Harry Pitts, CNRA, Ph. D

[Noyac]

So CRNA's cant do epidurals in Louisiana?

Are you really this ignorant or are you just playing dumb?

You are supposed to be a professional. Read my post. And then ask yourself, "can I do these things?" The answer is an overwhelming, No.

But this is just the beginning of what you can't do as an nurse that a doctor can do. And as mentioned earlier, we doctors go through much more education and training in order to be prepared to choose a specialty once we finish med sch. This training doesn't end here. We are also better able to pre-op pts and to tell when pts have been optimized for their surgery. Better able to treat pts post-op and better able to communicate our pts status to other physicians who may be assuming their care post-op, all because of our extensive training which you have not experienced.

But then again, it is impossible to realize what it is that you don't know if you in fact don't know it. Get it?

---

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[OB1🤙]

rmh- a simple question for you.

Do you think you could pass the MD anesthesia boards?

 

[rmh149]

Are you really this ignorant or are you just playing dumb?

You are supposed to be a professional. Read my post. And then ask yourself, "can I do these things?" The answer is an overwhelming, No.

But this is just the beginning of what you can't do as an nurse that a doctor can do. And as mentioned earlier, we doctors go through much more education and training in order to be prepared to choose a specialty once we finish med sch. This training doesn't end here. We are also better able to pre-op pts and to tell when pts have been optimized for their surgery. Better able to treat pts post-op and better able to communicate our pts status to other physicians who may be assuming their care post-op, all because of our extensive training which you have not experienced.

But then again, it is impossible to realize what it is that you don't know if you in fact don't know it. Get it?

Noyac...I was talking about scope of practice. If it is related to anesthesia, CRNA's can do it as a Licensed Independent practitioner. The scope of practice is decided by the nurse practice act of each state. Now, would I do those things you listed....only if I was trained. Which I am not....with the exception of epidurals and regional. The same thing goes for cardiac anesthesia for example. I have not done cardiac in over three years....so right now I wont do it. Does that mean it is not within my scope of practice? No. I can easily brush up on CRD Anes at become proficient in it. Its just not my gig right now. CRNA's as LIP's in my state are not limited to anything related to anesthesia.

Lasty, is it necessary to be so insulting just because you dont agree with someone. I picture a screaming kid in a sandbox when he doesnt get his way.

 

[Coastie]

Easily brush on up cards?

I feel sorry for your patients.

Noyac...I was talking about scope of practice. If it is related to anesthesia, CRNA's can do it as a Licensed Independent practitioner. The scope of practice is decided by the nurse practice act of each state. Now, would I do those things you listed....only if I was trained. Which I am not....with the exception of epidurals and regional. The same thing goes for cardiac anesthesia for example. I have not done cardiac in over three years....so right now I wont do it. Does that mean it is not within my scope of practice? No. I can easily brush up on CRD Anes at become proficient in it. Its just not my gig right now. CRNA's as LIP's in my state are not limited to anything related to anesthesia.

Lasty, is it necessary to be so insulting just because you dont agree with someone. I picture a screaming kid in a sandbox when he doesnt get his way.

 

[jeesapeesa]

don't you need a fellowship with cardiac anesthesia? EASILY brush up? isn't this statement a slap on the face of fellowship-trained cardiac anesthesiologists? sorry, i've just been following this whole thread and this is probably the most ridiculous statement i've heard thus far.

 

[rediculous]

i was respectful and tried to reply to post intelligently without reverting to name or profession bashing. This is a fact confirmed by any of my previous post.

It was called into question the fact i supervise med students because i am currently studying acute care. However, Acute Care will be my second masters, my first having been earned in 1997, Familyl Nurse Practitioner from Georgetown. I never claimed to supervise anesthesiologist or CRNA, though i do work with them frquently. I do however deal with many NP, PA and MD students daily. I take exception to being labeled a troll because i joined this forum a while ago and have never made any polarizing coments or even challenged the education, preparation or authority of medical training. In all my post, i have stuck to defending my profession or answered questions regarding it. i have always been truthful, but i guess you must be looking for reasons to believe any rational responses that dont agree with yours must be from a liar.

i thought this was a public forum where a person could engage in intelligent public debate. i was hoping to find this, especially among a bunch of MDs, but that must be too much to ask for with this subject as there are some very closed minded opinions regarding it. I am very surprised by the moderators decision to ban me because i have read much more inflamatory and negative post from other members who were never met with this response. Curious.

