Sunday, February 27, 2011

CRNA – Certified Registered Nurse Anesthetist: Another Medical Route to Consider

I’m a prior PJ and I’m currently in a CRNA program. I’m here to help any PJs thinking about pursuing a medical career in Anesthesia. When I was going through the pipeline, I was lucky enough to go through the Army’s Joint Special Operations Combat Medical Training Course. During our clinical training, we got our intubation practice in the operating rooms (OR) of big hospitals and medical centers. What I thought were anesthesiologists (MD-A) training me, were actually CRNAs. I never heard of them, and come to find out, in the general sense; they are Critical Care (ICU) nurses with a Master’s degree in Anesthesia. They are trained to provide the exact same anesthesia care as anesthesiologists, without having to obtain a medical degree.

CRNAs get paid pretty well (depends on which area of the country you work and the type of practice you’re in; which I will get into in another blog), not as high as MDAs, but high enough that you’ll be in one of the higher tax brackets. However, you do the same amount of work, if not more, than MDAs. You can compare the difference to Officers and Enlisted, CROs versus PJs. In the facility I originally trained in, there was one MDA to 4 CRNAs. The CRNAs were the ones actually in the OR providing anesthesia care to the patient having surgery. The MDA acted more as a supervisor and was only paged if the CRNA required additional help. Now this system differs between different hospitals and different states, but CRNAs are trained to do everything a MDA can do. The only real difference in terms of scope of practice in different hospital settings is what the CRNA is allowed to do.

Now the route to become a CRNA is very different than the route to become a MD. That’s not to say that becoming a CRNA is any easier, just that it requires less time, less schooling, and less cost (student loans to pay back) than going the med-school route. Getting into a CRNA program is very competitive. You still have to work hard nonetheless. But I can tell you from first hand experience, as long as you have the grades and high GPA to back up your resume, just having a PJ background will take care of the rest.

If you are interested in becoming a CRNA, you can find more information about the career and the colleges offering a CRNA program at I will post more info about the process and path to becoming a CRNA, and some extra details about the job itself in later blogs. For now, I can tell you in my experience, there is never a day where I do not look forward to coming to work at the hospital. This job will test and challenge your anatomy and physiology, as well as your pharmacology. If you have any questions or comments, just post your comments at the end of this blog. Good luck to you in your post-Pararescue medical career endeavors!


Saturday, February 26, 2011

In it for the right reasons

Hello all.
It took awhile to fully commit to the medical school path but it was important for me to ensure the road was being chosen for the right reasons. The reasons are plentiful but suffice it to say that the medical field I intend to go into affects me on a personal, everyday basis. Once the knowledge is attained I'll be able to relate to my patients on a deeper level.

I'm currently a senior in nutritional science at UofA. Aside from taking classes full-time at the U, I recently started shadowing a rheumatologist one day per week and working part-time as a tissue recovery technician. My application process is just beginning but there are some great J's that are helping me along the way.

If anybody out there is interested in studying for the MCAT I'll be on it full-time come the end of the Spring 2011 semester. I've taken two practice exams and scored as expected given the low volume of preparation. This is my first blog but I'll try to check in often and give/get a sitrep. If I can help anyone out there please feel free to contact me.

On a last note, a big hoo-ya to Checky for beginning this association. It's a great place to comm with others who have great interest in pursuing medicine. Let's spread the word and help our brothers!

Friday, February 25, 2011

Initial Admission Core Body Temperature Is a Better Predictor of Survival in Trauma Patients than Time to Normothermia.

C. Piercecchi, K. A. Snyder, R. S. Friese, J. L. Wynne, R. Latifi, N. Kulvatunyou, P. Rhee, T. O’Keeffe; University of Arizona, Tucson, AZ

Hypothermia on arrival has been shown to be a predictor of morbidity and mortality in trauma patients. No studies to date have examined the effect on outcome of the length of time taken by a hypothermic patient to achieve a normal core body temperature. Our hypothesis was that the time required to achieve normothermia is a better predictor of mortality than the initial core body temperature.

Methods: All trauma patients admitted to a surgical Intensive Care Unit (ICU) at a level I trauma center in 2008 were retrospectively analyzed to identify their presenting core body temperature in the Emergency Department (ED). For the purposes of this study we defined hypothermia as an initial temperature of less than 36 degrees Centigrade (C). Time taken to achieve normothermia was calculated from data extracted from the electronic medical record. We compared crude mortality between hypothermic and normothermic patients using Chi-square analysis, and then used a multivariate logistic regression model to adjust for confounders such as age, sex, injury severity as well as time required to achieve normothermia. Results are presented as proportions or means 6 Standard Deviation.

Results: See

In the multivariate logistic regression model, independent predictors of mortality included age, Head AIS, Injury severity score 25 or above, and temperature less than 35C. Time to achieve normothermia was NOT a predictor of mortality.

Conclusions: Even mild hypothermia of less than 36C was associated with decreased survival in trauma patients admitted to the ICU. Initial Emergency Department core body temperature was a better predictor of mortality than the length of time taken to achieve normothermia. Pre-hospital temperature conservation is an important part of trauma care, and should not be neglected.

Sunday, February 20, 2011

What NOT to do as a Doctor.

Not only are these "Doctors" committing fraud, they are doing it in broad daylight and on camera. BTW, the "patients" turning in these work notes are also committing fraud.

Fake Doctors’ Notes Being Handed Out at Wisconsin Gov. Union Rally | MacIver Institute

Saturday, February 19, 2011

Intubation Success Rates Are Similar with Rocuronium and Succinylcholine

A retrospective study of 327 patients who underwent RSI with etomidate (induction) and either of the two paralytics in an ED setting.

Overall, 113 patients received succinylcholine (median dose, 1.65 mg/kg) and 214 received rocuronium (median dose, 1.19 mg/kg).

All patients successfully intubated via direct laryngoscopy or a GlideScope.

First-attempt success rates were similar with succinylcholine and rocuronium despite a slower onset of action of rocuronium.


(You may need to be a member of Journal watch to view)

Monday, February 7, 2011

Society of Critical Care Medicines New ICU Sim

Try this self assessment of your ICU skills.