Hi readers of Nurse Jess,
It has been nearly a year since I posted on my blog. Some readers (aka a few junior anesthesia students) have met me and wondered if I’ve fallen off. Nope, I am right here!
Every time I considered posting, an exam, a care plan, paper, or even the limited time off to do nothing, pulled me away. But now I’m back.
I have so much to say and yet so little time to do it. I could write a lot, as I often do, to convey all of my thoughts. But I will try to keep it short to encourage me to post more.
Since the beginning, I’ve done over 700 cases and over 1800 clinical hours. And there’s still 4.5 months left of anesthesia school. It may seem like a lot, or a little, depending on who you are.
That time doesn’t include class days, the preparation for clinical, the preparation for anesthesia school (GRE, CCRN), the intensive care unit hours, the bachelor of science in nursing AND biology. In my mind, it’s been ten years of training. Wow.
I have to admit, the beginning of anesthesia school was tough. What makes the training challenging is at first, you are learning the basics of airway management (intubation, LMA, oral and nasal airway, chin-lift, jaw-thrust, etc.) and the anesthesia flow for each type of surgery and unique to each patient (preoperative, intraoperative, postoperative course). Not only that, but each anesthesia provider (CRNA and anesthesiologist) have their preferences and expectations of you. Even during the short breaks, one CRNA may be ok with your choice, but another CRNA would reprimand the choice. The only thing you can do is to understand their choice (What’s the rationale?). As they say, there are a 1000 ways to skin a cat.
Now, there’s less anxiety and more of a discussion, even as I go to different clinical sites. It’s much easier to anticipate changes and adapt to the circumstance. For example, just today there was a switch in the schedule. Last year, I felt more frantic and had to think about my each step more carefully (especially in pediatric cases when there’s a change in age and weight that require a change in equipment size and drugs). Today, it changed from a two-year-old, 15kg to a 6-year-old, 25kg for ear tubes (*real age and weight are changed). What are the appropriate emergency drug doses I would give? What equipment changes do I need to make? I switched a size 3 to a size 4 mask, and had a 5.5 ETT (endotracheal tube or breathing tube) with a MAC2 blade, and thought –
- atropine 0.02mg/kg = 0.5mg = 1.25ml,
- succinylcholine 4mg/kg IM = 100mg = 5ml,
- epinephrine (1:10,000 or 0.1mg/ml or the big stick) 0.01mg/kg = 0.25mg = 2.5ml.
Anyways, that’s it for today.