The funniest part is, reality doesn't even come close to reflecting the attitudes on this forum. Most people in my hospital get along great, and when they dont, its seldom because of title.

DQBANRN

 

[proclivity]

Proclivity, like I said in an earlier post, I don't introduce myself as:

Dr. Smith, A.A., B.S., M.D., ASA-MEMBER, AMA-MEMBER, ASARESPAC, etc

I'm Dr. to the patients, and I'm *first name* to everyone else.

Nurse Anesthetist Smith, A.S.N., B.S.N, CRNA, DIP (uh, DNAP), and the rest of the nursing letters, should introduce himself as

"Nurse Anesthestist Smith. I will be assisting Dr. Smith in your care today. We work as a team to best serve your needs in the OR".

I don't care if he has a Ph.D. In the clinical setting, especially Anesthesiology, he's not a doctor unless he has MD/DO.

I'm pretty sure we agree here......

 

[proclivity]

That is a really bad anaology? Do you think CRNA's are only capable of doing only one type of anesthesia? There is nothing an anesthesiologist can do relating to anesthesia that a CRNA cannot. It is within the scope of CRNA's to practice anesthesia independently....at least in my state it is. Sorry, it was like this when I got here....I had nothing to do with it.

As far as anesthesia is concerned...the anesthesia I deliver is the same as the anesthesia the anesthesiologist in the OR next door is delivering.

I thought it was a very valid analogy. You probably could train a nurse to do all of the ortho stuff......but what sense does that make? What all of the physicians on this board are pissed about is that some CRNAs say that they provide precisely the same kind of care.

 

[urgewrx]

I have not done cardiac in over three years....so right now I wont do it. Does that mean it is not within my scope of practice? No. I can easily brush up on CRD Anes at become proficient in it.

That's the problem with a lot of mid levels. They don't even know their limitations. How many anesthesiologists out of residency are willing to do cardiac? Not too many, because they know they don't have the training. They realize there is no "easy brushing up" on anything. It takes time, someone to teach you, and discipline.

Pent, sux, tube, right?

 

[proclivity]

Funny, I just was at the theatre, and sat next to a very talkative female who was telling me how her DPT degree allowed her to "be the doctor" at the VA, where she can "write for meds and treat diseases".

Needless to say, I thought Transformers was lame..

she is obviously mistaken about the meds save for some muscle cream or whatever else you can think of that PTs use a lot of. Pt do diagnose and treat diseases, malformations (congenital or otherwise) and injuries of the musculoskeltal system. This is nothing new. It would be interesting to see what she thinks "meds" are.


I truly enjoyed transformers.....the robots were a bit hard to follow at full speed but it certainly was entertaining. Ah, the good old days of the single digit age.

 

[TIVA]

That's the problem with a lot of mid levels. They don't even know their limitations. How many anesthesiologists out of residency are willing to do cardiac? Not too many, because they know they don't have the training. They realize there is no "easy brushing up" on anything. It takes time, someone to teach you, and discipline.

Pent, sux, tube, right?

Ha, Ha, Ha!

No, it's much easier: Propofol and LMA.

 

[proclivity]

CA-1, day 1 our program director brought up that CNRAs are creating Ph. D programs, which will enable them to ender a patient's room calling themselves "doctor." Has anyone else heard of this? It's a misleading and extremely devious way to avert the system. In that case, a Ph. D in English Literature could do the same thing. Very unacceptable practice. This is not intended to create debate, however we are in "GasForums, the Anesthesiologist's Forum" and should be able to discuss these issues openly.

it appears from the OP that we are still pretty much on topic. I was about to post the "beating a dead horse" icon.

it's still funny that his name is Hairy Pitts. I would have changed that at the courthouse on my 18th birthday.

 

[CremeSickle]

RMH: your digging a hole for yourself bub. While im pro-CRNA, i do not believe that CRNA = Anesthesiologist. In the OR im sure many CRNAs = many anesthesiologists, but that is one SMALL part of anesthesiology and what it is to be a physician.

I want to see transformers but i dont want to be the only 39 y/o guy in there and i cant convince my wife or anyone else to go! Anyone have a kid that they can give up for 2 hours?

 

[VolatileAgent]

But then again, it is impossible to realize what it is that you don't know if you in fact don't know it. Get it?

thank you!

 

[DrDre']

This question hasn't been answered.

