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CRNA 127 | Nurse Anesthesia Resident

What does a day in the life of a nurse anesthesia resident look like? Wonder no more as guest host David Warren takes us on his journey and day-to-day routine. In particular, he shares what it is like as a first rotation nurse anesthesia resident. From finding housing to managing the expectations and requirements as he sets off on his first clinical rotation, David gives us a great view of how someone in his role navigates and overcomes the challenges he faces daily. He talks about exams and care plans as well as the in-betweens like setting up the operation room and administering anesthesia. Through it all, David highlights the importance of being prepared. He reflects on his positive experience and the many learning opportunities it provided. Tune in and allow David’s experience to guide you through your own journey.

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A Day In The Life Of A Nurse Anesthesia Resident With Guest David Warren

I have a very special episode lined up for you and it is part of our Guest Host Series, where I am bringing current SRNAs on the show for you as a guest host on the CSPA show. My thought process behind doing this is I wanted you to hear from a variety of current students who are at different stages of their CRNA journey, allow you to step into their world, and have them talk about what it’s like to be a current student dealing with things like difficult preceptors, different anesthesia topics, clinical topics, maybe even things like time management, stress management, things like that. I think these episodes are going to be gold and I hope you enjoy as much as I always do, learning from current students.

I know for a fact that the reason why CRNA School Prep Academy is where it is and the reason why I have learned so much is from diving all in, listening to current students along with CRNAs share a wealth of information and taking all of that information and compiling it into the system that we have created. I know you’re doing the same thing by tuning into the show week after week, developing your own method, strategy, and system for success. I hope you enjoy these guest episodes. Let’s go ahead and get into the show.

I know how painful it is to have burning questions and not have the answers. CRNA School Prep Academy has played a large role in helping mentor you along your journey to becoming a CRNA. I also equally value every single one of you because you all, in turn become mentors in the future. This is why I started Nurses Teach Nurses– Now called TeachRN! I know the power of mentorship and I have seen it change lives. I believe every individual nurse has a role to play in mentoring future generations of nurses.

Nurses Teach Nurses is the only nurse-driven marketplace for nurses by nurses and it was developed by yours truly. I, again, have a passion for mentorship and I know you do as well. If you are looking for mentorship or if you want to become a mentor, you can earn income while doing what you love, which is helping fellow nurses. Head over to TeachRN.com and learn more about how to receive or give the gift of mentorship. Now back to the show.

I’m your guest host, David Warren. In this episode, we are going to talk about what a day in the life of a nurse anesthesia resident is like, including completing my first clinical rotation. For those of you who are new to the show, welcome. Thank you for tuning in. For those of you who are repeat audience, welcome back. We appreciate you as well. A special shout-out to Jenny for welcoming me on as a CSPA guest host. My background is quite a bit different than probably anyone you are going to run across. I’ve been an emergency nurse practitioner for years prior to attending CRNA school. I’m in a front-loaded DNAP CRNA program out on the West Coast and I am halfway through my CRNA school journey.

First Rotation Nurse Anesthesia Resident

I finished my didactic phase in March of 2023. I was in that for about fifteen months and then started clinical rotations in April of 2023. I finished that. I started my second clinical rotation. I want to talk to you about what a day in the life of a nurse anesthesia resident is like as a first-rotation.  To give you a little bit of background at my clinical site, I was at a level two trauma center and I had a really good experience. I will start out by saying that. It was a good experience for a first-rotation student. I feel I got exactly what I needed out of that rotation for a first-rotation student. 

I found out where I was going to go for my first clinical rotation, to a different state, about three months before I had to be there for my actual clinical rotation. That allowed me time to find housing and all the things that come with that and plan travel, time off, all of those things. My schedule was Monday through Thursday, which was amazing, and we ran the room, whatever time the room started, 7:00, 7:30, or 8:00 until we were done. Sometimes that was 2:00 in the afternoon and sometimes that was 6:00 at night. It depended on when the room was finished as to when we would leave. These are all things that are going to vary based on what clinical site you’re at. Maybe in your program or the program you’re looking at, you don’t have to travel for clinicals.

