CRNA

I must say that finally learning about anesthetic drugs has elevated my spirits about this whole process. I cannot wait to be YOUR CRNA.

Opioids

Induction Agents

Benzos

MAC or MAC?

I can’t wait to one day be able to teach all that I know to the people who are just starting off.

As the CRNA, (side note: who made up that name anyway… certified registered nurse anesthetist? I’m pretty sure I’m not getting a certificate when I complete 27 months of training … smells like politics to me & I hope future me can help tackle that) we will breathe, feel and think for you. As a control enthusiast, I am ecstatic that I can do that for someone. And to be able to be in sync (or lack thereof) with my fellow surgeon is a challenge I am looking forward to. 

 

Happy Daylight Savings!

Jas

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Gratitude and growing pains

Hi there,

Haven’t written here in a while and I must say, I thank every one of you who’s read my stuff and found it helpful or have been super supportive throughout my journey.

It’s been about two months since school started, and it’s almost 2018 — where does the time go? I have to say that whoever told us that anesthesia school was no joke.. was not lying.

This is the most stressed I’ve ever been in my whole, entire, life. And, I have been put to test a few times in my life and nothing comes close to this. I hate to admit it because admitting something is hard is a sign of weakness, right? No. I have come to realize that I am a very emotional person and I do cry sometimes… actually, I cry a lot and mostly because I lose control over a situation. Whether it be in the middle of a sentence when I’m talking about something or at home by myself. And, I hear it’s healthy. It’s my coping mechanism, and for those of you coping like I am right now, just know that you are not alone.

It’s normal to feel stressed, and depressed. And there is help out there. One thing I’ve learned this year is that mental health is just as important as every other disease, like hypertension or diabetes. With depression or high stress, your body will start to maladapt and can’t really function anymore and you will start getting sick and not want to do fun things or do anything at all… (shout to my patho professor Sally for making such a dry topic so passionately fun)

It will happen but to quote a classmate “nothing worth it comes easy” as we are being challenged to being the best version of ourselves. I would rather cry now than cry in the middle of a case while I have someone’s life in my hand – going through one of the toughest times in their lives, a surgery that was unexpected, and I’m the one making sure their anxieties are alleviated, and that I figure out the best concoction for them to not feel any pain in the safest and best way possible. That one day, I will have a family and I can tell them I too, went through what you’re going through. And you just have to trust the process. That these are just growing pains.

 

Again to quote Sally: “Stress response is meant to be short lived followed by respite.”

Understanding stress – this is normal.

Encountering stress on a regular basis, benefits us.

  • Healthy stressors: they make us healthier, smarter, stronger. For example:
    • Demanding mental activities: uncomfortable learning. So, pick up that hobby that you always wanted to do and keep at it! It’s meant to be uncomfortable. You can’t actually be learning anything if you are already comfortable with everything.
    • Demanding physical activities: the benefits of exercise is undeniable.
      • I recently tried out this boxing class called Rumble, it incorporates boxing and strength training all in one jam packed hour, and it is unbelievably hard but you feel SO good right after. Oh, it feels GREAT not being out of breath when I climb stairs, or be able to squat properly with good form 😉

 

  • Overwhelming stress, however, can be detrimental.
    • Cold stress, altitude stress (lower oxygen allows them to adapt and increase RBC count- increase oxygen capacity and help run more since more oxygen pumped to muscles)

Stress response

Stress in an individualized response. Certain circumstances vary for each person. Good support at home, and available support system.

1.Adaptive stress response – when a person goes thru their last straw but have a good support system at home.

2.Maladaptive stress- when a person goes thru their last straw and copes with alcohol or drugs.

 

So, to wrap it all up I think the lesson is – you’re not alone. And, this is a lesson to myself. There are always people who want to listen to you and in my case, I have more than handful of people that love me, friends and even acquaintances that are willing to lend an ear. I appreciate you. Stress can be detrimental, or it could make us stronger, I guess at the end of the day you get to choose. Find a healthy balance and keep the hustle. After all, they don’t call us the greatest city in the world or the city that never sleeps for no reason – just have to be aware of your own behaviors and seek the help you may need and keep moving forward.