I would like to see a non-inferiority/parity study. Take 100 randomly chosen CRNAs and have take their boards and ours within a week and compare pass rates. If the % is too high, then our test should be made more difficult so we do indeed have ownership rights to a higher knowledge base.

rmh- a simple question for you.

Do you think you could pass the MD anesthesia boards?

 

[rmh149]

That's the problem with a lot of mid levels. They don't even know their limitations. How many anesthesiologists out of residency are willing to do cardiac? Not too many, because they know they don't have the training. They realize there is no "easy brushing up" on anything. It takes time, someone to teach you, and discipline.

Pent, sux, tube, right?

I'm not talking about reading a couple of chapters the night before a heart. Im talking about taking a job where I can get 6 to 12 months of good experience. And yes, I agree, it does require discipline, time, and someone to learn from. That is EASY to find. It's EASY to pick up a job to get some good cardiac experience.

Talk about twisting!

 

[rmh149]

This question hasn't been answered.

I would like to see a non-inferiority/parity study. Take 100 randomly chosen CRNAs and have take their boards and ours within a week and compare pass rates. If the % is too high, then our test should be made more difficult so we do indeed have ownership rights to a higher knowledge base.

Keep in mind, your knowledge base includes being an MD. That is what sets us apart. Your knowledge base extends beyond anesthesia. Thats what makes us unequal. As far as the anesthesia I provide for my patients....it wouldnt be different than what an anesthesiologist would do.

Now, how is that different? I would consult with another physician (hematology, oncology, GYN, cardiothoracics, etc.) when there is a medical questions....not about anesthesia, but about medicine more than an anesthesiologists would. I know my limitations! That is why I would definitely consult more with other physicians(non-anesthesiologist) than an anesthesiologists would. Thats what makes us safe at what we do.

Where on this thread did I say WE are EQUAL? I never thought that....because of your education in medicine. But as far as the anesthetic we provide, it ends up the same as what an anesthesiologist would do. Mainly because we know when to incorporate the expertise of other providers (doctors). WE are pros at that....because we are nurses.

Are we equal= NO

Are we as safe = YES

Trust me...I am not trying to bring down the prestige of your specialty as an MD. You guys are physicians. No doctorate degree I get will ever match a medical degree. And the public agrees. But it is still a doctorate degree.....please dont bash it. I'm not trying to be equal. Just trying to give the best and safest anesthetic I can. And I think CRNA's nationwide are doing a pretty damn good job.

I am sincerely apologetic at pissing you guys off with this thread.

 

[rmh149]

I thought it was a very valid analogy. You probably could train a nurse to do all of the ortho stuff......but what sense does that make? What all of the physicians on this board are pissed about is that some CRNAs say that they provide precisely the same kind of care.

No, the anology stated that a nurse can be trained to do just knees. That would be like a CRNA that only does GYN anesthesia...nothing else.

Now, like you said, if a nurse was trained to do all the ORTHO stuff, then I guess that would make them a CORN. This is not likely to happen.

But as far as anesthesia is concerned....we follow "precisely" the same standards as anesthesiologists.

 

[urgewrx]

I'm not talking about reading a couple of chapters the night before a heart. Im talking about taking a job where I can get 6 to 12 months of good experience. And yes, I agree, it does require discipline, time, and someone to learn from. That is EASY to find. It's EASY to pick up a job to get some good cardiac experience.

That's called being supervised. The hardest part being setting up the room and charting. I don't know of any CRNA who does cardiac by him/herself. I don't know if it will ever happen. With an anesthesiologist on the side(to bail you out of trouble and/or take responsibility) anyone can do any complex case. But, that's not the point. We are talking about doing cases solo. Are you implying that after said 6-12 mo experience(is this what you call easy brushing up? About 40% length of your anesthesia trianing! ) you feel trained enough to do a cardiac case by yourself?

 

[toughlife]

.

Keep in mind, your knowledge base includes being an MD. That is what sets us apart. Your knowledge base extends beyond anesthesia. Thats what makes us unequal. As far as the anesthesia I provide for my patients....it wouldnt be different than what an anesthesiologist would do.

From a technical stanpoint you are correct. After all, you are a technician.

Now, how is that different? I would consult with another physician (hematology, oncology, GYN, cardiothoracics, etc.) when there is a medical questions....not about anesthesia, but about medicine more than an anesthesiologists would. I know my limitations! That is why I would definitely consult more with other physicians(non-anesthesiologist) than an anesthesiologists would. Thats what makes us safe at what we do.