That’s something to look into. For my program, I know that I’m going to have to travel for clinicals and that’s a given. I’m okay with that. The schedule and the types of things you do at each site are going to vary by each site. I feel like this place I went to was good for a first rotation because we got a lot of general surgery, ortho and a few pediatric patients. It’s a good place to get a good solid foundation. After I found out where I was going, I secured housing. I stayed at an Airbnb, which was 15 or 20 minutes from the hospital. It was great. I loved it. It’s a good place. Whenever I met the clinical coordinator for that particular clinical site, we went over the expectations.

Basically, the clinical coordinator sent out an email to me. It was a one-page document that detailed what the experience was supposed to be about, what we needed to do, what was expected of us, and things of that nature. For this particular clinical rotation, I was there for three months and there were going to be exams that I had to take at this clinical site, which was interesting. There were pharmacology exams and care plans that were due.

The exams were on common induction drugs that we have to know as nurse anesthesia residents and ultimately as CRNAs. Things like fentanyl, propofol, and then neuromuscular blockers like succinylcholine, Roc, Vec, and then remifentanil, Sufentanil, and alfentanil. Those were on the opioid test day or whatever it was. We did ketamine and dexmedetomidine. Those were the main drugs that we covered.

The exams were fair. It really wasn’t an exam. We would meet with the clinical coordinator and he would give us a blank sheet of paper and say, “Write down everything you know about X, Y, and Z drugs.” We did the volatile anesthetics as well as sevoflurane, isoflurane, and desflurane. He was like, “Write down everything you know about,” whatever drug it was or the class of drugs or drugs that we covered that particular day. Things like the dose, the onset, the duration, or the metabolism. All those things that we learned in CRNA school. Over the course of twelve weeks, we met once a week and discussed a drug.

We would go through and write down all of the things that we knew about the drug and then we would talk through it verbally if there were other students there. I was mainly the only student at this site. There were occasionally some other students from other programs. We would all sit together and discuss amongst ourselves the common things about those drugs. After, we would also discuss things that you may see in clinical practice that you don’t learn about in the textbook or things that are in the textbook that maybe aren’t super applicable in clinical practice. It was cool to learn it for the first time in CRNA school in the didactic phase and then in clinical to go over it as we’re using it day in and day out.

When I first got that email with all of those expectations and I saw there were exams and care plans, I was like, “Oh no. This is going to be a disaster.” It ended up working out well and it was a great rotation. People were nice and very understanding that it was my first rotation. I feel like, in that regard, it was great. The expectations were all very reasonable. That’s the layout of showing up and doing anesthesia. Outside of that, that’s what that looked like. The care plans were much similar, except it wasn’t necessarily patient-specific care plans. It was more disease-specific. We had to do a care plan for a COPD patient. What kind of anesthesia implications do you watch out for with COPD? Also, one for diabetes. What anesthesia implications do you watch out for in patients with diabetes? One was sepsis, I think.

There weren’t a full twelve care plans that we had to do. I think there were seven care plans, but it was all applicable. It was all things that we would see on a day-to-day basis of caring for patients that were undergoing anesthesia and what those implications were. Outside of the clinical arena and providing anesthesia, we had to do those things as well.

A Nurse Anesthetist prepares anesthesia medications for a patient
Nurse Anesthesia Resident: There were seven care plans, but it was all applicable. It was all things that we would see on a day-to-day basis of caring for patients that were undergoing anesthesia and what those implications were.

The pharmacology exams and the care plans are still great. I’m not knocking on it, but it was interesting when I first started to think I was going to be going back to exams and more care plans. It worked out well because that solidified the knowledge that I already had in my head. It solidified it when I could talk it out with somebody and see it in clinical practice.

Day-To-Day Life

That’s what the outside clinical duties looked like. Now, the day-to-day life, I want to take you through a day and share with you what that was like. I would usually find out the night before what assignment I would have. The clinical coordinator would text me and be like, “You’re going to be in such and such a room tomorrow with whoever X, Y, and Z CRNA.” I would text the CRNA the night before and be like, “So and so, I’m with you tomorrow.” They made sure I had access to their app. They had a particular app on the iPhone or Android that you could log into and see the OR track board for that next day. You could see what cases you were slotted to do.

I did not have access to patient-specific information the night before so I couldn’t look up my patients. I did have information like their age, gender, about the surgery, whatever surgery it was. If it was a lap chole, a lap appy, a colostomy takedown, or whatever the surgery was, that would be listed there as well. The night before, I would browse through some of my anesthesia textbooks and look up the surgical procedure to get familiar with it.

