Thoracic

[rmh149]

For you thoracic epidural guru's:

Walk some of us less capabable little people through how you do your thoracic epidurals. Please, go into detail.

My questions to you:

Do you use a midline or paramedian approach?

What land marks do you use?

How does the ligamentum flavum at the thoracic level feel compared to the lumbar space?

How many cm deep do you expect to hit the epidural space...and at what angle?

Do you use air or saline?

What is your usual dose?

Post-operative management (medication, rate, etc.)

Anything else you can think of......I want to know everyones tricks and pet peeves.

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[Taurus]

No offense to you, but why should we be sharing these tidbits with you? That would be just aiding and abetting CRNA's.

 

[Noyac]

So you have been out of training for 4 years as a crna and you don't know how to do a thoracic epidural? Did your training not give you this experience? You think I am going to tell you how to perform one here and you can go and start trying this?

Listen you are really starting to get on my nerves.

 

[The_Sensei]

So you have been out of training for 4 years as a crna and you don't know how to do a thoracic epidural? Did your training not give you this experience? You think I am going to tell you how to perform one here and you can go and start trying this?

Listen you are really starting to get on my nerves.

Yeah, man I was thinking the same thing....

Sure, nurse - here's a step by step guide to doing a thoracic epidural so you can do them yourself and even further negate our presence in the OR:

Ummm........hope you're not waiting for me to post, since I won't - I strongly encourage others to do likewise.

 

[jeesapeesa]

don't they have crna forums for this.

 

[Pooh & Annie]

I probably don't post often enough to tell people what to do, but this IS a forum for docs and doc students.

 

[jetproppilot]

For you thoracic epidural guru's:

Walk some of us less capabable little people through how you do your thoracic epidurals. Please, go into detail.

My questions to you:

Do you use a midline or paramedian approach?

What land marks do you use?

How does the ligamentum flavum at the thoracic level feel compared to the lumbar space?

How many cm deep do you expect to hit the epidural space...and at what angle?

Do you use air or saline?

What is your usual dose?

Post-operative management (medication, rate, etc.)

Anything else you can think of......I want to know everyones tricks and pet peeves.

Lets level here, Slim.

Theres alotta people here who know my real identity...

....my name, where I work.

No sinister agenda here.

And it seems you've got some posters here riled up...in a negative fashion....including the moderator of this forum.

SO, who are you?

And if you are not a pre-med/med student/resident/attending,

why are you here?

Yes, there are CRNAs/AAs that are respected posters here.

They contribute.

Trinity and JWK are the only proven ones here. No sinister political agendas. They're here to laugh like the rest of us, suck up new tricks, enjoy posts, and contribute.

I've seen JWK disagree......even put someone in their place on this forum....

yet he's still respected here.

I know Trin personally so he has nothing to prove with me.

We're always leery of new CRNA posters here......since most are here with a sinister agenda......

so why don't you give us some background on you that can be (clandestinely, non-publicly) verified/

Where ya from, Slim?....BTW....if you lie, Noy will know it.

Why are you, a nurse, posting on a doctor forum?

Remember, posters with hidden agendas/sinister motives will no longer be tolerated here.

And since this is a doctor forum that goes TWICE for non-doctor-visitors here.

We're here to provide a safe environment for pre-meds/med students/residents/attendings.

 

[rmh149]

Ah, the responses I expected. Not to worry though. I completely understand how those here are riled up in a negative fashion.

I can assure you I am not here with a sinister motive or a hidden agenda.

I am here to learn and engage in thought provoking interactions with experts in the field.

I am from Dallas, Texas. I am a practicing CRNA. Honestly, when I found the forum and read all the political posts about CRNA vs. anesthesiologists it pissed me off.
God **** you guys can be pretty damn egotistical, confrontational and condescending. That’s OK, I have to remember where you come from and how you view CRNA's.

After reading your posts I have a different understanding and viewpoint....confused maybe. It doesn’t really matter. I don’t really care what happens in the future...I am happy with the way things are with my work and family. Honestly, I don’t see much changing. CRNA's and anesthesiologists will be working together for a very long time. Yes, there are those out there that will be fighting for complete independence. Hell, some are already independent...except on paper. The whole idea is kind of dumb if you ask me. But the very nature of many nurses is to work with a team. There will always be a ton of CRNA's working with an anesthesia care team.

Now, the forums here are similar to the cases presented in M&M conferences when I was in school. It was beneficial to share experiences of cases other than the routine ASA I & II's. It is the real life experiences of providers that help me in shaping my knowledge and decision making skills toward my own practice. You can only get so much from journals and text books.

That’s all I want from this forum. You don’t see me starting any crap about CRNA's vs. Anesthesiologists. I respect you for the education and experience you received from your residency and fellowships.

Noyac, PM me if you would like for me to send you my cell number. You can call me and get details of my history and intentions.

 

[urgewrx]

Are you hawt? If so, can I have your cel # too?

 

[BlackSails]

Honestly, all personal feelings from everyone aside, is it really safe or prudent to explain how to do a procedure over the internet? My advice to you would be to ask someone who can show you how.

 

[Mman]

Honestly, all personal feelings from everyone aside, is it really safe or prudent to explain how to do a procedure over the internet? My advice to you would be to ask someone who can show you how.

I enjoy telling my patients that I learned this new technique online last night and will be giving it a shot for the first time with them (fingers crossed)

 

[rmh149]

Duh, yeah...I'm going to just go by what you guys say to do. I plan on printing out your instructions and taping to the patients shoulder.....it should be safe right?!

I rarely do thoracic epidurals. Just asking for input and experience. Everyone has their little techniques.

Guess you big bad attendings dont do it that often either !

 

[Planktonmd]

I enjoy telling my patients that I learned this new technique online last night and will be giving it a shot for the first time with them (fingers crossed)

You should add that you have stayed at the Holiday in express last night.

 

[Noyac]

Guess you big bad attendings dont do it that often either !

Quotes like this are not going to make you any friends here.

 

[rmh149]

Quotes like this are not going to make you any friends here.

It was a joke.....there is a smily face.

 

[YupGypsy]

you guys are mean, haha!

and urgewrx, I think rmh is a guy

 

[Intubate]

if you don't want to answer, don't. This thread has become ridicuolous though...

As a thread for the forum, I think it would be useful to see what everyone does for their thoracic epidurals and compare. I dont think we need to review how to place an epidural, but if everyone wrote what infusion they run, and gave some pearls, I'd read that.

If you don't want to to dignify a nurse with a response, just dont respond.

Some of you guys act like babies.

 

[Noyac]

if you don't want to answer, don't. This thread has become ridicuolous though...

As a thread for the forum, I think it would be useful to see what everyone does for their thoracic epidurals and compare. I dont think we need to review how to place an epidural, but if everyone wrote what infusion they run, and gave some pearls, I'd read that.

If you don't want to to dignify a nurse with a response, just dont respond.

Some of you guys act like babies.

Wow, OK thanks for the lecture.

I run ropivicaine and morphine or fentanyl or bupivicaine and morphine or fentanyl or Ropivicaine and demerol or bupivicaine and demoral. Or straight local. Or straight narcotic. How's that.