It is different because you cannot manage any medical issues for the patient you are caring for. If the patient is a diabetic, has afib and develops a PE and has to be admitted to the hospital, I can take over and ensure this patient will be ok. You cannot because #1 you don't have the training, don't have the knowledge and you are not allowed by law.

Who cares if you can consult other physicians. Your inability to manage complications and to require help from physicians to care for patients leads to overutilization of services and more cost to the patient. From that perspective your presence as a provider is a waste of time and money.

The point is that you are not safe because you cannot deal with complications. When you are able to deal with them, then call yourself safe. Right now, all you are is a liability to other physicians.

Where on this thread did I say WE are EQUAL? I never thought that....because of your education in medicine. But as far as the anesthetic we provide, it ends up the same as what an anesthesiologist would do.
From a technical perspective you are the same. I can change tires just as well as a mechanic can. Do I know everything there's is to know about the drive train and fix any complications? No

Mainly because we know when to incorporate the expertise of other providers (doctors). WE are pros at that....because we are nurses.

Again, reliance on a physician to help you do your job is expensive and time consuming. Just like NPs ordering all kinds of tests and over consulting due to lack of knowledge and training

Are we equal= NO

Glad you realize that

Are we as safe = YES
Only to the extent you are trained as a technician.

Trust me...I am not trying to bring down the prestige of your specialty as an MD. You guys are physicians. No doctorate degree I get will ever match a medical degree. And the public agrees. But it is still a doctorate degree.....please dont bash it. I'm not trying to be equal. Just trying to give the best and safest anesthetic I can. And I think CRNA's nationwide are doing a pretty damn good job.


I am sincerely apologetic at pissing you guys off with this thread.

 

[VolatileAgent]

Keep in mind, your knowledge base includes being an MD. That is what sets us apart. Your knowledge base extends beyond anesthesia. Thats what makes us unequal.

thank you for acknowledging that. your challenge now is to understand why that makes a difference, if possible.

As far as the anesthesia I provide for my patients....it wouldnt be different than what an anesthesiologist would do.

under direction.

the difference being that, in a crisis, critical information that is outside of your protocols is not readily available at your fingertips (ie, core knowledge). that is the difference. we have a larger toolbox to draw upon when the case takes a wrong turn and the predicted outcome is no longer on the table as a possibility.

Now, how is that different? I would consult with another physician (hematology, oncology, GYN, cardiothoracics, etc.) when there is a medical questions....not about anesthesia, but about medicine more than an anesthesiologists would. I know my limitations! That is why I would definitely consult more with other physicians(non-anesthesiologist) than an anesthesiologists would. Thats what makes us safe at what we do.

an anesthesiologist would not regularly consult outside parties on things that you are going to have to do. that's what makes us different. your suggestion is a misuse and abuse of consultation. other consultants would not be willing, as you surmise, to provide information to you on basic stuff that you should know to do a case; ie, that we already know as physicians. that's the difference.

Where on this thread did I say WE are EQUAL? I never thought that....because of your education in medicine. But as far as the anesthetic we provide, it ends up the same as what an anesthesiologist would do. Mainly because we know when to incorporate the expertise of other providers (doctors). WE are pros at that....because we are nurses.

first off, i'm glad you realize that we are not equal. the aana, the profession that speaks for you and your colleagues, does not seem to think so.

what you are having an impossible time realizing - and what you will never realize until you go to med school and do a residency - is that, yes, this does make a difference in overall patient care. we're talking about the breadth of our specialty beyond the techinical aspects of care, and the impact that has outside the operating room. you continue to say that you "incorporate the expertise of other doctors" as if this is some sort of blessing that should afford you the opportunity to practice independently. this only shows your ignorance. busy physicians do not want to provide consultation for your knowledge gaps. in fact, they often want call us in consultation to ask for our opinions, as experts, for issues pertaining to a variety of things related to peri-operative care and pain management, a fact that you do not know because you DO NOT RECEIVE THOSE CALLS!

Are we equal= NO

thank you!

Are we as safe = YES

in the ACT model, yes. as independent practitioners on a large scale, you cannot demonstratively say this. my feeling, shared by my physician colleagues is that this is likely "no" and, furthermore, they do not want to consult a nurse to answer a peri-operative medical question.

Trust me...I am not trying to bring down the prestige of your specialty as an MD.

you can't.

You guys are physicians. No doctorate degree I get will ever match a medical degree. And the public agrees. But it is still a doctorate degree.....please dont bash it. I'm not trying to be equal. Just trying to give the best and safest anesthetic I can. And I think CRNA's nationwide are doing a pretty damn good job.

