Archive for Anesthesia
Last Days at Arrowhead Regional
Posted by: | CommentsThe end of the month is soon coming and the clinical rotation at Arrowhead Regional Medical Center is coming to an end. Gina Wald and I have been there for the past four months during our second General Surgery Anesthesia rotation and we both have enjoyed being at Arrowhead – for many reasons. Now that the time has come to wind up our clinical experience there, a time of reflection is coming.
Today there is real food for thought on where we have been and where we are going in the growth process during our nurse anesthesia training. For regular general surgery cases for the normal person I am feeling that I can handle this just fine. We call these patients ASA class I or II. For these patients and the surgical procedures that are the norm both Gina and I feel that we need very little help in the management of the anesthetic. Today was a different day.
There is still a lot of growth that needs to take place for the sicker patients. The Whipple surgery that I participated in today is a good example of what I need to further learn. All of the line placements were difficult for me today. In this poor 83-year-old man with pancreatic cancer we placed a thoracic epidural catheter, central venous IV access and attempted an arterial line. They were all difficult for me. The anesthesia was not a problem but the technical skills involved in the line placement were. So you see there is always room to grow. For me there is a lot of room. I am just very glad that Dr. Enwall has chosen to put me in the difficult rooms where the cases are tough. That is a good thing because I was getting a little tired of all of the ortho cases.
I will miss Arrowhead and remember it fondly. The rest of this years clinical rotations will bring so much. I will remember Arrowhead and the people that have taught me so much about anesthesia.
The End of First Year Rotations
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The time has finally come to put the “Junior SRNA†title away and pick up the new “Senior SRNA†moniker. Starting this coming Thursday our class will have officially started our senior class rotations and the specialties that go with it. The monthly rotations will start September 1st and change with each coming month for the next year. Of course there will be some rotations that last two months, specifically pediatrics, but each month on the first we all will be shifting gears and on to a new experience.
For me, I will be starting the cardiac surgery rotation at Los Angeles County Hospital. This is a shared experience with the MD resident. Fortunately for me I will be with my good friend AJ who has shown me so much in the past. AJ is a 3rd year anesthesia Resident at the USC Keck School of Medicine program and was there when I started my clinical experience at LAC-USC Hospital.
The way it works is that we share the cases alternating each day who puts in the lines while the other person does the airway management and takes credit for the case. We can not both take credit for the case for certification purposes but the learning goes on anyway. In this way we both get the most out of the experience and for me this is totally acceptable. I will be finishing up my general surgery rotation at Arrowhead Regional Medical Center in Riverside tomorrow and AJ will do the preoperative evaluation for me so that I do not have to travel after a long day in the OR and then do the preop at another hospital for the next day. That is a relief.
David and two Texas Weslean Students at Arrowhead Regional Medical Center
Finishing Up at Arrowhead Regional Medical Center
Being at Arrowhead Regional has been a really great experience. This past month the schedule has been really good for me. In the morning a Whipple procedure is scheduled for my room. This will be the second Whipple for pancreatic cancer that I have done in the past two weeks. These are really big surgeries with the necessity for central line placement and central venous pressure measurement, arterial line placement before induction and two large bore IV’s for access. In addition I will be placing an epidural catheter for post operative pain management. All of this requires extra time so after discussing these plans with the MD attending staff this afternoon the patient will be in the preoperative holding area at 6 AM for the line placement. At least I will get the epidural and arterial lines in and after this gentleman is asleep we will get the central line secured.
David behind the Blood-Brain-Barrier during a hand surgery case
Looking back over the past year and seeing the growth that has taken place is easy today when I think about this Whipple case and how I am comfortable with the issues in the anesthesia management for this surgery. A year ago just getting a patient asleep was a major big deal. So it’s good to review how far we have come and to reflect on what is yet ahead to learn and grown in. This coming year of specialty rotations is bound to be extremely challenging and rewarding in all that we will learn. I am so much looking forward to all of it, the hard work and the satisfaction of knowing that we all have done a great job taking care of our patients when they are the most vulnerable.
