Archive for Anesthesia
Valley Anesthesia Review in Ohio
Posted by: | CommentsValley Anesthesia Review course for those that know is a great three day review for preparing for the CRNA certification exam given by the AANA. This certification exam is a very extensive computer controlled test prepared for the graduate nurse anesthetist. Unlike our physician colleges we cannot practice our profession of Nurse Anesthesia without national certification……you did know that physicians can practice anesthesia without Board Certification, we cannot.
One of the great things about going across the country for this kind of review course is that you run into old friends. Josette was here in Ohio for the review course. You may recall that she is from the nurse anesthesia program at Buffalo New York. It was so great to see her and meet her friends from their program. I did not take too many pictures while at the Review Course but what I have is uploaded to flickr.
Four of us from the University of Southern California along with another one hundred and fifty some odd other graduating students sat, studied and listened to the lectures and presentation given at the Marriott Airport Hotel in Cleveland Ohio this past weekend. Todd, Elisha Christy and I traveled together from Los Angeles to Ohio this past Thursday for the review course. The presentation of the review material was excellent and gave us all a plan of action for studying for the certification exam that will come up for us in another 9 or 10 months or so. That is plenty of time to get a really good handle on all of this material. The amount of information is exhaustive and is the summation of years of studying.
The best story I heard this weekend was about this Navy guy taking the review course with us. After completing his two and a half year program and thousands hours of clinical it all comes down to this one comprehensive exam. If he does not pass on the first try the US Military will ship him out to the front lines where ever as a staff RN. OH MY GOD, can you imagine that pressure. At least we can get a second shot at the certification exam if we do not pass it the first time. Well, we will all pass and go on with our careers so that is not even an option. How would you like that kind of pressure on you after several intense years of studying……pass this exam son or to the front lines with you for two years. Actually, it’s not a problem.
Elisha and DG have been getting up at O’Dark thirty every morning to get our seats in the conference room. The first morning I got into the great hall which was almost as dark as the outside landscape here in Ohio to see a figure way down in front huddled over her books preparing for the start of the day. I thought that I was nuts to get there so early but I guess Elisha and I are of the same mind. You know, “The Early Bird………..catches the worm.
CANA Conference in Monterey
Posted by: | CommentsThis past weekend Todd and I drove up to the CANA (California Association of Nurse Anesthetists) Fall Conference in Monterey. After a long day in the operating room on Thursday we took off for the Central California sea coast. We had to be at the business meeting bright and early Friday morning to witness the goings on partly for a school project and also to get the low down on what is really happening to our wonderful state of California in the anesthesia world.
The conference was not all business meetings and lecture. Todd and I were able to get out Saturday for lunch down at the wharf in Monterey Cannery row district for a sea side munch-out. We both were off of our tofu diets for the weekend. There is always next week to get back on the program of exercise and healthy living but this was a weekend to relax a bit. Both of us have been under a lot of strain from the demands of clinical rotations and needed a bit of a break.
During the conference we were able to hobnob with some of the great names in California history of nurse anesthesia but mostly we were there just to soak up the atmosphere. As seniors this year I think that both Todd and I have relaxed a bit and are enjoying these conferences a bit more than last year. The attendance in the Northern Californian meetings this fall seemed a bit down from last year but the tides on the shores on Monterey remind me that these things go in cycles anyway so not to worry. This coming spring should really be a big CANA conference some where nice. From what I have heard the next CANA conference is going to be in Palm Springs so we have that to look forward to.
One of the great things for me at the CANA conference is all of the vendors and the booths that are set up. The book seller was there with the new editions of Barash’s Clinical Anesthesia Fifth edition as well as the new Stoelting Pharmacology and Physiology in Anesthetic Practice. These are two of the must have books in my library. The new editions at first glance look like good investments especially the Barash text which has gone through extensive review. Keeping an up-to-date anesthesia library can be a daunting task but while I am a student I have determined to keep the most current texts available to me. Later on during clinical practice I will have to see which texts and books I upgrade with new editions but for now I am committed to this. These texts are so new that Amazon does not have them listed but you can see the links to the older texts in my Anesthesia Library list.
To view all of the pictures that I saved from the trip – well not all of the pictures but some of them anyway – you can see the Slide Show at flickr.