... with direction in over 90% of anesthetics provided nationwide! so, why does the aana continually try to obfuscate that paramount point?

I am sincerely apologetic at pissing you guys off with this thread.

no you're not.

 

[m3unsure]

Hey CRNAs on this forum,

How about these stories?
Double-anesthesia-death at an abortion clinic in Atlanta involving a single CRNA. Maybe you heard about it. Or a couple of SRNA-related anesthetic deaths at a now-closed Atlanta CRNA program.

How about those safety studies?
Interesting they only really end up in RN journals. It seems more political than scientific. I even decided to read the methodology for one, and since it was retrospective and used "some regression analysis" to adjust risk factors, I'm not convinced. Please note that I use the same scrutiny when somebody says drug A is better than drug B. Plus, let's see what kind of cases MD/DOs do versus RNs. Apparently, CRNAs must do cardiac cases alone with supervision from CT surgeons. I have yet to here of this, and based on what happens in those cases on a regular basis, it seems scary.

What about this reality about scope of CRNA practice/knowledge?
Dr. James E. Cottrell - "The issue of guaranteeing quality medical care in rural hospitals goes way beyond anesthesia. Some 96 percent of these hospitals are regularly referring complex procedures to regional medical centers where more sophisticated equipment and personnel are available. They [CRNAs] don't want to handle these cases...Patients' safety should not be negotiable through politics." This just shows that the same standards can't be applied. For example, medical professionals at the University of Michigan have different patients compared to Boonies hospital. I wonder what CRNAs do when someone has a heart attack on the table. I've never seen studies on this kind of scenario.


AND it seems people on this forum are not taking comments from members such as BLADEMDA seriously? He has a legitimate political point. Every person on this forum should contribute to the state and fed PACs. It may be rough as a resident, but there should be no excuse as an attending. Money = political power.

 

[rmh149]

I am capable of dealing with complications. I frequently deal with complications. As a independent practitioner I have to be able to deal the complications. Diabetes, A-fib or a PE.....it wouldn’t be safe if I couldn’t deal with that. Nobody is there to bail me out when this happens...and it does. Your going to have to come up with a different scenario that that.

Maybe you are right....cost may go up when we consult another MD, such as cardiology or hematology. Would be interesting to see a statistic on this....if one could be acquired.

 

[Taurus]

I don't know why the mods don't just ban rmh149 for being a troll. His lame attempts to ingratiate himself to us and then spewing misinformation is really annoying.

 

[The_Sensei]

I don't know why the mods don't just ban rmh149 for being a troll. His lame attempts to ingratiate himself to us and then spewing misinformation is really annoying.

I agree - from this point forward, unless some definitive action is taken, I will remain a passive participant on this forum. This clown has caused me to not wish to participate in this forum any further.

Sorry that I must resort to such drastic actions, but the moderators do not seen compelled to do anything. I guess this is my form of "silent protest". I wish you all well.

Please feel free to PM me with any and all questions related to private practice anesthesiology. It's been fun.......

 

[Coastie]

Sounds like you're trying to practice medicine.

How about the CRNA's answer to the medical board for all "scope of practice" issues?



That's what I thought. The disregard with which some (note: some. some.) CRNA's show towards patient safety in exchange for a few extra bucks and "takin' it to the man" (i.e., physicians) is appalling.

I am capable of dealing with complications. I frequently deal with complications. As a independent practitioner I have to be able to deal the complications. Diabetes, A-fib or a PE.....it wouldn’t be safe if I couldn’t deal with that. Nobody is there to bail me out when this happens...and it does. Your going to have to come up with a different scenario that that.

Maybe you are right....cost may go up when we consult another MD, such as cardiology or hematology. Would be interesting to see a statistic on this....if one could be acquired.

 

[toughlife]

I am capable of dealing with complications. I frequently deal with complications. As a independent practitioner I have to be able to deal the complications. Diabetes, A-fib or a PE.....it wouldn’t be safe if I couldn’t deal with that. Nobody is there to bail me out when this happens...and it does. Your going to have to come up with a different scenario that that.

Maybe you are right....cost may go up when we consult another MD, such as cardiology or hematology. Would be interesting to see a statistic on this....if one could be acquired.

You obviously didn't get my point. That's ok. I don't expect you to.

Ignorance is bliss.