The Voices of Experience
Posted by: | CommentsThe Voices of Experience is a testimony to those that have worked the hardest for the welfare of the Certified Registered Nurse Anesthetist Community. This current testimony is from the California Association of Nurse Anesthetist web page.
Provider of Distinction:
Christopher Stein, CRNA, MS
Born in the small farming town of Cedarburg, Wisconsin, Christopher Stein, CRNA, MS, developed a disciplined and strong, early to bed, early to rise, Midwestern work ethic. By age 17, Chris knew that he wanted to make a difference in the lives of others and chose to demonstrate his dedication by volunteering to serve his country and enlisted in the United States Navy. Chris met his wife Ann during his tour of duty in the Navy. She, too, had chosen to make a difference in the world by serving her country. Finding that they both had so much in common, Chris and Ann married before leaving the Navy in 1977. After joining civilian life, Chris worked as a mechanic in a foundry to support his growing family while Ann attended nursing school.
Following nursing school graduation it was Ann’s turn to support Chris while he attended the University of Wisconsin’s Nursing Program. In 1986, Chris started practicing nursing in the pediatric intensive care unit (ICU) at the University of California at Los Angeles (UCLA) Medical Center. Several years later, Chris set his sights on becoming a certified registered nurse anesthetist (CRNA) and entered the UCLA Program of Nurse Anesthesia. His first experience as a CRNA was at UCLA-Olive View Medical Center where he worked his way up to the top position of Chief CRNA while also maintaining a clinical faculty position for the UCLA Program of Nurse Anesthesia. For the last 5 years Chris has been the Chief CRNA for the Northridge Pain Management and Surgery Center, and a clinical faculty member for the University of Southern California (USC) Program of Nurse Anesthesia.
Chris became involved in the California Association of Nurse Anesthetists (CANA) immediately after graduating from the UCLA Program of Nurse Anesthesia. He started out on the public relations committee, and served as the public relations committee chairperson. As he became more familiar and interested in the issues facing CRNAs, Chris was voted in as a trustee, followed by vice-president, president-elect, and finally president of CANA. After his term as president ended, Chris assumed the position as 3-year director for CANA. This position, he feels, is his favorite position within CANA because he has acquired first-hand knowledge and experience of every position inside CANA while at the same time developing a global understanding of the issues facing CRNAs in California.
When asked to look back over his career and articulate the highlights, Chris replied that he had four experiences that will always fill him with great memories and grant him a sense of accomplishment. First, despite the challenges of his work for CANA, Chris was able to get people to see differing points of view while still trying to bring people together. Second, Chris was instrumental in developing the CANA Foundation – a foundation dedicated to providing financial stability to CANA, and also to sponsor student scholarship and research. Third, he is proud to be able to provide safe, excellent, anesthesia care and alleviate pain for people undergoing surgery or pain management procedures. Fourth, Chris spoke of what a tremendous honor it was to be the keynote speaker at the graduation celebration of the University of Southern California (USC) Program of Nurse Anesthesia. While presenting his opening statements Chris looked out over the audience and realized the importance he played in preparing the next generation of CRNAs, and what a tremendous legacy that was to leave behind as a gift to the world.
We appreciate the sacrifices Chris has made to our profession, and we find it a great honor to have him within our ranks. Thank you Chris.
The End of First Year Anesthesia School
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The end of the First Year at USC Anesthesia School has come at last. At the end of the month of August – it has come so quickly – will mark the beginning of our senior rotations. This means for me that I will start at LAC-USC in the Cardiac Surgery rotation September 1st.
To celebrate the occasion a little letter from the Chief CRNA at LAC-USC is recorded below. Kari Cole is one of the most outstanding CRNA’s I have had the privilege to work with and her letter of encouragement is heartily welcome by all of the new senior students.
Dear All,
I hope this email finds you in good spirits.
Here are a few housekeeping issues:
1. BACKPACKS:
If you haven’t already, please reduce the size of the backpacks you are bringing into the ORs. At this point, the only thing you need to bring in the OR is ONE reference book, a couple of pens, stethoscopes (regular and precordial) and maybe a nerve stimulator and head strap (depending on where you are rotating). You may want to think about losing the backpack altogether and move into something a bit more professional like a black attaché.
