Supervision of CRNAs

[ruggerdoc123]

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In residency you live by these rules:

1. Trust no one
2. Everybody lies (ie, may be giving you inaccurate information)
3. You have no friends

How do attendings deal with the fact that the medical, ethical, and legal responsibility is fully yours- Yet someone else is providing some portion of the care.

Are you a control freak and double-check everything? Do you try to work with only crnas you trust? Is there time to double-check what you want?

I don't have tons of experience with crnas. at one affiliate in particular, i see endless bitching about they have to do all the work because the attendings are lazy. every time i see an attending, they're hopping from room to pacu to prep & hold, etc

One incident that stuck in my mind is the harried attending coming in the room with the prepped/draped patient for a preop spinal. I (as surg resident) am flipping through the chart and the last INR is 3-something. I circle this and silently show it to the attending who is sticking the patient. The crna is quite irritated with this intrusion and says, "that's from the lovenox. he stopped it already."

the attending has a minor stroke. is then urgently called into another room. returns momentarily. notes that a connector that used to be on the bedsheet next to the patient is now on the sterile tray. asks the crna how it got there. "well, it's still sterile. we didn't use it yet."

how do you deal and keep your sanity?

 

[Planktonmd]

In residency you live by these rules:

1. Trust no one
2. Everybody lies (ie, may be giving you inaccurate information)
3. You have no friends

How do attendings deal with the fact that the medical, ethical, and legal responsibility is fully yours- Yet someone else is providing some portion of the care.

Are you a control freak and double-check everything? Do you try to work with only crnas you trust? Is there time to double-check what you want?

I don't have tons of experience with crnas. at one affiliate in particular, i see endless bitching about they have to do all the work because the attendings are lazy. every time i see an attending, they're hopping from room to pacu to prep & hold, etc

One incident that stuck in my mind is the harried attending coming in the room with the prepped/draped patient for a preop spinal. I (as surg resident) am flipping through the chart and the last INR is 3-something. I circle this and silently show it to the attending who is sticking the patient. The crna is quite irritated with this intrusion and says, "that's from the lovenox. he stopped it already."

the attending has a minor stroke. is then urgently called into another room. returns momentarily. notes that a connector that used to be on the bedsheet next to the patient is now on the sterile tray. asks the crna how it got there. "well, it's still sterile. we didn't use it yet."

how do you deal and keep your sanity?

In private practice there are good CRNA's that you actually can work with very well and develop a certain degree of trust.
You never trust anyone 100%, but there are different degrees of trust that you can live with.
The young CRNA's who show up on this forum, who are obviously inexperienced and dangerously ignorant, do not represent the CRNA's of the real world, these are just guys in very early stages of their development, and they don't even know what they don't know.

 

[rmh149]

In residency you live by these rules:

1. Trust no one
2. Everybody lies (ie, may be giving you inaccurate information)
3. You have no friends

How do attendings deal with the fact that the medical, ethical, and legal responsibility is fully yours- Yet someone else is providing some portion of the care.

Are you a control freak and double-check everything? Do you try to work with only crnas you trust? Is there time to double-check what you want?

I don't have tons of experience with crnas. at one affiliate in particular, i see endless bitching about they have to do all the work because the attendings are lazy. every time i see an attending, they're hopping from room to pacu to prep & hold, etc

One incident that stuck in my mind is the harried attending coming in the room with the prepped/draped patient for a preop spinal. I (as surg resident) am flipping through the chart and the last INR is 3-something. I circle this and silently show it to the attending who is sticking the patient. The crna is quite irritated with this intrusion and says, "that's from the lovenox. he stopped it already."

the attending has a minor stroke. is then urgently called into another room. returns momentarily. notes that a connector that used to be on the bedsheet next to the patient is now on the sterile tray. asks the crna how it got there. "well, it's still sterile. we didn't use it yet."

how do you deal and keep your sanity?

