Wrapping up trimester 5 of 7 CRNA school

Wrapping up trimester 5… its a great feeling. Research papers done, projects presented and a whole lot of time in my hands except for the 40 hours in clinical rotations. 2 more weeks till trimester’s end and I can’t stress enough how much I’m looking forward to my upcoming vacation. I managed to pull off 1 week off for the AANA conference in Boston back to back with 2 weeks off for vacation. In all this results in 3 weeks off from school and clinicals. I can’t stress enough how I really need this time off, I find myself easily irritable at this point. Now on to the nitty gritty….

As previously described, classes during this term have been a breeze, and all projects and papers are ready for submission. Conversely, clinical rotations never stop, and during my Neuro specialty rotation I’ve had the opportunity to play around with managing narcotic drips (Remifentanil, Sufentanil) in a daily basis. Its definitely  a different form of doing things, since right anesthetic balance is essential to maintain appropriate SSEP and MEP monitoring. All in all its a different technique but nothing out of this world. Attention to ICP’s and prone positioning is also a big part during this rotation. Other than these minor technicalities, it is a case lie any other and vigilance is key as with any other anesthetic plan.

Now on to the political side of things… Overall my clinical experiences have been great, I can’t praise enough the school and anesthesia group for the wide range of experiences and expertise there offered. Working with a large anesthesia group allows us to experience a wide range of techniques and you realize there is 101 ways to skin a cat. Conversely, you can also become irritated when someone bashes you for attempting to do one thing (stating that it is wrong) when you just did it the day before with someone else and it was considered perfect. Take home message here is, whats absolutely right for one practitioner may be extremely wrong to another. You must adapt not only to the patient but to the practitioner in a daily basis. With that said, my only true rant from my program is the lack of “independent days” or as some may say, running your own room by yourself without someone there the whole time. Although instruction and direction is always appreciated and I’m aware I need it, it is a huge short coming to hardly ever run your own room throughout a program. I must admit they do allow independent days sporadically while being very limited. For the last 3 months 4 of my classmates have been allowed to do it, once each. It is important to note that this is not the rule, many programs offer independent practice throughout your senior year. I believe there are both pros and cons to this. Pros are obvious, you learn to make decisions for yourself and work thru problems. There is definitely a “sphincter” factor that plays a role. The cons are that you have less direct instruction that could have molded you to a better practitioner. Many things happen during the case, and insight of each individual practitioners actions in order to reach a resolution may mold you to react more effectively when your on your own. I believe a balance of supervision and independence is the most appropriate choice.

And now to my rant… so new CRNA grads just started in the O.R this month, while most are well aware of a senior’s level of experience at this point, I had to listen to one explain to me that there is 50mcg of fentanyl in 1ml and we should use at least 2 liters of flow with Sevoflurane because of compound A buildup. “Thanks, go to know.” All sarcasm aside, I appreciate someone trying to teach me, but give me some credit for the time I’ve been here, I know it is not much and that I have tons to learn, but really… 50mcg in 1ml… thats pushing it.