After a while, if you’re doing general surgery, you’re going to be doing some of the same procedures over and over. That was another thing for this first rotation. The clinical coordinator was like, “I want to put you in general surgery for the first six weeks so you can get used to the anesthesia machine, being in the OR, getting intubations, and all of the things.”

I had some good consistency for six weeks, which was amazing because, at the end of the six weeks, I was like, “This is good. I can do this.” It’s not like I was jumping from all these different cases on day one. In some places you’re going to go, it’s going to be like that. You may start out doing pediatric cases. You’ll jump to OB and then you’ll jump to hearts. You may not get that consistency, but that’s why I appreciated this as a first-rotation. I got good consistency from day one for six weeks straight doing a lot of general surgery like urology, GYN, robot cases, and then strict general surgery like hernias, choles, and appies.

I found it very helpful to be doing that day in and day out because you’re going to get a tube with everyone. You’re going to push induction drugs, paralyze, or reverse. You’re going to do all the things. It’s good to get your flow down on your first rotation, getting familiar with the OR and everything when you’re in a repeat environment over the course of a few weeks. I appreciated that.

Back to what I was saying. I would find out the night before and look up the patient. Not only the patient but I would look up the procedure and see if there was anything that I needed to know that was anesthesia-specific about that procedure. If you’re doing a laparoscopic case, initial abdominal insufflation with either trocar or variceal is the area where complications are most prone to happen.

You can have a venous embolism and can get a significant parasympathetic response or a vagal response with insufflation. They go very bradycardic and hypotensive. Things like that. That’s the things that I would look out for when I’m reading over the procedure the night before like, “Are there any anesthesia-specific things that I need to watch out for in this case?”

After doing general surgery for six weeks, a lot of the same cases started to reappear. I got pretty consistent with knowing what to expect and where. Still to this day, if there’s a new procedure, I’ll take a look at it the night before and see if there’s anything that I need to know or if I remember anything from my didactic training, if there are any anesthesia-specific implications for a procedure that I need to look out for.

That’s what I would do the night before. I would arrive at the hospital the next day, usually about an hour before my procedure or my surgery was scheduled to start. If I had a 7:30 start, I would be there by 6:15 or 6:30. That would give me time when I roll into the building, go to the OR, and get changed into scrubs and then I would go to pre-op and pre-op my first patient.

This particular site was an ACT site or an Anesthesia Care Team site. There were physicians and anesthesiologists who were supervising the CRNAs and the supervision was very loose because half the time, they were there if needed, but it’s not that they were in the room every time we were doing something. There were so many times that we did cases where the anesthesiologist was not around, which is fine. They were there if we needed them. The CRNA could say, “I can call up so-and-so,” and they’ll show up.

However, there were some of the anesthesiologists who knew that I was a first rotation student and who would come in on induction on every patient. This was very dependent on the particular provider. They would teach me things or give me tips and tricks as I was inducing and intubating. It depended on the provider as to who would show up there, as far as the anesthesiologist who would show up in the room and help out with the anesthesia.

A nurse anesthetist with medication in their hand and another nurse leaning over a patient on an operating table
Nurse Anesthesia Resident: It really depended on the provider as to who would show up there, as far as the anesthesiologist and who would show up to help with the procedure or with the anesthesia.

I would get to the OR, change into scrubs, and go pre-op my first patient. I would go through the typical pre-op. This takes some getting used to for sure because, as a nurse practitioner, I did plenty of patient interviews and HPIs, exams and then come up with an assessment and plan. That’s the bread and butter for a nurse practitioner working in any area.

As a CRNA student, it is a little different to go through an anesthesia preoperative assessment. This is not the format or the forum for going over an anesthesia preoperative assessment, but to get the basic idea, you want to hit the major body systems and find out if they have any medical problems. For the airway, we would ask, “Do you have any history of asthma or COPD? Do you smoke? Do you have sleep apnea? Do you wear a C-pap at night? Do you have any heart problems? Did you ever have a heart attack? Do you have any heart valve issues and wear heart rhythms? Have you ever had any stents? Can you walk? How do you get around? Can you walk a flight of stairs? Can you walk outside? Things like that.

