's mouth.

Perhaps a freudian slip? MilMD clearly makes his true intentions known. It's guys like this that are just about the money that are raping our specialty and leaving nothing behind.

Who cares if he's ICU trained. This sort of greed is what's devastating to our specialty.

 

[militarymd]

One thing we agree on.

I've definitely advocated for residents to open their wallets and donate to the ASAPAC. I've put my money where my mouth is. Nevertheless, I think what you are doing...margainlizing our profession to 'warming a stool' is counterproductive to what the ASA is doing....advertising anesthesiology as a MEDICAL specialty.

How many medical specialties do you know of where the physicians spend 95% of their time with their lard asses parked on a stool...and THINK that it is OK to do that?

You, my young friend, is making a mockery of this medical specialty by advocating that we should continue to spend 95% of our time with your asses glued to a stool.

 

[militarymd]

From the horse's mouth.

Perhaps a freudian slip? MilMD clearly makes his true intentions known. It's guys like this that are just about the money that are raping our specialty and leaving nothing behind.

Who cares if he's ICU trained. This sort of greed is what's devastating to our specialty.

NOT a freudian slip......I'm calling a spade a spade...

As an employer, I don't have to pay a crna what I have to pay a md.

As of RIGHT now...nurses are cheaper......If you want to pay MORE for the same thing...then YOU go ahead.

If you want that job, I'll gladly give it to you over a crna.....

 

[Bertelman]

How many medical specialties do you know of where the physicians spend 95% of their time with their lard asses parked on a stool...and THINK that it is OK to do that?

radiology
pathology
both 100% stool sitting minus bathroom breaks

Come to think about it, most office-based specialists spend much of the day with their ass parked on the special "doctor stool", only getting up long enough to go to the next exam room. If they could find a way to efficiently turnover patients with one exam room, they wouldn't leave that stool-on-wheels all day.

This impression that top-notch work requires standing on your feet makes no sense. There are plenty of highly-compensated professionals that spend most of their time parked in a chair.

 

[militarymd]

radiology
pathology
both 100% stool sitting minus bathroom breaks

Come to think about it, most office-based specialists spend much of the day with their ass parked on the special "doctor stool", only getting up long enough to go to the next exam room. If they could find a way to efficiently turnover patients with one exam room, they wouldn't leave that stool-on-wheels all day.

This impression that top-notch work requires standing on your feet makes no sense. There are plenty of highly-compensated professionals that spend most of their time parked in a chair.

allow me to rephrase...

all those folks sit there to do work that ONLY physicians do...interpreting films.....interpreting slides......etc.

When anesthesia folks sit on the stool ...they:

- surf the internet
- read the paper
- chart vital signs
- check urine...

the kind of stuff that OTHER specialties have nurses do....

WHY are you guys GETTING so WORKED up about the RIGHT/the NEED to sit on a stool.

If you have a practice where the payors allow that...GREAT...good for you...but it's going away.....it WILL go away....or accept that your income will be in the range of what a nurse (crna) will make.

 

[drmwvr]

Not to take anything away from this discussion, but as an aside, that photo is staged. If you enlarge that photo, although fairly bit-mapped you can make out that the cable running from the hand peice is going straight down to the floor. Also, she's not standing anywhere near where an echo machine would be to be able to manipulate the image, let alone see well enough for a good exam. Courage men! All is not lost!

 

[coprolalia]

Not to take anything away from this discussion, but as an aside, that photo is staged. If you enlarge that photo, although fairly bit-mapped you can make out that the cable running from the hand peice is going straight down to the floor. Also, she's not standing anywhere near where an echo machine would be to be able to manipulate the image, let alone see well enough for a good exam. Courage men! All is not lost!

Dude, it doesn't matter. The point is that this opens up the entire nursing profession to challenge physicians role in the sole dominion of doing, even if only the technical aspects, of placing a TEE.

Before I ever place a TEE probe, I ask whether or not the patient has atresia or achalasia, is there a history of varix or varices, has the patient had prior esophageal surgery or problems, etc., etc. And, even if they do, I weigh the benefit/risk of whether or not I should still put the probe in. That's the decision a physician makes, as well as fully dealing with the consequences, good or bad.