Who are you bashing here, the attending or the CRNA? How did the patient (on lovenox) get to the OR suite ready for a spinal without the attending looking at the recent coags. How old was that INR result?

 

[ruggerdoc123]

Who are you bashing here, the attending or the CRNA? How did the patient (on lovenox) get to the OR suite ready for a spinal without the attending looking at the recent coags. How old was that INR result?

part of my point was that lovenox does not affect pt, inr, or ptt. and she did not know that. and clearly you don't either.

i don't know how it works. i assume the crnas "preop" (i use that term loosely) the patient.

doesn't matter how old the coags are. that is the most recent set. and that is what you have.

 

[Noyac]

Hilarious.

And rmh's response shows that he was unaware that lovenox couldn't be measured with INR as well.

rmh, when you respond here looking to start something or not you are opening yourself up for scrutiny. I wonder how much you have actually learned from this site. I'm sure it tremendous.

 

[rmh149]

Hilarious.

And rmh's response shows that he was unaware that lovenox couldn't be measured with INR as well.

rmh, when you respond here looking to start something or not you are opening yourself up for scrutiny. I wonder how much you have actually learned from this site. I'm sure it tremendous.

Have to admit. It is hilarious. I didnt even think about that. I am way too spoiled by the TEG. I have forgoten about that....I should have known. oops.

What I was thinking about is if the patient has been off lovenox for 24 hours then the spinal should be fine, right? Was she on anything else that would have caused her INR to be 3.0?

 

[ruggerdoc123]

Have to admit. It is hilarious. I didnt even think about that. I am way too spoiled by the TEG. I have forgoten about that....I should have known. oops.

Tee-hee, I'm sorry about the paralysis from your epidural hematoma, Mr. Smith. I forgot! Luckily the physician is really the liable party. Anyway, you look cute in a wheelchair. Chicks really dig those fat rims. Are they chrome?

 

[rmh149]

Tee-hee, I'm sorry about the paralysis from your epidural hematoma, Mr. Smith. I forgot! Luckily the physician is really the liable party. Anyway, you look cute in a wheelchair. Chicks really dig those fat rims. Are they chrome?

C'mon now...its a forum, not a hospital. Its not like I have to perform here. But go ahead...bash away. I deserve it this time 🙂...this is going to be painful.

 

[Noyac]

Have to admit. It is hilarious. I didnt even think about that. I am way too spoiled by the TEG. I have forgoten about that....I should have known. oops.

What I was thinking about is if the patient has been off lovenox for 24 hours then the spinal should be fine, right? Was she on anything else that would have caused her INR to be 3.0?

So you made a mistake here right? "didn't even think about that", what happens in the OR? I don't believe you just overlooked the fact that the INR doesn't reflect lovenox therapy.

 

[georgia_aa]

Tee-hee, I'm sorry about the paralysis from your epidural hematoma, Mr. Smith. I forgot! Luckily the physician is really the liable party. Anyway, you look cute in a wheelchair. Chicks really dig those fat rims. Are they chrome?

Gets my vote for GasForum's post of the year.

 

[dhb]

Was she on anything else that would have caused her INR to be 3.0?

Heparin?

 

[swpm]

In residency you live by these rules:

1. Trust no one
2. Everybody lies (ie, may be giving you inaccurate information)
3. You have no friends

Well, that's a bit over the top, but I don't entirely disagree. 🙂

How do attendings deal with the fact that the medical, ethical, and legal responsibility is fully yours- Yet someone else is providing some portion of the care.

Are you a control freak and double-check everything? Do you try to work with only crnas you trust? Is there time to double-check what you want?

I'm not an attending, just a measly CA-2, but sloppy CRNA care inflicts its toll on residents as well. There have been countless times I've taken cases over from CRNAs only to discover core temps of 34 ("the surgeon likes the room cold"), vent setting tuned to an ETCO2 of 70 or PIPs of 40, unbelievably superficial/incomplete signouts (followed by irritation when I demand more info), absolutely bizarre plans relayed, etc.

