Now, in addition to CRNAs...

[JasonGreen]

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Look I know your in the OR alot, but you aren't an MDA or CRNA, and you havn't even completed your nursing training yet. Don't you think maybe you should wait a bit before you make judgements like that.

No. I don't. I work in the same OR as my father ( an MDA ) and as my wife ( a CRNA ). I know what I'm talking about. And if there is something that I don't know, it's only a matter of seconds before I do.

When I talk of 1-5 MDAs, it's usually supported by 12-15 CRNAs. Why 12-15 CRNAs? Because it's cheaper to run a CRNA doing the same job as an MDA. Then why do we need MDAs? Because hospitals have by-laws supporting the role of MDAs in the hospital.

The real question is......why do I keep making you look like an idiot? And as many posts and the time of day you make your posts, it's really hard to believe you are an MDA. In fact, I'm calling bull****.

 

[NaeBlis]

I never said I am a MDA, I am a resident in training. I am starting to doubt your story very highly myself. Fisrt you said you know several CRNA's, then you say you have spoken to CRNA's. Then you have several CRNA's in your family, and a CT SURGEON, which you have dreamed of being since you were 4 (CT surgery hasn't even been around that long, and that brings your age into question). Now your father is an MDA and your wife is a CRNA? Next you'll be the surgeon general. You seem to know enough medical terms to show you do work in an OR, but you don't seem to understand much else. Insurance pays the same for CRNA care as for MDA care, so they aren't cheaper. I don't see where you've made me look like an idiot except in your own mind. If you are so bright, and you have a father who is a doctor, why haven't you gotten into medical school already? If you've dreamed of being a doctor since you were 4 then you must have at least tried to get into medschool, or are u saying you choose to go into nursing first? And what exactly do you do in the OR? A surgical techs job is to stock the OR, and other technical business like that. Anything else would require some training. Did this MDA father of yours tell you that being an OR tech and then a nurse was the best path to take?

If you are so bright and knowledgeable about everything prove it, answer some of those medical questions I posed to you. If you don't know them look them up, or ask your wife or dad. I'm not gonna waste anymore time with you until you show me you know something, or at least know people who know something. Otherwise you should just go post on the nursing forum, if they will take someone who isn't even a nurse yet.

 

[MacGyver]

naeblis,

you absolutely crack me up. thanks for the comic relief.

Now, maybe you could try attacking my arguments with logic and evidence instead of stupid ad hominem attacks which are totally irrelevant?

 

[JasonGreen]

I never said I am a MDA, I am a resident in training.

That would explain it. Let me guess, an intern? R2 perhaps? I bet I have more clocked OR hours than you do.

Fisrt you said you know several CRNA's, then you say you have spoken to CRNA's. Then you have several CRNA's in your family, and a CT SURGEON, which you have dreamed of being since you were 4 (CT surgery hasn't even been around that long, and that brings your age into question). Now your father is an MDA and your wife is a CRNA?

Uh, yeah. Did I stutter? CT surgery has been around, longer than you think. And I never said since I was "4". Again, you can't comprehend simple text ( I pointed that out to you already ). Let me quote myself AGAIN :

Uh, no. Despite the fact my father is an MDA, I'm going into CT surgery. Or at least that's the plan for now (and has been since 1st grade).

Not really sure how 4 years of age equals first grade. I was checking out books on how the development of penicillin was helping troops in the first grade and talking to my uncle about his surgical job.

If you are so bright, and you have a father who is a doctor, why haven't you gotten into medical school already?

Because I put my wife through nurse anesthesia school. Is this ok with you, or should I have checked?

If you've dreamed of being a doctor since you were 4 then you must have at least tried to get into medschool, or are u saying you choose to go into nursing first?

Yes, I did choose that route on account of my father telling me how hard it was to get into med school. I first started out with a Molecular and Cellular Bio degree, but didn't complete that by one year and decided to get my BSN incase I didn't get into medical school. A fall back degree if you will. I will go into Nurse Anesthesia if I for some weird reason don't get into medical school. I'd rather shoot myself than be a floor nurse.

And what exactly do you do in the OR? A surgical techs job is to stock the OR, and other technical business like that.

Basically, what you have admitted to was saying that, "HEY! I'm an intern that doesn't know ANYTHING about what goes on in the O.R." If you think a Surgical Technologist just stocks the O.R., you're an idiot. Why don't you look over this website ( http://www.ast.org ). First off, depending on where you work, SSAs (or Surgical Support Assistants) stock the O.R. Anywhere else, the ADN nurses and BSN nurses as well as the techs, or anyone else that is around stocks the O.R. I've attached some pictures of me "stocking" the O.R. The first one is an RGB (go look that one up) and the second is a pectoralis flap (go look that one up, too, as to as to why we were doing it).