If people start allowing nurses to have this kind of discretion, then there's absolutely no point in going to medical school anymore because this would become a de facto assertion (by whomever making it and - more importantly - accepting it) that there's no difference in our training... which, I and hopefully most of you believe, would be complete bullsh*t.

-copro

 

[drmwvr]

Dude, it doesn't matter. The point is that this opens up the entire nursing profession to challenge physicians role in the sole dominion of doing, even if only the technical aspects, of placing a TEE.

Before I ever place a TEE probe, I ask whether or not the patient has atresia or achalasia, is there a history of varix or varices, has the patient had prior esophageal surgery or problems, etc., etc. And, even if they do, I weigh the benefit/risk of whether or not I should still put the probe in. That's the decision a physician makes, as well as fully dealing with the consequences, good or bad.

If people start allowing nurses to have this kind of discretion, then there's absolutely no point in going to medical school anymore because this would become a de facto assertion (by whomever making it and - more importantly - accepting it) that there's no difference in our training... which, I and hopefully most of you believe, would be complete bullsh*t.

-copro

Of course, I was being cheeky and I'm not missing the point. This is a variation on a theme which exists with or without a canned snap. If it isn't echo, it's something else. On the echo front, if there are places where the CRNA's perform the exam, it is the surgeons that accept them. All the discussion in the world adds to nil as long as that reality is so.

 

[deleted50478]

.

 

[slunk]

allow me to rephrase...

all those folks sit there to do work that ONLY physicians do...interpreting films.....interpreting slides......etc.

When anesthesia folks sit on the stool ...they:

- surf the internet
- read the paper
- chart vital signs
- check urine...

the kind of stuff that OTHER specialties have nurses do....

WHY are you guys GETTING so WORKED up about the RIGHT/the NEED to sit on a stool.

If you have a practice where the payors allow that...GREAT...good for you...but it's going away.....it WILL go away....or accept that your income will be in the range of what a nurse (crna) will make.

Depends on the case. If you are doing a difficult peds case or cardiac where a split second means the patient can crash, then I want the most qualified guy sitting in that stool. I think we can agree that in these situations that anesthesiologist > CRNA.

Also, just getting to the point where you can sit and breathe in a big case is sometimes an achievement. It means you finally got the patient normothermic, vitals stable, anesthetic depth good, positioning good, lined up, etc.

Maybe out in private practice there are more bread and butter cases that allow for sitting around and doing nothing.

 

[slunk]

I think there is an element of infringement.
Anesthesiologists have helped advance the fields of anesthesia, critical care, and perioperative medicine. They have done studies, come up with innovative patient care techniques and monitors, etc. which have made the field safer for patients and easier to do.

CRNAs take our standards of practice and try to use them to better their own profession by mimicing ours. You think CRNAs change their anesthetic practice based on their own CRNA journals? No, it is all based on physician-led advancements.

Them using TEE is just another example.

On the one hand, anesthesiologists are advancing the field, on the other, CRNAs are taking our ideas and mimicing us.

In the business world, this would not be allowed.

 

[SleepIsGood]

Dude, it doesn't matter. The point is that this opens up the entire nursing profession to challenge physicians role in the sole dominion of doing, even if only the technical aspects, of placing a TEE.

Before I ever place a TEE probe, I ask whether or not the patient has atresia or achalasia, is there a history of varix or varices, has the patient had prior esophageal surgery or problems, etc., etc. And, even if they do, I weigh the benefit/risk of whether or not I should still put the probe in. That's the decision a physician makes, as well as fully dealing with the consequences, good or bad.

If people start allowing nurses to have this kind of discretion, then there's absolutely no point in going to medical school anymore because this would become a de facto assertion (by whomever making it and - more importantly - accepting it) that there's no difference in our training... which, I and hopefully most of you believe, would be complete bullsh*t.

-copro

not if you subscribe to MilMD's thinking

 

[mille125]

actually fmg's are ok....I was just taking a jab at mille..
Nurses are better because they are cheaper.

your jab missed

 

[mille125]

So, I guess you stand during a case......then you're just stupid.

sadly, you missed the point...