On Monday I finished the anesthetic for a 50ish year old patient getting an exlap, and there's some ST seg depression on II and monstrous elevations in V ... asked the CRNA what was up and he reached under the drapes and moved the lead for V around until the waveform was more pleasing. I thought I was going to have an MI. And of course, II is still ugly, but he assures me in a very confident way that it's "baseline" ... I picked up the chart, found a 12-lead from a couple days earlier, and gee, that looks a hell of a lot different. So I reach past his annoyed scowl, and pull up the ST segment trend on the monitor, and golly, it dipped right about the time his HR shot from 65 to 100. Even then, when spoon-fed proof that his patient's ST segment depression was acute, his response was "well, his BP's OK, he's doing fine."

As the resident saddled with covering the PACU, I lost count of the number of times I'd have to deal with some CRNA inflicted issue ... large doses of morphine or Dilaudid timed to peak after they arrive in recovery, brittle old folks with CAD taching away at 110, known diabetics exiting 5 hour cases with 300+ glucose levels, etc.

Just 'cause it's not on my credit card yet doesn't mean it doesn't wrench my gut.

And in the basic, supremely-relevant but often deficient knowledge base department, a couple weeks ago an attending related a recent ulcer-inducing experience with a CRNA who gave a dose of succ to manage laryngospasm about 15 minutes after a reversal dose of neostigmine ... and then couldn't figure out why the patient was weak.

how do you deal and keep your sanity?

Dunno. I'm working on it. Somewhere out there is a physician-only group with my name on it.

 

[badgas]

Tee-hee, I'm sorry about the paralysis from your epidural hematoma, Mr. Smith. I forgot! Luckily the physician is really the liable party. Anyway, you look cute in a wheelchair. Chicks really dig those fat rims. Are they chrome?

 

[badgas]

Who are you bashing here, the attending or the CRNA? How did the patient (on lovenox) get to the OR suite ready for a spinal without the attending looking at the recent coags. How old was that INR result?

Originally Posted by rmh149
I have asked an anesthesiologist nicely to leave during a difficult case. Not because I didnt want an anesthesiologist there, but because he tried to take over the anesthetic management. I owned the case...cant have two captains.


Strong work CAPTAIN!!

 

[rmh149]

Yup, I sit here in shame. But remember....it was the anesthesiologist that was about to put a needle in the back.

 

[rmh149]

Go ahead. Keep em comin...I deserve it.

 

[ruggerdoc123]

Yup, I sit here in shame. But remember....it was the anesthesiologist that was about to put a needle in the back.

1. exactly. that goes to the crux of my question.

you have incompetent personnel who are one 'equivalent practitioner' to a room. you as the attending have multiple rooms/pacu/preop.

do you REALLY, for the love of god, have to personally check every basic lab value pre-procedure? can you not count on them for anything? does it get more basic than coagulopathy before a spinal is a bad, bad thing?

2. the above quote reveals the freedom, which must be rather lovely, that NURSE anesthetists enjoy while 'practicing medicine.' they never have been the final authority and thus have the typical nursing attitude. how many calls did you get as a resident where they read you an isolated vital sign. before you can get a word out of your mouth in reply, you are asked, "what's your name?" because all they really want to do is document that "md aware" and hang up.

i have held medical students, completely wet behind the ears, to a higher standard than the nurse whose quote is above. if a 3rd year medical student f*ed up and said, 'well, you're the doctor' i would kick their ass.

 

[ruggerdoc123]

I'm not an attending, just a measly CA-2, but sloppy CRNA care inflicts its toll on residents as well. There have been countless times I've taken cases over from CRNAs only to discover core temps of 34 ("the surgeon likes the room cold"), vent setting tuned to an ETCO2 of 70 or PIPs of 40, unbelievably superficial/incomplete signouts (followed by irritation when I demand more info), absolutely bizarre plans relayed, etc.