Anesthesia for Aortic Aneurysm Repair
Posted by: | CommentsThis is the last week of my Cardiac Surgery rotation at the County Hospital. The anesthesia techniques that I have learned this past month have been very interesting. Today I was able to put it all together for a sort of cap-stone experience in a big case.
Aortic dissection repair is not a surgical case that is approached lightly. This condition may result from chronic hypertension and possibly congenital weakness of the intima of the aorta leading to aneurysm formation and dissection. Unchecked an aortic dissection often proves to be fatal. Remember John Ritter from Three’s Company – he fell victim to a ruptured aortic dissection. Death is usually extremely quick and mercifully without drawn out pain.
This vascular case required not only sternotomy but a thoracotomy as well. These are big surgeries. Initially, the plan was for circulatory arrest and profound hypothermia with lumbar drain for cerebral protection. The surgical team decided on the double incision providing a greater exposure and was able to perform the surgery without the circulatory arrest. This was a good thing for everyone. Rewarming after a complete circulatory arrest with profound hypothermia takes several hours. As it was the surgery was long.
Preparation and setup for anesthesia was nevertheless extensive with two arterial line placements both a right radial and right femoral, double lumen introducer central line placement in the internal right jugular and floating a pulmonary artery catheter. Additionally because of the thoracotomy and the extensive dissection into the left chest that was required we used a double lumen endotracheal tube which allowed us to deflate the left lung improving the surgical exposure on the left side. At the end of the case the double lumen tube was replaced with a single lumen endotracheal tube. This was a great experience and wonderful case for me to participate in. You can see the entire Slide Show of the case at flickr. I must warn you that some of the pictures are very graphic and not for the squeamish.
These cases require cardio-pulmonary by-pass. For this case it was a partial bypass that was used when the surgeons isolated the aortic arch. Never the less this resulted in full heparinization and use of the “heart lung machine”. You can see Julia here with her bight smile behind the mask. The presence of the perfusion team in the cardiac room is always a pleasure.
Enjoy the pictures at flickr. If you can recall your anatomy you will notice the aortic arch repair and marvel at the gortex graft creation by the sugical team.
Cardiac Surgery at LAC-USC
Posted by: | CommentsThis month I have been in the Cardiac Surgery Room at LAC-USC and sharing the rotation with me is the coolest MD resident AJ Vaca. We all just call him Angel or Eeyore which ever comes to mind first but mostly we just call him AJ.
The rotation with him here at LAC-USC has really been a great experience. AJ has been terrific to work with and our time together has been of great benefit to me. I just keep him laughing at my clumsiness so he is entertained and is getting something out of this too.
AJ and David at the LAC-USC Anesthesia Office after giving report to the Chief.
The great thing about AJ is his humility. One thing I have learned in the process of anesthesia training and working with the MD residents is that we are all in training together and that humility is one of the great survival traits. It’s wonderful to know the book and to be able to put those principles into practice but even better to be able to learn from all of those around – even when they see things differently than you do.
How do I say this with political correctness? In the process of training it is possible to run into some of the more experienced practitioners that have seen much more and paying attention to ‘their’ wisdom is always a good thing. Sometimes that wisdom for me comes in doing other than what is explained but for the most part keeping an open mind and being receptive to input from experience has been very helpful in my anesthesia training. AJ is really good at this. He calls everyone, “Sir” no matter who they are and always takes the humble position. I have really enjoyed working with Eeyore, which is what everyone calls AJ.
Eeyore in the Cardiac Surgery Rotation
Anesthesia Library
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I am in the process of updating the Anesthesia Library information transferring and expanding on the information that I have in the Library Page. All of the books that I review and list in the Anesthesia Library I own and have looked through. My recommendations for texts are well thought out and have cost me more than a few pennies to research.
Enjoy the trip as I have because it is all very good. There are a few books that have redundant material but for the most part all of these texts add something worthwhile. In the past several months I have been simplifying my reading and going back to the basics. My reading plan of one chapter a day is working out well. I recommend the text, Basics of Anesthesia by Miller as a review daily. You could not spend too much time in this text as simple as it is every line is well thought out and of value. Have a pleasant ride.
Patric O'Brian
Radical Brewing