We would go through each body system and ask those pertinent questions and then tailor our anesthetic plan to that preoperative assessment. When I would get there, sometimes the CRNA would be like, “I’ll go with you and listen.” Some of the times, they were like, “Go do the pre-op. I’ll come behind you and ask if there are any questions or sign the consent.” That’s how things would go. It was dependent on what provider I was working with as to whether or not they would come in with me and do the preoperative assessment or come behind me, follow up with the patient, and ask if there were any questions. That’s how that went.

After talking to the patient and figuring out if they had any medical problems, if there are any anesthesia implications for those medical problems or I need to alter my plan in any way, then I would come up with a plan and determine, “I’m going to do a general anesthetic. We’re going to use an ET tube, induce with X, Y, and Z drugs, or the maintenance phase. We’re going to use this gas, do TIVA, or do these regional blocks and then emergence and extubation. We’re going to give these meds. We’re going to wake up deep or all the way awake, and then we’ll extubate the patient and take them to the PACU.”

That’s how I would go through my plan. I would formulate a plan in my head. It’s not something that I would take an inordinate amount of time to do. I would literally go see the patient, look at the pre-op, and then determine the plan within the next few minutes about what I want to do for that patient. I would then go talk to the CRNA and be like, “This patient has X, Y, and Z. Here’s my plan. I want to do this and this.”

Usually, the CRNA would have some follow-up questions like, “What if you did this or would you want to do this? Have you ever tried this? Would there be any problems with doing this?” We would talk through a plan, get a plan together, and then go to the room and get the room set up. That is variable depending on what surgery you’re doing and where you’re at. We’re going to take a normal general endotracheal anesthesia case and I’ll walk through how it’s set up for that case.

SAMMTIDE

When I would get into the room, I use the mnemonic SAMMTIDE. S stands for Suction. I would always make sure I had my suction on and ready to go, especially during induction, because you don’t want to go to intubate the patient and get your view, there are goobers everywhere. Have your suction ready and make sure the suction is on.

In Airway, make sure you have airway equipment available. This is part of doing that preoperative assessment. It’s doing an airway assessment on the patient and then determining what’s the patient’s Mallampati score. Go through the LMA assessment and then determine if this person is a candidate for an RSI. Should we do a normal induction? What kind of airway equipment am I going to use? Do they need a glidescope or am I going to DL this person?

Have plans B, C, D, and E in the back of your head. If I’m DL-ing with a Miller two and I can’t get a view, what am I going to do next? What are the next steps? That goes down to a difficult airway algorithm. This is not the talk for that, but for a big-broad 30,000-foot view, have multiple plans for what you want to do for your airway. It also includes getting a tube out and making sure the cuff works, either put a stylet in it or go no stylet, whichever you prefer. Have an oral airway out ready to go like a tongue blade and then know where your adjuncts are, where your bougie is, where your LMAs are, where the glidescope is, or where your fiber optic is. I got sidetracked.

I got to use a fiber optic scope three times. It’s super interesting and very challenging. I did an asleep fiber optic on patients to practice but know where that’s at. I would encourage you, if you’re in CRNA school or a student, to ask and be like, “I want to try a fiber optic on this person.” We don’t have to do a wake fiber optic, but we can put them to sleep like we normally do and then use a fiber optic instead of doing DL or glidescope. That’s the airway equipment.

If you're in CRNA school or if you're a student, try to ask if you could try a fiber optic on this person. Click To Tweet

The first M is either for Machine or Monitor, whichever one you want to choose first. We’ll go with the machine first. Make sure a machine is on and checked. A lot of the machines now do self-check. You’ll have to initiate the self-check. Make sure the circuit is ready to go. A mask is there and your vaporizers are filled and ready to go. All those things that do a high-pressure test.

The other M is for Monitors. Make sure monitors are in the room, you have a pulse ox, blood pressure cuff, cardiac monitor, and then temperature if it’s a longer case. We would use an esophageal temp probe or a skin temp and then a bear hugger goes under monitors. I usually put it under there because of the temperature. Make sure you have a bear hugger either an upper body or lower body, depending on what surgery and where on the body you’re doing the surgery.

T for Tape. Have tape for the eyes. After you push your prop and ROC, if you do them right back to back, tape the eyes down and then you want to have tape for the ET tube you can use. I usually use paper tape for the eyes and then either the orange ET tube tape or the clear tape, whichever one you have available. I grab whatever is there.