As the resident saddled with covering the PACU, I lost count of the number of times I'd have to deal with some CRNA inflicted issue ... large doses of morphine or Dilaudid timed to peak after they arrive in recovery, brittle old folks with CAD taching away at 110, known diabetics exiting 5 hour cases with 300+ glucose levels, etc.

Just 'cause it's not on my credit card yet doesn't mean it doesn't wrench my gut.

so how do you deal with it? seriously. slow, deep breaths? surgery residents aren't known for their people skills. my attempts at education in the hopes that it would reduce floor pages (Yes, she needs to be npo for the OR- no coffee. No, she can't take her C-collar off because her neck hurts.) these attempts, in a very polite tone, are useless. it took me ~ 2 years to figure out that they aren't interested in learning.

this is not to slam nurses. our pacu nurses kick ass. the sicu nurses are the best in the hospital, with surg floor nurses running second. they know when to call you and if something smells funny (besides the leaking colostomy)

i trust them. it's asking crna how many units of blood were transfused as you're writing the op note and hearing 'I don't know, i just took over.' over and over again.

if you want to be the captain, go to captain school. (in the words of an ortho resident)

 

[core0]

1. exactly. that goes to the crux of my question.

you have incompetent personnel who are one 'equivalent practitioner' to a room. you as the attending have multiple rooms/pacu/preop.

do you REALLY, for the love of god, have to personally check every basic lab value pre-procedure? can you not count on them for anything? does it get more basic than coagulopathy before a spinal is a bad, bad thing?

I think that it is a developing relationship like any in medicine. In medicine you quickly learn that for certain pathologists or radiologists it is a good idea to go look at the path or scan yourself. There is probably a similar process in OR.

I can't speak for the CRNA/MD relationship, but having been through the PA/MD relationship several times there is usually a progression. In the PA world ideally the physician gives the PA progressive responsibility while supervising that responsibility. You have less need for supervision as you become more sure of their abilities.

2. the above quote reveals the freedom, which must be rather lovely, that NURSE anesthetists enjoy while 'practicing medicine.' they never have been the final authority and thus have the typical nursing attitude. how many calls did you get as a resident where they read you an isolated vital sign. before you can get a word out of your mouth in reply, you are asked, "what's your name?" because all they really want to do is document that "md aware" and hang up.

i have held medical students, completely wet behind the ears, to a higher standard than the nurse whose quote is above. if a 3rd year medical student f*ed up and said, 'well, you're the doctor' i would kick their ass.

Personally I think this is the underlying problem with "independence". Either you are capable of doing the whole thing yourself or you need supervision. There should be no in between. Supervision is a two way street. The physician is responsible for the acts committed in their name, but the person being supervised has to be aware that they the physician has essentially trusted them with their license.

Along with patient protection, my motto has always been never set your SP up for failure. That means you double check things. If I was setting a patient up for an EGD for example, I would know what their INR was, what their crit was and what their sedation risk was. As a consequence my SP trusted that these things were done. Ideally the standard of care should be the same. The medical decision making should also be the same.

David Carpenter, PA-C

 

[OB1🤙]

Who are you bashing here, the attending or the CRNA? How did the patient (on lovenox) get to the OR suite ready for a spinal without the attending looking at the recent coags. How old was that INR result?

Holy $hit, dude. This statement gives me The Fear.

You'd think that by now you might have figured out that you'd do best to shut up, lurk, and learn something.

 

[deleted59964]

do you guys make formal complaints to the CRNA's managers when they breach their standard of care? if you get a bad CRNA - how do you go about performance managing them?

 

[badgas]

if you get a bad CRNA - how do you go about performance managing them?

with a rolled up newspaper.

 

[Planktonmd]

do you guys make formal complaints to the CRNA's managers when they breach their standard of care? if you get a bad CRNA - how do you go about performance managing them?