 

[johankriek]

No, the anology stated that a nurse can be trained to do just knees. That would be like a CRNA that only does GYN anesthesia...nothing else.

Now, like you said, if a nurse was trained to do all the ORTHO stuff, then I guess that would make them a CORN. This is not likely to happen.

But as far as anesthesia is concerned....we follow "precisely" the same standards as anesthesiologists.

dude

I know you are nite cap.. i know it dude.. why dont you go to all nurses and debate over there.. You are a nurse and no matter how many volumes you read, no matter how many swans you can float no matter how many epidurals you placed you are still a NURSE. Your qualifications for patient care will never ever be equal to a physicians.. You chose your path, if you are not happy with your station in life. suck it up and go to medical school and at that point you can say you are physician. Until then keep quiet and follow physicians orders.

 

[proclivity]

No, the anology stated that a nurse can be trained to do just knees. That would be like a CRNA that only does GYN anesthesia...nothing else.

Now, like you said, if a nurse was trained to do all the ORTHO stuff, then I guess that would make them a CORN. This is not likely to happen.

But as far as anesthesia is concerned....we follow "precisely" the same standards as anesthesiologists.

CRNAs can complete the anesthesia task........the analogy made was that CRNAs can only do anesthesia and nothing else. They cannot be in charge of the SICU, MICU etc, they cannot do pain management, they cannot be the last man to call in case of a code. An anesthesiologist can do all of this and be a pediatrician if they wanted to switch careers. they certainly have more degrees of freedom, you must admit.

This is one of the things that turns me off to anesthesia as a nurse.

 

[CremeSickle]

You KNOW everyone is nitecap. Geesus, get a life.

dude

I know you are nite cap.. i know it dude.. why dont you go to all nurses and debate over there.. You are a nurse and no matter how many volumes you read, no matter how many swans you can float no matter how many epidurals you placed you are still a NURSE. Your qualifications for patient care will never ever be equal to a physicians.. You chose your path, if you are not happy with your station in life. suck it up and go to medical school and at that point you can say you are physician. Until then keep quiet and follow physicians orders.

 

[johankriek]

You KNOW everyone is nitecap. Geesus, get a life.[/QUOTE

go home!

 

[johankriek]

You KNOW everyone is nitecap. Geesus, get a life.

go home!

 

[urgewrx]

I frequently deal with complications.

Why am I not surprised?



Yes, I'm pretty sure you have a lot of them.

 

[johankriek]

As a independent practitioner I have to be able to deal the complications. Diabetes, A-fib or a PE.....it wouldn’t be safe if I couldn’t deal with that. Nobody is there to bail me out when this happens...and it does. Your going to have to come up with a different scenario that that.

.

there are full 3 day conferences that cardiologists go to that deal with the best way to treat afib. And this horses ass thinks his nursing degree suffices.. when you dont know.. you really dont know.. WOW..

 

[rmh149]

CRNAs can complete the anesthesia task........the analogy made was that CRNAs can only do anesthesia and nothing else. They cannot be in charge of the SICU, MICU etc, they cannot do pain management, they cannot be the last man to call in case of a code. An anesthesiologist can do all of this and be a pediatrician if they wanted to switch careers. they certainly have more degrees of freedom, you must admit.

This is one of the things that turns me off to anesthesia as a nurse.

Well said. I wish I could have put it in those words. I agree with you completely......except for the "turns me off to anesthesia as a nurse" part.

 

[rmh149]

there are full 3 day conferences that cardiologists go to that deal with the best way to treat afib. And this horses ass thinks his nursing degree suffices.. when you dont know.. you really dont know.. WOW..

Of course I dont know what to do. when I see a-fib...or what I think is a-fib (cuz I'm just a nurse), I call a cardiologist to come into the OR and help me treat it. When they are in SR, I give them the patients face sheet so they can bill for it and thank him for saving a nurse.....then ask him kindly to keep it from the anesthesiologist so they dont know I am just another stupid nurse (or horses ass) that needed to be saved by a doctor.

You should see what happens when someone goes into asystole.....35 minutes later when the cardiologists showes up...thank god because I am so tired of doing chest compressions.

Of course I have no clue as to the pharmacodynamics or pharmacokinetics of the drugs I use...I am just following the special nurse anesthesia protocol card I have in my back pocket.

LOL, give me a break.

 

[Trisomy13]

please go away.