2. VALLEY REVIEW:
For those of you who are planning on attending Valley Review Courses, please inform me (and the schedulers at other sites) when you are planning on attending. Since you are now in the ORs on your own at LAC, I will need to know when you will be out for the review.
3. POLISHING:
Start working on polishing your skills. You all have the basics down, now start fine tuning your anesthetics and your approach. Push yourself to try new things…..do NOT use roc and propofol on every induction! You may have to “sell”: your plan to the attending and/or CRNA, which can be a lot of work but in the long run, it is worth it. You need these skills (anesthetic and interpersonal) before you graduate.
4. CHANGING OF THE GUARDS:
The seniors are graduating and you will be taking their places as seniors and as mentors. The new group starts in a week and a half so be prepared to meet and greet your new colleagues in the ORs and in class. Remember, first impressions are lasting impressions! Think about the senior that impressed you the most when you first started. Were they: approachable? genuine? enthusiastic? helpful? Your attitude makes a world of difference to those individuals who are just starting.
5. CONGRATULATIONS:
Be sure to give yourself (and your classmates) a pat on the back and/or a congratulatory hug for successfully completing the first year of the Program!! YOU ROCK!!!!!!!!!!!!!!!
Aloha,
Kari
Kari M. Cole, CRNA, MS
Chief Nurse Anesthetist
Assistant Clinical Professor
Keck School of Medicine, USC
Department of Anesthesiology
May you always do for others and let others do for you.
My First Spinal
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Josette Salas, RN BSN
Josette Salas is an RN from California. She has worked as a traveling nurse in some of the busiest Medical Centers on the West Coast including UCLA, USC University Hospital, Cedars Sinai and others. Her specialties includes Cardiothoracic ICU and Neuro/Trauma intensive care. She comes to Nurse Anesthesia School with a lot of great preparation and motivation.
Hey Gang, How is it going for everyone? I have been reading the blog and it sounds like everyone has been very busy. FUN FUN FUN at the old anesthesia corral. My clinical rotation is not as scary yet as others so I am kind of jealous about that. But I can’t wait for the good stuff to come around. Right now I am just doing a lot of hernias, D&C’s, laparoscopic stuff, tons of Orthopedic surgery and hysterectomies.
I can finally say I like the MAC blade and I have been pretty successful with tracheal intubations these past two weeks so I am feeling better about the whole induction thing. I hate placing Laryngeal Mask Airways but I am getting the hang of those too. You know I have small short fat fingers which is not helpful.
Today I got to do a spinal anesthesia case and ooooh-la-la first one here so of course I was all thumbs and asked a lot of dumb questions. Learning is such a great adventure but I hate feeling stupid all the time. I can’t wait till I am past that point of feeling stupid every single day to where I am feeling stupid just every other day.
I love using local anesthetic for my IVs starts. I think all nurses should do this but I don’t know if this is in the scope of practice for the RN instead of our purview as Advanced Practice Nurses in training – Oh just give me a break already!
OH I am going to the Washington DC in August for the annual AANA meeting which lasts for 5 days. I have never been to DC so this is going to be cool. I want to see the Capitol building if I can.
Currently I will be ending a rotation at the end of this month and then I will be going to the big Buffalo General Medical Center so hopefully I will see some interesting cases there. I don’t know when I will have the opportunity to go to the County Hospital for a Call/Weekend shift. I don’t think everyone here gets to do this but I am excited about doing this and am planning of learning so much there. I want to get the experience to equip me to handle anything that comes through the door.
Right now I hate the summers here in Up-State New York – it is like tropical hot humid disgusting nasty weather kind of place. Did I tell you about the winters here? Now it’s funny because the people here are just happy that it is hot and not frozen over like it was a few months ago so there’s no place like home.
Anyway I am going on and on. So take care and good luck with the rest of your current clinical rotations and I will write again soon. My picture is in the mail if you know what I mean.