 

[coprolalia]

not if you subscribe to MilMD's thinking

Well, in reference to my point, I'd at least hope a physician has assessed the patient before any TEE probe goes in.

If MilMD agrees with that, then I agree that actually putting the probe in is essentially a monkey skill.

If OTOH he doesn't agree that they need a physician assessment prior to insertion, well... then... he's wrong.

If anyone thinks a nurse is qualified to interpret the TEE findings... that's a completely different argument that falls far beyond the scope of this discussion and involves, among other things, necessary agreement by the CT surgeons and the entire field of Cardiology.

-copro

 

[Bertelman]

actually fmg's are ok....I was just taking a jab at mille..

You shouldn't back down from your comments so easily. This board is littered with the history of your remarks disparaging FMGs.

 

[militarymd]

sadly, you missed the point...

You didn't know that you're a fmg????

 

[militarymd]

You shouldn't back down from your comments so easily. This board is littered with the history of your remarks disparaging FMGs.

I'm not backing down from my feelings towards fmgs, urms...or whatever....I believe in the trends that exist.

I'm just saying my group, although HIGHLY unlikely, could potentially hire a fmg...

 

[mille125]

You didn't know that you're a fmg????

What you need my friend is a good psychologist because you easily fit most of the DSM IV criteria for several personality disorders....

 

[flashgordon]

Dudes & Dudettes, can we please stop fighting amongst ourselves? There are much larger issues at hand...

i.e. Some hoodlums broke into one of our neighbor's house, and my wife has been super paranoid all week. Think it's time to buy a gun. Should I get a Glock 27 or 23? How about a pistol-grip Mossberg 500? Please advise.

 

[periopdoc]

If it is strictly for home protection then get the shotgun. You have no need to conceal it, in fact you want the bad guy to see it and hear it, you will be more accurate if you ever have to shoot it, and you will minimize mechanical risk.

I believe there are a couple of other threads talking about this.


Sorry to hear about the trauma to your wife. Things like this can be very jarring to the psyche.

- pod

 

[coprolalia]

i.e. Some hoodlums broke into one of our neighbor's house, and my wife has been super paranoid all week. Think it's time to buy a gun. Should I get a Glock 27 or 23? How about a pistol-grip Mossberg 500? Please advise.

Broad subject. Previously addressed. Many caveats.

Shotguns are great and cost-effective weapons, a little difficult to yield effectively in closed quarters, and you definitely need hearing protection if you ever discharge one indoors.

I recommend a relatively inexpensive revolver for your uses, preferably .38 special or .357 magnum. The reason is that it is very difficult, if not impossible, to have a malfunction during your "time of need" with such a weapon. You and your wife should become proficient shooting it (several hundred rounds) so that the first time you fire it isn't at a potential would-be perpetrator inside your house.

I also HIGHLY suggest that you get a locking gun case to go at your bedside that the gun would be placed inside of. You take the drawer out and bolt the locking case from the inside. Not only does this help prevent theft, it also helps prevent little hands from getting their grubby mitts on it.

When you keep the gun locked in the lockbox, it's okay to keep it loaded. I suggest that you longterm store it unloaded and preferably in a more secure location. Also, use frangible ammo indoors. There are a lot of good makes with excellent stopping power, including loads in .38 special + P. This prevents overpenetration and possible killing someone in a neighboring apartment or house if you miss.

Also, recognize that, in all actuality, the likelihood of actually using the gun effectively on a criminal attempting to enter your house is - statistically - far less likely than you (or your spouse) using accidentally (or intentionally) on someone otherwise near-and-dear to you, including yourself.

This shouldn't deter you, however, from legal and responsible gun ownership.

REMEMBER: Keep earplugs and a flashlight in the drawer with the lockbox. You don't want to fire any gun indoors without hearing protection.

This is advice from a legal and responsible gun owner for decades. 🙂

-copro

 

[coprolalia]

For example, this model, a .38 Special Ultra-Lite from Taurus, is an excellent first-time owner revolver.