 

[VolatileAgent]

Of course I dont know what to do. when I see a-fib...or what I think is a-fib (cuz I'm just a nurse), I call a cardiologist to come into the OR and help me treat it. When they are in SR, I give them the patients face sheet so they can bill for it and thank him for saving a nurse.....then ask him kindly to keep it from the anesthesiologist so they dont know I am just another stupid nurse (or horses ass) that needed to be saved by a doctor.

You should see what happens when someone goes into asystole.....35 minutes later when the cardiologists showes up...thank god because I am so tired of doing chest compressions.

Of course I have no clue as to the pharmacodynamics or pharmacokinetics of the drugs I use...I am just following the special nurse anesthesia protocol card I have in my back pocket.

LOL, give me a break.

okay, smartypants. you're called to the pacu because the pacu nurse pages you to tell you the patient you've just dropped off now has an irregular heart rate of 115-135. she's already given a total of 20mg of morphine and the patient is somewhat snowed. what do you do? it sort of looks like a-fib on the 5-lead monitor above the patient. would you make a diagnosis? you think it might be a-fib, but it might also be something else. what do you do then?

after assessing the ABCs (what every nursing student should know to do), what's the first thing you do (and the right answer isn't call a cardiologist)? after that, what's the next thing you do? after that, you make the right decision that you have to treat it. now what do you do? think quickly... your patient might become unstable...

(okay, i know you don't know the answer. so, go ask dr. google and get back to us. )

 

[rmh149]

please go away.

fine....its amazing how juvenile some of you are. You must really feel threatened by CRNA's.....for no reason. Maybe its just your insecurity as a physician.

 

[rmh149]

okay, smartypants. you're called to the pacu because the pacu nurse pages you to tell you the patient you've just dropped off now has an irregular heart rate of 115-135. she's already given a total of 20mg of morphine and the patient is somewhat snowed. what do you do? it sort of looks like a-fib on the 5-lead monitor above the patient. would you make a diagnosis? you think it might be a-fib, but it might also be something else. what do you do then?

after assessing the ABCs (what every nursing student should know to do), what's the first thing you do (and the right answer isn't call a cardiologist)? after that, what's the next thing you do? after that, you make the right decision that you have to treat it. now what do you do? think quickly... your patient might become unstable...

Rhythm? Lets see it. First thing I do is look at the rhythm myself.

 

[Trisomy13]

fine....its amazing how juvenile some of you are. You must really feel threatened by CRNA's.....for no reason.

no, it's just that you are incessantly annoying and add zero value to a discussion. security has nothing to do with it. if i lose a job to someone with your personality, it's my own fault.

 

[VolatileAgent]

Rhythm? Lets see it. First thing I do is look at the rhythm myself.

wrong! you've already looked at the rhythm on the monitor above the patient, and you can't make a diagnosis with that (which is what you'd know if you were actually a physician). first, you get a stat 12-lead. then you get a chest xray. you can order labs, but that's gonna take some time (even stat labs) and you don't have that much time. how you treat is based upon what that 12-lead actually shows.

so, now you have your twelve-lead and your chest x-ray. but, even before then, you should already have a list of differential diagnoses floating through your head. what are they? (hint: what you're seeing on the monitor is real, and it actually isn't a-fib... it's something else that looks like a-fib.)

 

[rmh149]

wrong! you've already looked at the rhythm on the monitor above the patient, and you can't make a diagnosis with that (which is what you'd know if you were actually a physician). first, you get a stat 12-lead. then you get a chest xray. you can order labs, but that's gonna take some time (even stat labs) and you don't have that much time. how you treat is based upon what that 12-lead actually shows.

so, now you have your twelve-lead and your chest x-ray. but, even before then, you should already have a list of differential diagnoses floating through your head. what are they? (hint: what you're seeing on the monitor is real, and it actually isn't a-fib... it's something else that looks like a-fib.)

Ok, does this patient have any other co-existing diseases? Specifically pulmonary. What is the patients past medical history.

First thoughts...is this AF, stable or unstable. I am assuming unstable.

If it looks like AF...but not sure...is it multifocal atrial tachycardia. Is the patient hypoxic?

Consider sync cardioversion.

will come back to this. got to run.

 

[Planktonmd]

Nurse: eyes and ears for the doctor....helping him/her make good clinical decisions. An RN has a particular mindset that makes them excellent nurses...I wont get into it. very basic example: knowing when to administer a drug ordered by the physician.

Practitioner: as in nurse practitioner, able to make clinical decisions without a doctor. very basic example: knowing what drug to use...ordering or administering the drug.