I is for IV, so make sure you have a working IV on your patient. Pre-op should take care of that. If not, get an IV started, and then make sure you have two IV poles. There should be two IV poles in the room and little clips so you can hang the drape whenever they go when the drapes go up. D is for Drugs. Make sure you have the drugs that you would need. For standard induction, you can use fentanyl to block the sympathetic response and to block surgical stimulus to pain. You can also use esmolol to block that sympathetic response and then propofol for induction or ketamine.

There are a million things or different combinations that you can use. Have those induction drugs ready to go with your neuromuscular blocker. If you’re going to succs the patient, have succs drawn up and ready or a ROC. I will say this. If you’re doing an LMA, I found this out the hard way. If the LMA doesn’t seat and you can’t get good tidal volumes, the patient starts desatting, pull the LMA out and you try it again. Try to mask the patient and bag the patient back up, but you’re going to need to jump to a tube.

If I’m doing an LMA, I always have an ET tube and a blade out and ready to go and I have a vial of succs sitting on top of the machine with a 10 cc syringe. If I’m in that situation, nobody is having to go pull through the anesthesia cart to pull drugs. Everything is sitting right there. Pull the succs, push it, and you’re good to go. I’m only a second-year nurse anesthesia resident. That’s my tip of the day, though. Have succs and an airway ready to go if you’re using an LMA.

Have sucks and an airway ready to go if you're using an LMA. Click To Tweet

For neuromuscular blockers, have those ready to go. If you’re doing a general surgery case and you need paralysis, have extra paralysis ready to go. Have extra ROC, VEC, or something if you succ, especially have some longer acting stuff there that you can get on board as well if you need paralysis. If you don’t need paralysis, then you don’t need paralysis. If you need paralysis, then definitely have that extra available. Have your reversals and your multimodal type stuff ready to go and antiemetics like Zofran and Decadron.

Multimodal like Tylenol, Toradol, ketamine, dexmedetomidine, and those things. Sugammadex is the standard of care now, so have it ready or have your neo glyco ready to go as well whenever you’re ready to reverse. For your emergency drugs, I always mix up a bag of neo at the beginning of the day. Have neo ready to go. Sometimes, I find if I’m pushing neo all throughout the case for whatever reason, it’s easier to have a pump and a drip. Start a neo drip and you’re going to save yourself going over to the IV and giving 50 to 200 of neo every few minutes; start the drip. It’s very easy.

I always have Ephedrine ready to go as well. The thing with neo-Ephedrine is you have to watch the heart rate. You’ll get the reflex bradycardia with neo-synephrine. However, you can give 0.2 to 0.4 of glyco to treat the heart rate and then give neo. That’s a way around it or you can treat it with Ephedrine, which is direct and indirect-acting. You get the blood pressure up either way but have those emergency drugs ready.

It really depends on who you’re working with. At my first site, the only emergency drugs I had ready to go were my pressors. I would always mix up a bag of neo. I wouldn’t always mix up Ephedrine, but I knew if it was ready to go. Succs was out and ready, but I didn’t draw up anything else. I didn’t draw up atropine, epi, or any of that, but I knew where everything was, just in case.

That was another thing. After I got in the OR for the first day, I went through everything. I went through the drawer, the machine and got familiar with everything that was in the room where everything was. That’s the drugs. E is for Everything else. It’s anything else you might need. We did a lot of tap blocks and QL blocks for our general surgery patients.

Have an ultrasound in the room, have your local drawn up with your needle attached to do the nerve block, and have a nerve stimulator if you’re using nerve muscular blockers. Not everybody uses a nerve stimulator, but it’s good to have one there before you pull that ET tube and paralyze. You document that you’ve got four twitches back. It’s a personal preference thing, I feel like, for whatever CRNA you’re working with, if they want that or not. It’s always something you can ask ahead of time.

Post-SAMMTIDE

After I did my SAMMTIDE, I got my room set up and the drugs laid out. I would make sure you’re ready to go before the patient rolls back. I would uncap my syringes, lay everything out like I needed, and put the oral airway there. When the patient rolls in, I will move the IV bag over from the bed to the pole in the OR. Get the patient scooted over, get a blood pressure cuff hooked up, cycle the blood pressure, hook up pulse ox, and then cardiac monitors. I get that initial set of vital signs while I’m pre-oxygenating.