 

Thats all,

 

xo

Jas

abbu

I joined my father for our usual dinner catch-up sessions. Well, you know, more like me analyzing my food as he talks to me. You see, our relationship has never been an ideal one. But the unconditional love is understood.

He starts telling me about a construction site and piles and piles of gravel and how it’s never fun to look at gravel when you look at a building being built because I mean.. who does? And it takes months and months for them to finally get the gravel out of the way and start building the building they were planning on.

Then he said, well, that’s kind of what you’re going to be going through the next couple of months. Nobody likes the beginning, and it’s not fun at all because you don’t even know what the future is going to look like. But you need a strong foundation and the foundation takes time. And it’s going to be hard but that’s how it was like for me during medical school. Things only got fun during clerkship years. This too shall pass in like six-seven months….And, sometimes you need to read the textbook not once but twice, and that’s ok.

/endshare.

 

God.  I needed to hear that so badly.

 

 

 

 

 

 

cortisol

I always found writing to be my escape and I never thought I would say that. I never liked writing growing up, probably because I wasn’t good at it. Well, my best friend who majored in English said that like everything in life it’s something you have to practice and do it everyday.

And I think thats what we tend to forget. Practice makes perfect. Grit. You can essentially do anything if you put in the time and effort into it. Ha, so my point is actually pointing back to the fact that I feel this very thing right now. About CRNA school. They weren’t lying. I already feel the depression looming in as I exchange my free time with pages on gas laws, pharmacokinetics, and membrane potentials. The FOMO is real.

Here I am – stuffy nose, head, and hacking cough the night before my first anesthesia school exam. First pharm exam (on hormones, diuretics, pharmacodynamics/pharmacokinetics, and COPD& asthma). My cortisol level has to be at least 150mg (stress response). Normal secretion per day is 20-30mg. Please let be a test question.

 

Here’s more on cortisol. So, it is secreted by the adrenal glands and it is primarily responsible for your stress response.

 

  • Increases gluconeogenesis, inhibition of glucose uptake — fancy way of saying helps your body make sugar!
  • Breaks down protein –to mobilize to the liver to make sugar
    • In excess can cause muscle wasting. So, don’t stress or you’re going to lose all your gains!
  • Mobilizes fatty acid – used for energy and metabolism
  • Has anti-inflammatory effects
  • May help cardiac function and improve blood pressure
    • Increases number or responsiveness of β-adrenergic receptors.
    • Promotes normal responsiveness of arterioles to catecholamines (norepinephrine, epinephrine)
  •  Inhibits bone formation
    • Can lead to fractures 😦

 

Ciao for now! And wish me luck …

 

 

The homestretch.

The physical manifestation of stress in the crook of my neck (and several of my other classmates), the inability to take a deep breath, the pounding heart rate when you wake up in the morning and when you step out of class, are signals enough that finals week is fast approaching. I mean, how is it Thursday already, oh and August? I feel like I just started. My friends are off getting married, at their honeymoons, and planning Halloween costumes.
But here I am slugging along for the next two exams: Health assessment (learning all about heart murmurs, peripheral vascular disease, skin disorders, STDs, pediatrics and all of their heart murmurs and developmental stages and all of their different types of assessments, neuro assessments, & Musculoskeletal for adults) and pharmacology (everything you need to know about Infectious Diseases). Whew. To many of you, it may seem like oh, it’s just another exam but for us

To many of you, it may seem like oh, it’s just another exam but for us SRNAs we kind of have to get this 4.0 as we hear the ominous stories from the GAS2s (Graduate Anesthesia Student Yr. 2s) that the fall is nowhere near as easy as the summer semester. Next semester, we learn about principles of anesthesia, the pharmacology of anesthesia, and pathophysiology.

So, wish me luck in learning/understanding/cramming two exams’ worth of stuff in the next 7 days! After next week Thursday, I am a free soul for about 3 weeks (one of which I will be in Peru!).

Then, 24 months of CRNA school to go… Le sigh.

GASTRIC

If you guys are Bengali (from Bangladesh), you know what I mean when I say “I have gashshtick” and it refers to someone experiencing heart burn.