I think you know the difference. Knowing you Planktonmd, you probably were trying to stir up an argument because I left off "nurse" from practitioner. AGAIN, the word "nurse" is not a bad word in the vocabulary of CRNA's or NP's. Why do I have to keep saying this.

Yes, I was trying to point out that you left out the word nurse because I think that you are ashamed of it.
All that other sweet talk about how proud you are of being a nurse is B.S. you see yourself as superior to nurses and it's obvious when you say that the first thing they taught you at CRNA school was to "stop thinking like a nurse and think like a practitioner".
There is no such thing as a "practitioner" it's called NURSE PRACTITIONER, got it?

 

[Planktonmd]

maybe we just need to introduce ourselves to our patients as "physician" and forego the word doctor altogether from the common vernacular. a crna can never be called a physician.

if i have a broken bone, i don't go see bill cosby, for example. but, after all he's a "doctor"... of education, that is.

For once I love something Volatile has said!

 

[TIVA]

Ok, does this patient have any other co-existing diseases? Specifically pulmonary. What is the patients past medical history.

First thoughts...is this AF, stable or unstable. I am assuming unstable.

If it looks like AF...but not sure...is it multifocal atrial tachycardia. Is the patient hypoxic?

Consider sync cardioversion.

will come back to this. got to run.

In all fairness, Volatile, this isn't really fair. You're putting rmh on the spot. And he/she doesn't even have the advantage of looking at the rhythm. You're essentially asking him/her to make a spot diagnosis without the spotting part ... it's so vague ... "a rhythm that looks like A-fib, but isn't" ... come on, dude, be a little more fair. If you're gonna ask a question like that, at least provide the EKG trace.

Personally, if I were confronted with this clinical scenario, I'd treat it first and ask questions later.

 

[VolatileAgent]

Personally, if I were confronted with this clinical scenario, I'd treat it first and ask questions later.

okay, fair enough. rmh gets a one point for considering MAT, which this was (i treated a patient exactly like this in the pacu). but, then he/she loses that same point for suggesting cardioversion - the wrong option in this case for many reasons.

the differential would include a-fib, PE, and MI among the likelies. but, now, rmh is dangerously close to practicing medicine in offering those. and, that's the bigger point. peri-operative complaints don't just happen in the OR, and the medical training beyond the technical training is what distinguishes us and is what's important. if we grant unrestricted practice of anes

in this scenario (happened when i was a ca-2), cardioversion would be the wrong next step. i actually successfully converted this patient with 2g of mag sulfate, and then started a beta-blocker. the patient, who was supposed to go home, instead went to the intermediate care floor.

i'm slightly impressed that rmh would even consider MAT in his differential. but, that's only half of it... and you have to get it ALL right. and, i hinted enough, though, at it. the fact is, most crna's i know would not this. a few would. but, the important part is that the next conservative, effective treatment step was skipped for cardioversion - which would likely only temporarily ameliorate the problem at best and put the patient at additional unnecessary risks.

 

[toughlife]

In all fairness, Volatile, this isn't really fair. You're putting rmh on the spot. And he/she doesn't even have the advantage of looking at the rhythm. You're essentially asking him/her to make a spot diagnosis without the spotting part ... it's so vague ... "a rhythm that looks like A-fib, but isn't" ... come on, dude, be a little more fair. If you're gonna ask a question like that, at least provide the EKG trace.

Personally, if I were confronted with this clinical scenario, I'd treat it first and ask questions later.

I wouldn't necessarily call it unfair. If he is telling you it looks like a-fib and even gave you a rate, you should start thinking supraventricular tachys like afib, aflutter, ST, MAT, SVNRT, etc. Next step is to know how you can tell them apart. Whether the Murse knows this or not is another story. If you are still unsure, you can use adenosine and see what happens, etc. You have to use your head and training. You can't be spoonfed all the time.

 

[proclivity]

Whenever i catch up on my threads (when there are a bunch in bold) i save this one for last because it is the most entertaining.

 

[johankriek]

Keep in mind, your knowledge base includes being an MD. That is what sets us apart. Your knowledge base extends beyond anesthesia. Thats what makes us unequal. As far as the anesthesia I provide for my patients....it wouldnt be different than what an anesthesiologist would do.

Now, how is that different? I would consult with another physician (hematology, oncology, GYN, cardiothoracics, etc.) when there is a medical questions....not about anesthesia, but about medicine more than an anesthesiologists would. I.

anesthesia is medicine you dip****.. nitecap