If you have a bad CRNA you need to micro-manage the cases and worry more.

 

[johankriek]

Well, that's a bit over the top, but I don't entirely disagree. 🙂



I'm not an attending, just a measly CA-2, but sloppy CRNA care inflicts its toll on residents as well. There have been countless times I've taken cases over from CRNAs only to discover core temps of 34 ("the surgeon likes the room cold"), vent setting tuned to an ETCO2 of 70 or PIPs of 40, unbelievably superficial/incomplete signouts (followed by irritation when I demand more info), absolutely bizarre plans relayed, etc.

On Monday I finished the anesthetic for a 50ish year old patient getting an exlap, and there's some ST seg depression on II and monstrous elevations in V ... asked the CRNA what was up and he reached under the drapes and moved the lead for V around until the waveform was more pleasing. I thought I was going to have an MI. And of course, II is still ugly, but he assures me in a very confident way that it's "baseline" ... I picked up the chart, found a 12-lead from a couple days earlier, and gee, that looks a hell of a lot different. So I reach past his annoyed scowl, and pull up the ST segment trend on the monitor, and golly, it dipped right about the time his HR shot from 65 to 100. Even then, when spoon-fed proof that his patient's ST segment depression was acute, his response was "well, his BP's OK, he's doing fine."

As the resident saddled with covering the PACU, I lost count of the number of times I'd have to deal with some CRNA inflicted issue ... large doses of morphine or Dilaudid timed to peak after they arrive in recovery, brittle old folks with CAD taching away at 110, known diabetics exiting 5 hour cases with 300+ glucose levels, etc.

Just 'cause it's not on my credit card yet doesn't mean it doesn't wrench my gut.

And in the basic, supremely-relevant but often deficient knowledge base department, a couple weeks ago an attending related a recent ulcer-inducing experience with a CRNA who gave a dose of succ to manage laryngospasm about 15 minutes after a reversal dose of neostigmine ... and then couldn't figure out why the patient was weak.



Dunno. I'm working on it. Somewhere out there is a physician-only group with my name on it.

when i was a ca3 i supervised CRNAs as the attending for a few months... It was very very very painful watching them practice let me tell you.. And you cant really tell them listen numnuts you are doing this wrong... like you would a resident so they could learn.. because of the politics behind that.. so they continue to do the wrong thing over and over and over again.. they never get better and their judgement never improves... I hated supervising crnas for the 2 months i did it as a resident.. so thats why i never did it again. They are inferior clinicians in every single respect.. and I want the residents out there to realize that.. and they ask the surgeons stupid questions about medical things

 

[johankriek]

do you guys make formal complaints to the CRNA's managers when they breach their standard of care? if you get a bad CRNA - how do you go about performance managing them?

i dont have this problem.. but i would assume you avoid them like the plague or you leave the practice or you leave specific instructions for them.. dont give this narcotic.. give 2 cc of norcuron and thats it.. extubate awake.. and if they defy you.. you take them in the back and you bust some tiles..

 

[deleted59964]

wouldn't it force them to be a bit more on their game if they feared professional repercussions, instead of drifting along till a patient has a bad outcome and someone gets sued?

 

[Taurus]

If nurses want to play doctor and call themselves "practitioners", then they need to drop the nursing attitude and take responsibility. Or reality can be forced upon them by higher malpractice premiums and lawyers coming after them more.

 

[Arch Guillotti]

Turned over a case a few days ago to a nurse - limiting fluids in a chf pt. was a lost cause on my relief, as was the importance of diastolic bp and maintaining good coronary perfusion pressure in someone with severe cad. sigh.

 

[flashgordon]

part of my point was that lovenox does not affect pt, inr, or ptt. and she did not know that. and clearly you don't either.

i don't know how it works. i assume the crnas "preop" (i use that term loosely) the patient.

doesn't matter how old the coags are. that is the most recent set. and that is what you have.