So, in the case of someone experiencing heart burn (which often feels like you’re having a heart attack btw!) you may ask why? Well, we ask when does the heartburn happen? As there are many factors that cause this interesting process. Stress, caffeine, acidic foods, spicy foods, nicotine (as it relaxes your muscles including your stomach’s little sphincter, think of it like a little muscle that acts like a rubber band, that keeps it nice and closed.)

So! There are obviously a ton of drugs you can take for this and I am going to share with you guys how they work…

They either cancel out the acids that your stomach is producing OR allowing your body to create a defense.

Antacids: fight off the body has already created so it works right away! This is the drug of choice if you already ate…

  • Tums
  • Alka seltzer 
  • Maalox

H2 inhibitors: Blocks off one of the pumps(histamine-2 receptor) that promote the cascade of acid productions

  • Tagamet– DO NOT USE because it causes interference in hormones causes males to have impotence, lactation, and breast formations. It should also be avoided in pregnancy as it crosses the placenta and is toxic to the baby. So, why is it even a thing? Because it’s one of the H2 inhibitors invented. So, generally, when drugs are first founded, they have really bad side effects they learn about later….
  • Pepcid 
    • Some Asians are deficient in the enzyme known as aldehyde dehydrogenase (ALDH2), which breaks down the byproduct of alcohol. This enzyme also processes histamine – a chemical involved in allergic reactions that allow more blood flow to areas of your body like your face, causing a flush. That means that if you have a genetically changed ALDH2, you don’t break down histamines as quickly, either. That’s where the glow comes in. When the enzyme works overtime to try to process the alcohol, histamine builds up and causes an extreme flush. This is when you should take Pepcid to prevent the redness. But, be warned it accumulates alcohol in your body and sometimes you don’t even feel it until the drug wears off.
  • Zantac
    • don’t give to your grandma, it will make her confused. But another solution for Asian glow if Pepcid doesn’t work!
  • Axid 

 

PPIs: Blocks of the last pump that causes the acid. Indicated for chronic use and VERY effective . Takes about 1-3days to kick in irreversible.

  • Prilosec
  • Nexium  – you can see this also in the hospital IV use
  • Prevacid
  • Protonix- you can see this also in the hospital IV use

MSN vs. DNP?

Hi Everyone!

Long time no post, as you know I recently started in the MSN CRNA program at Columbia University in New York. Its been a smooth first two weeks so far, although I’ve already taken one exam to place out of a 3 credit Evidence- Based Practice class (would have cost me $4k, vs. the $375 I took to the test). Instead, I removed a class (Genetics) from my fall courses & decided to take it now to lighten my load later.

“The Nurse Anesthesia program is a 27-month, full-time, front-loaded program that includes a clinical anesthesia residency. The first year curriculum is devoted to advanced science courses, graduate core courses and specialty courses which form the basis for advanced specialty concepts later in the program.”

(http://nursing.columbia.edu/academics/academic-programs/master-s-and-post-master-s-programs/nurse-anesthesia-program-anes)

Basically, after the 27 months and taking the anesthesia boards you will have earned a Master’s (2.5yrs) degree in Nurse Anesthesia and can begin working and earn the same amount as someone with a DNP in nurse anesthesia like a lot of schools are offering. HOWEVER, by 2025 all advanced nurse practitioners are going to be required to get a DNP (~36months). So, the perk about getting your Master’s now is that you can start working right away, pay off your loans, and then get your institution to pay for the school you will need to get back into for your DNP. IF you do your DNP now, you just don’t have to worry about the additional schooling later on in your practice, for example, when you have a family and children. But, would have to take upon the burden of paying for it on your own.

 

Traveled into new beginnings

Just came back from one of the longest trips I have ever taken. Well, not actually the longest in duration but more the number of things we were able to do in 16 days. Let me tell you about it!

So we took a red-eye flight Friday night May 5, 2016, out of NYC. In the midst of settling into the unease of knowing that I will no longer have a full-time job when I get back and trying to do some clean cleaning, with trying to submit pre-registration new student forms, its safe to say that the day was pretty hectic. You see, anesthesia school starts the week after I get back and I opted out of working full-time and going to school as well. This would be my last hurrah!