Did this MDA father of yours tell you that being an OR tech and then a nurse was the best path to take?

I decided that I'd better "get my feet wet" before I dedicated my life to CT surgery. So far, I have not been dissuaded, despite know-it-all residents. Actually, the more advanced a resident gets, the less s/he feels they have to "prove". As far as the nursing, re read what I wrote. I know you have trouble with simple text, but try it anyway.

I'm not gonna waste anymore time with you until you show me you know something, or at least know people who know something.

You're serious? You actually want me to tell you what MAC is? It's as simple as looking it up on the net. Any trained monkey can do that, but uh, here it goes. MAC is the minimum alveolar concentration. It's the percentage of alveolar gas that takes 50% of the patients to become immobilized. Should I actually tell you what the MAC is of Iso, Enf, Halo, Sevo and Des? If we're going to start asking simple questions, how about this one: What is the impact of Physiologic and Pharmacologic factors on MAC in 1. No change in MAC, 2. Increase in MAC & 3. Decrease in MAC. And by the way, the answers for patients 30-55 years of age are 1.15, 1.68, 0.75, 2.05 and 7.25, respectively. I could give you the "rounded" numbers based on age if you'd like too.

How about questions that you can't get in a book. Here are several for you:

1. What is the most difficult aspect of providing an anesthetic?
2. Intuitively, how do you know your patient is about to crash? (hint: There is a paper written by a UT Nursing professor on ICU nurses "6th" sense and "knowing" that their patient was going to die.)

I'll give you a few days to ponder those questions.

You might think I'm a "stocker boy", but until you actually set foot into an OR, you'll have no idea what I do.

[edit] pic deleted

 

[JasonGreen]

Is that blood on my hands? Oh yeah, it was from all that Biogel and Ortho gloves I stocked.

[edit] pic deleted

 

[tkim]

Originally posted by JasonGreen
Is that blood on my hands? Oh yeah, it was from all that Biogel and Ortho gloves I stocked.

In this age of HIPAA regulations flying all over hospitals and clinics, I find this photo to be, if not a violation of HIPAA and patient confidentiality rules, at the very least, in extremely poor taste and in bad judgement.

Pissing match aside, I find it very sad that you would resort to posting alleged pictures of you with a patient for no other purpose than to validate yourself in an internet forum.

I am very sure that no one can identify the person undergoing surgery - but that's not the point. It simply makes my skin crawl to think that that person is unconscious and had their photo taken, and have that photo find its way onto an internet website that *anyone* can access. That photo was not posted for teaching purposes, and I highly doubt that if permission was given for these photos, that it was given to be used for some personal flame war ON THE FRIGGIN INTERNET.

We may never know who that person is. But Jason Green of Seattle, who runs/used to run www.groove-salad.com tape exchange site, whose birthday is May 24, how hard would it be to identify *you*?

- Tae

 

[JasonGreen]

duly noted. Both pics are down.

 

[MacGyver]

tkim,

give me a break. Its impossible to identify the patient in those photos, therefore there is no violation of HIPAA or any other regulation.

I guess you didnt read HIPAA very carefully did you?

 

[NaeBlis]

Right off that website:

The role of the Certified Surgical Technologist.

Before the operation, the CST prepares the OR by supplying it with the appropriate supplies and instruments. Other preoperative duties include adjusting and testing equipment, preparing the patient for surgery, and helping to connect surgical equipment and monitoring devices. The CST, usually the first member of the OR team to "scrub" and put on gown and gloves, prepares the sterile setup for the appropriate procedure and assists other members of the team with gowning and gloving.

During the operation, CSTs have primary responsibility for maintaining the sterile field. In order that surgery may proceed smoothly, CSTs anticipate the needs of surgeons, passing instruments and providing sterile items in an efficient manner. As directed by the surgeon, CSTs may sponge or suction the operative site, prepare suture material, dispense appropriate fluids and drugs, and prepare specimens for subsequent pathologic analysis.

---------------------------------------------------------------------

It sounds like your a stock boy to me. The only momentous thing I have seen a surgical tech do was to forget to take the plastic wrap off the soda lime container, nearly killing the patient. The CRNA didn't think beyond ketamine for what he thought was bronchospasm, if the MDA hadn't come in at the right time the patient would have died. Way to go surgical tech!