Wow. Nurses making medical decisions. That is the scariest f'ing thing ever. You know, as much as I try to keep an open mind about crnas, I think it's too late. Even as a 4th year when I got treated poorly by most (not all) of the crnas at 3 different hospitals I rotated through, I still had hope. Do you know how many times they regurgitated their AANA manifesto: "we were the first to give anesthesia"? And after the anesthesiologist left (to bounce from room to room) they made sly comments about him going to the lounge and implied that they could do his job. So nice in front of the doctor, but when he leaves the room... Wow. Almost made me want to choose another specialty.

I firmly believe that crnas are specialized technicians in administering anesthesia, NOT medical providers. They are good at doing just that. Their knowledge base in pathophysiology and pharmacology is severely limited. How the bloody hell do you make medical decisions when you don't even have a firm grasp of the basic science knowledge? So what if you know some anesthesia, do you know anything else about the patient's comorbidities? You're damn lucky that anesthesia has gotten safer and that the human body can take a lot. Do they learn all of this science in two years? Let's not even talk about nursing school and ICU experience 🙄, since they take orders from physicians and not making the medical decisions. Even 3rd & 4th yr medical students have a stronger knowledge base than the crnas i've met.

You militant crnas need a good dose of humility. It is disrespectful to even try to compare yourselves to an anesthesiologist. You're good at what you do, but not at making medical decisions. Leave that to the DOCTOR. Know your place in the TEAM.

P.S. Please stop visiting this forum to pollute and leech. We do not go to your forums. This especially applies to those invisible trolling nurses...

 

[Gern Blansten]

Earth to Derek, I don't think you knew about Lovenox and INR. Why don't you go set up your Derek Zoolander Center For Nurses Who Don't Read So Good and Who Want to Learn To Do Other Cool Stuff Too

Who are you bashing here, the attending or the CRNA? How did the patient (on lovenox) get to the OR suite ready for a spinal without the attending looking at the recent coags. How old was that INR result?

 

[chimichanga]

...P.S. Please stop visiting this forum to pollute and leech. We do not go to your forums...

wrong: all posted in clinician's forum:

http://forums.studentdoctor.net/showpost.php?p=5447619&postcount=6

http://forums.studentdoctor.net/showpost.php?p=5432565&postcount=173

http://forums.studentdoctor.net/showpost.php?p=5438937&postcount=176

http://forums.studentdoctor.net/showpost.php?p=5399659&postcount=5

http://forums.studentdoctor.net/showpost.php?p=4949757&postcount=7

took 3 minutes to find these...

 

[Taurus]

Go ahead. Keep em comin...I deserve it.

No, I'm going to sit here and bash rmh149. I'm not like the AANA. I'm better than that.

What's scary to me is that rmh149 probably considers himself among the top tier of CRNA's. If he truly is one of the better CRNA's out there, patients are in trouble. Big trouble. It is our fault for not doing a better job of informing the public about this safety issue. Would patients allow surgical first assists to do solo surgery on them? No. Why do we then allow the equivalent of surgical first assists in anesthesia to do solo anesthesia?

As long as patients experience mortality and morbidity from anesthesia, there will always be the need for anesthesiologists, who are physicians. I wish the CRNA's would realize that. There's no way that a CRNA, even with a DNP, would ever be considered as equal with anesthesiologists. CRNA's are technicians. Period.

 

[johankriek]

. CRNA's are technicians. Period.

they are not even good ones...

physician assistants are better and i think we should get the ball rolling and get them in the OR in all the OR suites.. and let the crnas go back to changing bed pans.

 

[JackieTreehorn]

I'm just a premed, so feel free to use me as a punching bag, but when I shadowed a neurosurgeon, the anestheseologist put the guy to sleep and left and the nurse anesthetist sat there reading Cosmo during basically the entire operation. I didn't want to offend anyone so I kept my mouth shut, but is this standard?