May 6, 2017 Casablanca to Marrakesh 

Landed in Casablanca, Morocco. Luckily we landed in the morning so it was easy to maneuver through the city. What we didn’t know was that our T-mobile phones notorious for having worldwide LTE exempted Morroco from the list. So, we were stuck with no wifi but luckily had offline downloaded maps where we starred the places we wanted to see on Google Maps. We took their version of an air train out of Casablanca airport into the city center. Oasis. From here, we were connected to a fast train going to Marrakesh. Mind you, when you buy this ticket please please please mark first class and pay extra. We were cramped, extremely hot, fatigued and the smell of BO did not help.

Finally arrived in Marrakesh to find out the Bahia Palace was closed. They closed at 4 pm. Also, pro-tip: ladies do not travel without a man by your side. My girlfriend and I were literally covered from head to toe but still catcalled and harassed to buying things and trying to lead us to wandering allies. SAM_1226.JPG

We explored the Koutoubia Mosque and ended up walking through the souks during sunset.

SAMSUNG CAMERA PICTURES

Must go to restaurants: Cafe Arabe, and Nomad (try their Amylou icecream!).

 

(Cafe Arabe)

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(Nomad)

 

May 7-9 Marrakesh to Merzouga Tour

We were picked up by a tour bus that accommodated 17 people. We bought tickets online in the Merzouga Tour website, don’t get ripped off! We paid about ~80euros for the 3 -day, 2 nights deal. We stopped in multiple towns along the way. Including a Berber village. Berber meaning the natives who lives in Morroco before the Arabs came.Here we were cajoled into buying a Berber blanket and drank some tea with the locals.

On Sunday we explored kasbahs on our way to the desert and slept at a kasbah hotel. There they fed us dinner which was of course tagine and couscous!

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Monday we drove further in and made it in time for the sunset in the Sahara desert. They arranged a camel for each of us to ride into the sunset. The ride was about 1.5 hours. Our guide also gave us a complimentary ride through the sand dunes. I thought I was going to die. Then, we laid out in the desert and looked at stars and told stories around a fireplace. We slept in the tents they set up for us.

 

On the morning of May 9, we woke up at 4 am to ride into the sunrise. Not as thrilling as the sunset. We arranged for a grand taxi to Fes, Morocco. Luckily we had 4 other Americans that also wanted to go to Fez instead of Marrakesh. We paid about ~25USD for an 8hr ride. On our way we were greeted by a sandstorm. Unreal. We arrived in Fes at about ~4pm.

 

May 9-10 Fes, Morroco 

We only spent less than 24 hours here. Mainly because there wasn’t much to do in the old Arab city and we wanted to hurry up and get to Spain. The markets all close at 6pm. Fez is known for their leather tanneries where they hand make their leather goods. We went and bought leather jackets and literally, bounced the next morning!

May 11 Chefchouen, Morroco to Tangier Port, Morroco; Tangier Port- Tarifa, Spain

From Fes we luckily found a grand taxi that was charging us 1000 dirhams (~100USD) to Chefchouen. This is a steal from taking the CTM bus (which gets booked days in advanced apparently ~14USD) as you pay 16USD if split between 6 people. CHefchouen is known for its aesthetically pleasing town thats literally painted blue. We took some snaps here and then carried on.SAM_1828.JPG

From Chef, we took a local bus which cost us about 3euro to take us to the port of Tangier. This took about 3hours. From Tangier, we took a fast ferry FRS or intershipping ~35min to get into Spain. I recommend taking the 6 or 7pm to catch the sunset!We took their free shuttle bus to Algeciras and spent a night in Algeciras as there was no late night transportation to Seville.

May 12 Algeciras, Spain – Seville, Spain

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We used the app called blabla car sharing ride feature to go to Seville. It took ~2hrs and paid 10euros. The ride was pleasant and our driver was a girl our age. We are in Plaza de Espana above. Must go to the Alcazaar! This is where Dorne in Game of Thrones takes place.

May 12-14 Seville, Spain –  Pisa, Italy; Pisa, Italy – Florence, Italy

May 14 On our way to Florence, we took a flight out of Seville into Pisa with Ryanair. Print your boarding passes ahead of time! 50euro charge at the counter FYI. This was the cheapest option as direct flights from Seville to Florence was hundreds of dollars more. In Pisa, we ran to take pics with the tower, grabbed some pizza, and ran to catch a fast train that took about an hour to come into Firenze SMN.