Glad you took the time to look up one of my questions, even if it was the simplest one. Yes it is easy to look that up, but Medical students spend 2 years learning thousands of little facts like that, and memorising them, before they go into clinical work. I have been in an OR. I spent the last 2 years working in OR's(3months in surgery rotations, and 3more in anesthesia rotations), medicine floors, and ER's, and I did get some blood splashed on me, though I can't say that it imparted any great wisdom to me. I guess your supposed MD father didn't tell you what medical school was like. Well, its good you have a back up degree, because i don't think you'll make it to medschool. There are hundreds of people who did manage to complete a molecular and cellular bio degree, that couldn't get into medschool. That explains why you believe the whole aana philosophy, if you don't get into medschool, it is the only why you'll escape being under MD supervision for the rest of your career.

As to your questions:

1. What is the most difficult aspect of providing an anesthetic?
---an incredibly vague and subjective question, one that only an outsider would ask. I would say the answer is the big hole the surgeon creates in the patient.

2. Intuitively, how do you know your patient is about to crash? (hint: There is a paper written by a UT Nursing professor on ICU nurses "6th" sense and "knowing" that their patient was going to die.)
---How do you answer a question who's answer is supposedly intuition. As for the your hint, there are more than enough articles written by doctors that I could read instead. Just as a hint, if you make it to any med school interviews, I wouldn't quote any research articles by nurses, i doubt anyone will be impressed.

I didn't get to see those pics, but I can't believe you did that, I must really have you riled up. Well, I sent an e-mail out to the HIPPA people. I also sent an e-mail to RIAA, a guy like you probably has illegal mp3's too.

 

[NaeBlis]

Originally posted by tkim6599
In this age of HIPAA regulations flying all over hospitals and clinics, I find this photo to be, if not a violation of HIPAA and patient confidentiality rules, at the very least, in extremely poor taste and in bad judgement.

Pissing match aside, I find it very sad that you would resort to posting alleged pictures of you with a patient for no other purpose than to validate yourself in an internet forum.

I am very sure that no one can identify the person undergoing surgery - but that's not the point. It simply makes my skin crawl to think that that person is unconscious and had their photo taken, and have that photo find its way onto an internet website that *anyone* can access. That photo was not posted for teaching purposes, and I highly doubt that if permission was given for these photos, that it was given to be used for some personal flame war ON THE FRIGGIN INTERNET.

We may never know who that person is. But Jason Green of Seattle, who runs/used to run www.groove-salad.com tape exchange site, whose birthday is May 24, how hard would it be to identify *you*?

- Tae

hehe, this thread really has become a pissing match w/o any real focus or goal. Oh well, the ER isn't that busy tonight and the med students jump all over the suturing (looking at these students I can't believe I ever wanted to suture so eagarly). You know, I blame this whole thing on Mac, if he hadn't butted in I'll bet jason and I could have been good friends, or at least tolerated each other.

 

[JasonGreen]

I didn't get to see those pics, but I can't believe you did that, I must really have you riled up. Well, I sent an e-mail out to the HIPPA people. I also sent an e-mail to RIAA, a guy like you probably has illegal mp3's too.

No, you didn't rile me up, I was proving a point that instead of stocking the OR, I'm first assisting the surgeon, something you've never done. Let me ask you, ever attached a distal end of a jump? Ever extracted a saphenous vein? I have, but I doubt you have. I've even intubated before a case. So, please don't mistake me for an orderly. You think a "stocker boy" would know what I know? No.

As far as HIPPA, again, I'm calling bull****.

You also show you don't know crap about trading taped shows. Not a single taper will mp3 out his show, instead we use SHN. It's a lossless compression. I mean, why would I throw down $5,000 on a taping rig just to mp3 it and have it sound like crap. I bet you don't have any idea what this means: Source: DPA (B&K) 4022s > Sound Devices MP-2 > Audio Magic Sorcerer XLRs > Sonic AD2k+ @ 16NS3, +20, 44.1khz > Emagic EMI 2|6 > AiBook > Coaster > Soundedit 16 > shntool (no DAT) > SHN (matrixed with ) AKG480/CK61 > MP2 > 24 Bit Mod. SBM-1 > TCD-100 @ 48Khz ~ DAT > CD Conversion: Tascam DA-30 > Digital Coax > Sek'd Prodif32 > Samplitude > Cool Edit Pro > MKW Audio Compression Tool ** No DAE - DAT > .WAV > .SHN ** Seek Tables Appended

And I know you have no idea what it means to run mics at FOB, NOS, ORTF, Stereosonic or MS.