 

[Planktonmd]

I'm just a premed, so feel free to use me as a punching bag, but when I shadowed a neurosurgeon, the anestheseologist put the guy to sleep and left and the nurse anesthetist sat there reading Cosmo during basically the entire operation. I didn't want to offend anyone so I kept my mouth shut, but is this standard?

Are you asking if it is standard for the Anesthesiologist to leave? or for the CRNA to read Cosmo?

 

[OB1🤙]

I'm just a premed, so feel free to use me as a punching bag, but when I shadowed a neurosurgeon, the anestheseologist put the guy to sleep and left and the nurse anesthetist sat there reading Cosmo during basically the entire operation. I didn't want to offend anyone so I kept my mouth shut, but is this standard?

Obviously. Why the hell do you think we signed up for this gig?

Check the FAQ, it has answers to this question.

 

[JackieTreehorn]

Both I guess

 

[Planktonmd]

Both I guess

Well,
They are both standard:
1- The Anesthesiologist has to leave because he has 3 more Rooms that he is supervising, 12 patients in the recovery room having all kinds of issues, he also has to see the next 4 patient he will be anesthetizing later, put in some epidurals, Central lines, A lines, nerve blocks, and make sure none of the CRNA's is left without a coffee break.
2- The CRNA has to read Cosmo because the patient is on autopilot and the machine makes a loud noise if anything goes wrong so you can call the anesthesiologist in.

 

[cfdavid]

No, I'm going to sit here and bash rmh149. I'm not like the AANA. I'm better than that.

What's scary to me is that rmh149 probably considers himself among the top tier of CRNA's. If he truly is one of the better CRNA's out there, patients are in trouble. Big trouble. It is our fault for not doing a better job of informing the public about this safety issue. Would patients allow surgical first assists to do solo surgery on them? No. Why do we then allow the equivalent of surgical first assists in anesthesia to do solo anesthesia?

As long as patients experience mortality and morbidity from anesthesia, there will always be the need for anesthesiologists, who are physicians. I wish the CRNA's would realize that. There's no way that a CRNA, even with a DNP, would ever be considered as equal with anesthesiologists. CRNA's are technicians. Period.

Many of you know that when I was looking into medical school, I also considered going the AA route. I spent a day down at Case Western's program and chatted with the director as well as interacted with senior AA's and student AAs (impressive bunch and a great program down there).

Anyway, and this is no slam on AA's, the director knew I was also considering going to medical school. But, he came right out and stated (this is the director of the AA program whom is also an AA, but mostly is in admin at this point) that AA's are technician's. Highly trained, master's level technicians in providing anesthesia. But, if I wanted to be an anesthesiologist, then go to medical school.

I think this difference in self-perception is monumental in terms of how the two mid-level providers are being educated from day one. AA's aren't trying to be anesthesiologists, but apparently many CRNA's (and those at the AANA) think they're "equivalent" to you guys. Whatever.

 

[flashgordon]

wrong: all posted in clinician's forum:

http://forums.studentdoctor.net/showpost.php?p=5447619&postcount=6

http://forums.studentdoctor.net/showpost.php?p=5432565&postcount=173

http://forums.studentdoctor.net/showpost.php?p=5438937&postcount=176

http://forums.studentdoctor.net/showpost.php?p=5399659&postcount=5

http://forums.studentdoctor.net/showpost.php?p=4949757&postcount=7

took 3 minutes to find these...

I wasn't referring to the "clinician's" forum here (which I didn't even know existed). There is another forum on the internet for nurses. You can google it as I dare not speak it's name. It is a place for extremely delusional individuals who desperately try to be someone they're not. It's sick.

 

[flashgordon]

Hilarious that one of my posts got tossed into this mix, since I'm a surgical intern, and I don't much care for either Anesthesiologists or CRNAs.

Even more hilarious that you consider a forum titled "Clinicians" as somehow belonging to nurses.