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May 14-19 Florence, Italy — Duomo! Gelato! Hot chocolate! Oh and panini toscani and Ali’s kebabs.

May 17 Chianti Tuscan Wine Tour 6 hrs. We were taken to 3 vineyards. Got our deal from groupon for about ~70USD.

May 18 Cinque Terre (The Five Towns in Italian). Caught a train from SMN to La Spezia (train outside of Cinque Terre). Bought an all day train pass to ride from town to town. There is a hike from Town 3 to 5 which is apparently beautiful but we opted out for the sake of time.

May 19 Florence, Italy – Bologna, Italy; Bologna Italy – Ibiza, Spain

We took a train out of Firenze SMN into Bologna. From Bologna train station we took an airport bus to Bologna airport. You have to buy your ticket to the airport bus with the guy that sells magazines! Be careful of the gypsies, they will try to rob you. We have videos!! we caught a cheap flight to Ibiza.

May 20 Ibiza- Barcelona, Spain

As our returning flight was leaving from Barcelona. WE left Ibiza Saturday evening and spent a night in Barcelona in time for our flight back home the next day. Also, who doesn’t love Barcelona and it’s nightlife. Opium and Shoko for the win! Get there before 130am to avoid lines and 20euro cover. Other must dos: Park Guell, Sagrada Familia, Casa Batllo, Casa Mila, Magic Fountain of Montjuic (light show on Friday and Saturday nights)

May 21 Barcelona, Spain – Casablanca, Morroco; Casablanca – New York City

We were able to check our luggage and only have a small purse. We had an 8-hour layover in Casablanca and decided to use the time to check out Hassan II mosque. Once again, took an airport train out to the city center and took a cab there. Must do! It’s a mosque on the beach. Apparently, it’s helpful to just hire a guide while you are there. But, in our case we planned everything on a whim so did not have that luxury.

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My roundtrip flight was ~375USD. Luckily, with Chase Sapphire Reserved I booked it with my points. Overall, I would describe my trip to be rushed, unreal, and amazing!!!!

 

just a nurse.

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“I raised a doctor. You only raised a nurse.”

This phrase honestly doesn’t even phase me anymore. It makes me chuckle actually. It’s a clear source of ignorance of the different roles that healthcare has. I, for one, am comfortable in my role in the healthcare system. And we should all be, and go into it for the right reasons. God knows, with our evolving healthcare system, we all need each other. Our roles are all so precious and sometimes stretched so thin we may need more roles to work together efficiently for better patient outcomes. In an ideal world, we should get rid of the silos and come up with plans that start with “we” will do this for the patient.

As “just a nurse,” the role translates to being the 24/7 eyes, ears, hands, voice for patients who can’t do it for themselves. The nursing process is as such that we treat the patient not just as a disease, but as a whole- incorporating their social and spiritual belief to come up with a plan that best suits the individual patient.

 

(http://www.nursingworld.org/EspeciallyForYou/What-is-Nursing/Tools-You-Need/Thenursingprocess.html)

The common thread uniting different types of nurses who work in varied areas is the nursing process—the essential core of practice for the registered nurse to deliver holistic, patient-focused care.
Assessment
An RN uses a systematic, dynamic way to collect and analyze data about a client, the first step in delivering nursing care. Assessment includes not only physiological data, but also psychological, sociocultural, spiritual, economic, and lifestyle factors as well. For example, a nurse’s assessment of a hospitalized patient in pain includes not only the physical causes and manifestations of pain, but the patient’s response—an inability to get out of bed, refusal to eat, withdrawal from family members, anger directed at hospital staff, fear, or request for more pain medication.

Diagnosis
The nursing diagnosis is the nurse’s clinical judgment about the client’s response to actual or potential health conditions or needs. The diagnosis reflects not only that the patient is in pain, but that the pain has caused other problems such as anxiety, poor nutrition, and conflict within the family, or has the potential to cause complications—for example, respiratory infection is a potential hazard to an immobilized patient. The diagnosis is the basis for the nurse’s care plan.