And please don't retort with, "Oooh! Bootlegs, that's illegal." because you don't know what you're talking about. Tons of bands, including mine, are taper-friendly. Dave Matthews Band, Phish, Howie Day, Jason Mraz, Grateful Dead, Pat McGee Band, David Gray, Govt Mule, Allman Bros Band, etc, etc are to name a few.

There's a lot you don't know about and with each post, you make that more and more apparent.

So, any more questions I might answer, doc?

Here's some first assistant questions for you.
1. True or False: TVH requires a 45 deg suture load
2. and with what driver.
3. What medication is given prior to being put on the pump (and at what ratio?)
4. What medication is used while extracting the saphenous vein
5. What is the one major complication for a cemented total?
6. What instrument/soft good is used prior to being put on a tourniquet?
7. What are the major differences between K-Wires and Steinman Pins?
8. True of False: For a Bilateral Derotational Osteotomy on a 5 year old, a mini frag can be used.
9. For a crainy, what instrument is used to seperate the dura.
10. What kind of clips are used for a crainy, just prior to burr holes?

These are as simple as they get, I could make them harder if you'd like.

 

[JasonGreen]

The only momentous thing I have seen a surgical tech do was to forget to take the plastic wrap off the soda lime container, nearly killing the patient. The CRNA didn't think beyond ketamine for what he thought was bronchospasm, if the MDA hadn't come in at the right time the patient would have died. Way to go surgical tech!

What? Ok, now I am completely convinced the only thing you've done in reguards to medicine is watch E.R.

A surgical tech forgetting to take the plastic wrap off the soda lime container? First off, those things last for ages and secondly, that's the anesthesia techs job. That's not even in our role.

And Ketamine for a bronchospasm? WTF? Ketamine is a dissociative anesthetic. Now, I'm not a doctor, but that doesn't have anything to do with spasms. Most likely it was a laryngospasm and a little bit of positive pressure and some succs would have done the job. I bet you just froze once the patient went into that and the MDA had to come into the room. Way to go, intern!

 

[NaeBlis]

First off, The RIAA HIPPA line was meant to be a joke, so calm down, the RIAA death squads won't be breaking down your door.

Second, ketamine is one of the drugs used for bronchospasm (believe it or not some drugs have multiple uses), ketamine is one of the favorites out here, look it up if you want. Also, out here the soda lime containers are disposable cartrages, that come prefilled. The OR techs are supposed replace them, and before they put it in the machine take off the plastic wrap, which they frogot to do. it was part on, part off, and creating a ball valve effect, that the CRNA thought was bronchospasm (not laryngospasm, which you can't have once the tube is in). The MDA i was shadowing was called into the room, and figured out what was going on. BTW, succs is used for bronchospasm, your wife could tell you that.

Why would I know what kinda suture you need for a hysterectomy, I'm not going into obgyn, and I don't need to keep the OR stocked with the stuff. The same for the other procedures you mention, I won't be doing them, so I don't need to know the specifics. I could ask you alot of questions on the indications for hysterectomy, the different pathologies, their presentations, and outcomes. I could ask you about different neurological defects caused by different cranial pathologies. But, you haven't learned those so you won't know them.

As for your vast procedural experience, I have been first assist in surgery quite a few times during OR rotations (there are no surgical residents where i did my OR rotations), and during my anesthesia AI's I have done dozens of intubations, 5 LMA placements, and a handful of other procedures.

Well, bottom line, we are getting way off course if you are trying to impress me by throwing around your knowlege of ripping music and video. I could pick a random topic I know about and throw info at you too. All your "medical" questions prove is that you have been in the OR, and know the materials used because you keep them stocked, and get them when they are called for. That doesn't really impress me, the materials used in procedures are very replacable, its not what was used 5 years ago, and in 5 years they will be using something else. Surgical techniques change just as frequently, a surgeon will publish a new technique and everyone will be itching to try it. If you don't believe that you can ask you uncle the surgeon. The physiology, pathology, pharmacology, presentation of disease that I and every othger useless intern has learned will not change, and will be infinately more valuable in the long run.


I think we need to refocus this argument:

I'm trying to convince you that an MDA is more skilled than a CRNA, and provides a better outcome.

Your trying to convince me that a CRNA is just as good as an MDA, that surgical techs are more than stock boys, and that you know far more than us lowly interns.

I think its clear neither of us will convince the other, so we may as well quit, and retain whatever is left of our image on this forum. Truce?