But best of all is that you'd pick a fight with the most militant, angry physicians to be found in all of SDN and its associates.

I will enjoy watching you flounder.

Couple issues here, chump. What do you mean by "don't much care for either anesthesiologists or CRNAs" and the "most militant, angry physicians"? Good to know you respect your physician colleagues.

You obviously have no clue what's going on here, silly kid... scurry back to the surgery forum.

 

[SouthSideSteve]

Tee-hee, I'm sorry about the paralysis from your epidural hematoma, Mr. Smith. I forgot! Luckily the physician is really the liable party. Anyway, you look cute in a wheelchair.

Post of the year.

Earth to Derek, I don't think you knew about Lovenox and INR. Why don't you go set up your Derek Zoolander Center For Nurses Who Don't Read So Good and Who Want to Learn To Do Other Cool Stuff Too

a close runner up.

 

[chimichanga]

Even more hilarious that you consider a forum titled "Clinicians" as somehow belonging to nurses.

I don't consider anything here...I believe LEE Burnett (or with help from his webmaster) made those kinds of decisions...

And I didn't pick a fight, not here to do that...

surprised you even bothered responding to this guy.

but...not to beat a dead horse- the stem of all of those links?

student doctor forum

Oh yea, SDN, the internet site that has a nursing career ad on its main page...

Mental note made, thanks...

 

[BlackSails]

Oh yea, SDN, the internet site that has a nursing career ad on its main page...

Mental note made, thanks...

Ive seen civil rights sites advertising spy cams. Ads != content.

 

[fakin' the funk]

Go ahead. Keep em comin...I deserve it.

CRAP like THIS is the only reason RMH gets to stay on this forum. It is so blatantly transparent.

He KEEPS POSTING at a steady rate and we are the dumber for it. Then, when he puts his foot in his mouth, he says "I deserve to be made fun of" in a completely insincere way, usually with a "😀" following it, and everyone goes "Oh, look at the dumb nurse who we've put in his place."

WHY a nonphysician who consistently stirs up trouble and who NEVER contributes anything meaningful is allowed to stay on this forum baffles me.

 

[fakin' the funk]

Well,
They are both standard:
1- The Anesthesiologist has to leave because he has 3 more Rooms that he is supervising, 12 patients in the recovery room having all kinds of issues, he also has to see the next 4 patient he will be anesthetizing later, put in some epidurals, Central lines, A lines, nerve blocks, and make sure none of the CRNA's is left without a coffee break.
2- The CRNA has to read Cosmo because the patient is on autopilot and the machine makes a loud noise if anything goes wrong so you can call the anesthesiologist in.

 

[VentdependenT]

Have to admit. It is hilarious. I didnt even think about that. I am way too spoiled by the TEG. I have forgoten about that....I should have known. oops.

What I was thinking about is if the patient has been off lovenox for 24 hours then the spinal should be fine, right? Was she on anything else that would have caused her INR to be 3.0?

You run a TEG on all your neuraxials?

 

[Planktonmd]

You run a TEG on all your neuraxials?

​

 

[Noyac]

CRAP like THIS is the only reason RMH gets to stay on this forum. It is so blatantly transparent.

He KEEPS POSTING at a steady rate and we are the dumber for it. Then, when he puts his foot in his mouth, he says "I deserve to be made fun of" in a completely insincere way, usually with a "😀" following it, and everyone goes "Oh, look at the dumb nurse who we've put in his place."

WHY a nonphysician who consistently stirs up trouble and who NEVER contributes anything meaningful is allowed to stay on this forum baffles me.

I'm sure you are aware of the "ignore" function. Feel free to use it.

 

[Noyac]

What I was thinking about is if the patient has been off lovenox for 24 hours then the spinal should be fine, right? Was she on anything else that would have caused her INR to be 3.0?

Are you asking use if it fine to do a spinal in someone that has been off Lovenox for 24 hrs? What do you think?

What do you think may have caused her INR to be 3.0?