Outcomes / Planning
Based on the assessment and diagnosis, the nurse sets measurable and achievable short- and long-range goals for this patient that might include moving from bed to chair at least three times per day; maintaining adequate nutrition by eating smaller, more frequent meals; resolving conflict through counseling or managing pain through adequate medication. Assessment data, diagnosis, and goals are written in the patient’s care plan so that nurses, as well as other health professionals caring for the patient, have access to it.

Implementation
Nursing care is implemented according to the care plan, so continuity of care for the patient during hospitalization and in preparation for discharge needs to be assured. Care is documented in the patient’s record.

Evaluation
Both the patient’s status and the effectiveness of the nursing care must be continuously evaluated, and the care plan modified as needed.

 

 

~~~~~~~~

 

Imagine a day in the ICU per se without nurses. 

That aortic graft would have blown out because of a hypertensive episode and lack of monitoring and titrating of vasoactive medications. The patient would die.

Room 1 who is waking on the ventilator, would probably self- extubate, bleed go into respiratory insufficiency and climb himself to the floor. The patient would die.

That ECMO would have already clotted off. The patient would die.

Every chronic patient would have a pressure ulcer and die from it.

Every surgical patient besides one or two that PT can get to first will have atelectasis and catch pneumonia. The patient could prolong his hospital stay and run his medical bills through the roof.

That low flow alarm on the LVAD would go unaddressed, clot off, and the patient who waited so long for a potential heart transplant would… die.

That complaint of shortness of breath would go unwarranted as the patient turns blue.

That pulseless vtach would be dismissed as another alarm fatigue. The patient would die.

The absent bowel sounds with hardening and distension would only contribute more to his creeping lactate levels. Anaerobic metabolism. The patient would need emergent surgery, if at all possible.

Long story short, you need a nurse to save your life. There is a science behind our practice. You need the nurse’s assessments to relay your concerns to the team. To help during such a vulnerable time. To build that relationship for the next 12 hours. So we can help fix you. Doctors are important, yes, but they cannot be with you at the beside all the time or ever really if you’re a regular floor. Be kind to nurses, they will help you I promise.

 

 

 

 

What you need to know to apply for CRNA school

  1. You need to be an RN.
  2. Are you ready to be broke for at least 27 months? Yes, broke because unless you wanna pull all your hair out working full time, only a per diem job is realistic for a grueling program like the CRNA one. Well, I’ve only heard so don’t quote me on it.
  3. Did you take your CCRN? Everyone who applies for CRNA school are all ICU- experienced nurses. For at least 2 years. You can start the program when your two years is up, meaning you can apply ater the end of your first year in the ICU. Everyone from the ICU’s is CCRN certified. I know, it’s almost like whatever to them, because EVERYONE has it. I recommend Laura Gisparis’s question book and her videos as study materials! 100%.
  4. What kind of ICU experience you ask? I am biased and say CTICU. When I interviewed at Columbia I would say 80% of the people who interviewed had CTICU experience. Well, because we are creme of le crop.
  5. Do you have to take a test? Duh…. it’s grad school. Can’t get off the hook that easy. Most schools require the GRE or the MAT. I recommend the Magoosh GRE prep program! They give you a nice qbank and video explanations. As well as practice tests that are much harder than the actual exam. Magoosh verbal flashcards on your mobile devices are extremely useful for knowing the frequently used words. Especially while you’re on the train or on the go. I also took all of the practice tests on Kaplan and the 5lb book of practice problems (SO HARD FOR NO REASON). I got a 70% on verbal and 60% on math. There is also a writing section. Anything above a 50% on each subject is considered competitive. So anything above a score of 350.
  6. GPA of atleast 3.0 if your experience isn’t all that great.
  7. Certain pre-reqs that vary with each school.
  8. Recommendations- atleast 3. I got mine from my first nursing manager, hi Nicole! I love you!, our ICU medical director, and a charge nurse. Just make sure it’s someone who can vouch and say nice things about you and mean it! Not something generic that they write for everyone else…
  9. Essays – why you want to be a CRNA etc.
  10. Interview! Some schools require you to have extensive clinical knowledge and others just want to get to know you as a person.

 

I think that summarizes it enough.  If you have any questions please comment below! 🙂