 

[JasonGreen]

The OR techs are supposed replace them, and before they put it in the machine take off the plastic wrap, which they frogot to do. it was part on, part off, and creating a ball valve effect, that the CRNA thought was bronchospasm (not laryngospasm, which you can't have once the tube is in). The MDA i was shadowing was called into the room, and figured out what was going on. BTW, succs is used for bronchospasm, your wife could tell you that.

You must work in a small hospital. Either that, or a poor one. Most, if not all, have dedicated Anesthesia Techs for changing out the circuits and making sure the machine works properly for the CRNAs and MDAs.

I think what's happening is that you're walking into the OR and you're lumping everyone that isn't the circ. nurse and surgeon into one category. Truth of the matter is, there are a lot of different "players" in the OR, with completely different spectrums of knowledge and scopes of practice. I for one, don't fit into the category of an orderly that stocks the room, changes the sheets or changes the circuits to an anesthesia machine. Next time, I suggest you introduce yourself to the staff and see who is who.

And yes, I know succs can be used for a broncospasm. It is a paralytic agent, yes? Therefore if you give succs, it'll paralyze you. You didn't say the patient was still intubated, therefore I thought what was going on was a laryngospasm induced during stage 2.

Why would I know what kinda suture you need for a hysterectomy, I'm not going into obgyn, and I don't need to keep the OR stocked with the stuff.

Those aren't the questions I asked. And obviously, you didn't know the answer to any of them.

All your "medical" questions prove is that you have been in the OR, and know the materials used because you keep them stocked, and get them when they are called for.

Did I say I was a circulating nurse? I dont believe so. Answer me this. How could I go and get something when it's "called for", when I'm scrubbed in and sterile?

Oh and by the way, truce.

 

[NaeBlis]

Originally posted by JasonGreen
You must work in a small hospital. Either that, or a poor one. Most, if not all, have dedicated Anesthesia Techs for changing out the circuits and making sure the machine works properly for the CRNAs and MDAs.

I think what's happening is that you're walking into the OR and you're lumping everyone that isn't the circ. nurse and surgeon into one category. Truth of the matter is, there are a lot of different "players" in the OR, with completely different spectrums of knowledge and scopes of practice. I for one, don't fit into the category of an orderly that stocks the room, changes the sheets or changes the circuits to an anesthesia machine. Next time, I suggest you introduce yourself to the staff and see who is who.

And yes, I know succs can be used for a broncospasm. It is a paralytic agent, yes? Therefore if you give succs, it'll paralyze you. You didn't say the patient was still intubated, therefore I thought what was going on was a laryngospasm induced during stage 2.



Those aren't the questions I asked. And obviously, you didn't know the answer to any of them.



Did I say I was a circulating nurse? I dont believe so. Answer me this. How could I go and get something when it's "called for", when I'm scrubbed in and sterile?

Oh and by the way, truce.

Ok, I might be lumping people together, but in all honesty, the only people out here who assist Surgeons in the actual procedure are med students, im residents circulating through surgury, and PA's. Perhaps things work different out there.

Succs is a paralytic agent, it blocks muscle ACh receptors, and it can be used for laryngospasm (at the level of the vocal cords), but not bronchospasm. The constriction of bronchioles isn't by skeletal muscle that exists in the vocal cords, so you can't use agents that block ACh. You need to use things that might be used for an asthma attack, like B-agonists, or ketamine, which is a favorite, and very effective. Lidocaine or steroids will also work. Not trying to create a new argument here, but that is the physio involved.

Thanks for taking the truce, I admit some stuff I said was out of line. Good luck in your career, what ever path you choose.

 

[trg2002]

.........AND CUT!!!

Great acting guys...Thanks for the entertaining debate!

Now which thread am I going to read???

 

[NaeBlis]

Originally posted by trg2002
.........AND CUT!!!

Great acting guys...Thanks for the entertaining debate!

Now which thread am I going to read???

HAHA, don't worry man, starting next week Jason and I are planning to debate the virtues of east coast vs west coast rap. I think macgyver is planning to chime in with support for the greatest hits of Yanni.

 

[JasonGreen]

Ok, I might be lumping people together, but in all honesty, the only people out here who assist Surgeons in the actual procedure are med students, im residents circulating through surgury, and PA's. Perhaps things work different out there.

Yeah, it might depend on the hospital. Where I work, I teach a lot of scrub techs how to scrub surgical cases....( I don't agree that this violates HIPPA and have had these on the website for quite some time....check them out http://groove-salad.com/gallery/Surgery )

Thanks for taking the truce, I admit some stuff I said was out of line. Good luck in your career, what ever path you choose.

My apologies as well.

 

[hndrx1a]

great pic's jason!😎