You should be able to buy this basic model for under $400. It should be more than adequate to meet your needs.

(I'm not endorsing Taurus or any other model of firearm. I own several guns, none of which are Taurus, but have shot many Taurus firearms. They are generally excellent, dependable, reliable guns. But, there are also many other brands of firearms. My "bedside" gun happens to be a Smith and Wesson .357 magnum six-shot revolver. I feel genuinely sorry for anyone who attempts to break into my home while I'm there.... I'm a very light sleeper. 😉 ).

-copro

 

[coprolalia]

And, this is the ammo you should load that .38 Special revolver with...

[These] loads reduce the possibility of over penetration through the intended target. They provide for an added margin of safety. A missed round is much more likely to break up on an interior wall and dump its energy rather than proceeding unabated into an adjoining room. The light fast bullets reduce the felt recoil and are excellent loads for the small compact carry guns and snub nose revolvers. For over 27 years the Glaser Safety Slug has been the overwhelming choice for the "house gun" stored in the nightstand.

https://dakotaammo.net/shop/product_info.php?cPath=24_101&products_id=155

-copro

 

[badasshairday]

When people talk about having a bed side gun... where do they really put it? In a lock box under the bed or something?

 

[deleted50478]

Might be a good idea to load your gun with blanks. You are more likely to use it to scare a robber off than to shoot one, and it takes out the risk of accidental shootings of children and neighbors. Then again, I'd want to really shoot any m f who entered my house...

 

[2win]

give me a fu cking break......What ARE YOU DOING? if you aren't sitting on a stool or supervising....

I KNOW you ARE NOT attending in the ICU like I CAN.

You CAN but you aren't attending in the ICU.
Come on dude - why did you leave the nurses board - you were great there...
The GURU of CRNA discussion board.
Be careful here - we are heavy weight.
btw : FMG - and really I consider what you said insulting. Please comment and let's see...Maybe your group doesn't hire blacks or latinos either. What about homos? LOL

 

[periopdoc]

+1 on the revolver if you are going with a pistol, I still like shotguns for home defense, but you will want some training in CQB.

If you get a pistol, get something heavy. Unless you are carrying it all day every day, the weight won't be a problem, and your shots will be more accurate.


My weapon of choice

- pod

 

[Bertelman]

Be careful here - we are heavy weight.

I don't think you realize the depth of your misunderstanding. I've seen what you submit, and I've seen mil's.

You won't win.

 

[militarymd]

+1 on the revolver if you are going with a pistol, I still like shotguns for home defense, but you will want some training in CQB.

If you get a pistol, get something heavy. Unless you are carrying it all day every day, the weight won't be a problem, and your shots will be more accurate.


My weapon of choice

- pod

I wish I had bought a python when I had the opportunity. The are hard to come by these days.

If I had one, I don't think I would risk losing it, to the law, by using it in a self-defense situation.

All my CCW and home defense pieces are ones that are easily replaced...glock, usp, ruger....stuff like that.

 

[Leverage]

I can't believe I just read about 95% of this thread...

politics is politics and economic is economics, who knows what the future holds and if MD practices will have a place of not. One thing I do know is if myself or any family member were ever to go under the knife... I want a MD surfing the net, reading the newspaper, charting vitals, and checking urine on my family member as MillMD put it. Because I know I never do the first two and I don't chart vitals, the computer does that, I inturpert them, diagnosis, and provide intervention. This is what the job of a doctor and I often wonder how CRNA finangled their way in.

 

[flashgordon]

I can't believe I just read about 95% of this thread...

politics is politics and economic is economics, who knows what the future holds and if MD practices will have a place of not. One thing I do know is if myself or any family member were ever to go under the knife... I want a MD surfing the net, reading the newspaper, charting vitals, and checking urine on my family member as MillMD put it. Because I know I never do the first two and I don't chart vitals, the computer does that, I inturpert them, diagnosis, and provide intervention. This is what the job of a doctor and I often wonder how CRNA finangled their way in.

They donate heavily to their PAC. Every single one of them contributes a ****load more than the average anesthesia resident/attending. What they can't accomplish clinically, they do so politically.