When that first blood pressure rings up, then you can start your induction. If your blood pressure is fine, you’ve pre-oxygenated for five minutes or so or some deep breaths to get your end-tidal O2 up to 60% to 80% depending on the patient. Push your induction drugs after you’ve induced and then intubate the patient and tape the tube. After I intubate, confirm placement. Listen to bilateral breath sounds. If you have misting in the tube, you have a positive end tidal for a few breaths. Inflate the cuff before you check placement.

Obviously, I’m jumping ahead here. Intubate, inflate the cuff, check placement, and then tape the tube. After that, turn the gas on and the vent on. That’s something I feel everybody forgets every now and then. You’ll leave the patient on manual or spontaneous and you look over. They’re not moving and not breathing because they’re still paralyzed, so turn the vent on. It’s the very first basic step and then titrate your gas to whatever it needs to be.

After that, I would put the bear hugger on the patient, give antibiotics, give antiemetics, start my multimodals, and then do a block, if we needed to do a block. We would do a tap block or a QL block if it is physician general surgery day. Going through the case, we would monitor the patient and then treat as necessary, like blood pressure or whatever we needed to do in that maintenance phase of anesthesia. Waking up was much of the same. We would determine what the plan for wake-up was. If we’re going to do a deep extubation, we would want to get the patient back breathing where we could pull the tube. It was the end goal.

After the procedure or the surgery is over, I would go up to the head of the bed, suction the airway well, put it in an oral airway, and then try to build the CO2 because you drive to breathe the CO2. I would turn my respiratory rate down quite a bit to turn the tidal volume down to build their end-tidal CO2 up so they would have that drive to breathe.

Once I know they’re closing fascia or they’re closing up, then I would reverse with Sugammadex. At that point, turn the patient on pressure support. If I’m doing a deep extubation, make sure I have a MAC of gas on or 1.5 MAC. It depends on who I was working with. Usually, most people were good with a MAC. There were a few people that were like, “No. You need to have 1.5 MAC to pull deep.”

It depends on who you’re working with. As long as you’re wiggling the tube and the patient is not coughing or bucking, then they’re deep enough to be deeply extubated. That’s going to vary from patient to patient. After reversing, they’re on pressure support. Let them work their way down on pressure support.

Usually, start at 10 with a trigger of 2 PEEP of 5, and then if they’re not breathing very well, work the trigger down or work their pressure up, whatever they need. If they’re taking these big giant 900 tidal volume breaths, they’re not going to breathe frequently. Drop their pressure down or even put them on spontaneous. Put them on the bag and let them breathe. The tidal volumes will start very small like 60 to 80 tidal volumes, and then it slowly build up over time and they’ll get to 200 or 300 tidal volumes within a pretty short amount of time.

The only thing you run into with trying to do deep extubations is sometimes the patient won’t get back breathing. Is the patient fully reversed? Check your twitches. Did you give Sugammadex or neo glyco? If they’re fully reversed, then you have to make a decision. Am I going to continue to wait for the patient to breathe or do I want to wake them up? Thankfully, most of the patients that I had that I deep extubated breathed fine. Eventually, you work them onto the bag. Once they’re breathing on manual or spontaneous ventilation and taking good tidal volumes, then they’re ready to be extubated.

You’re at a MAC of gas, their vital signs are stable, I would pull the tape off their eyes, suction again, and an oral airway is in. Once I pull the tube, they have something holding their soft tissues open so they don’t obstruct. Right before we suction and put the oral airway in, we would turn them to 100% FiO2, so they have some reserve.

After that, cut the gas, turn the flow up to 10, and then unhook my circuit. I hook it up to the mask, pull the ET tube, and then put the mask on the patient to make sure they’re breathing and moving. A few things you have to worry about. Laryngospasm is the most common thing. It is the place to talk about it, but not the time to talk about it, but if you can have a laryngospasm, to treat that, you can do positive pressure ventilation or Larson’s maneuver.

Those are the two most common things. As soon as you put the mask on the patient, make sure you see fogging. Look at your machine, make sure you see tidal, and then if they’re not breathing, bag them and assist the patient until they can start breathing. If they’re breathing with a tube in, they should be breathing with a mask on. It may take them a moment, but they should start back breathing. Pull the mask off, put their face mask on, and make sure you have fogging or misting. Sometimes, you have to tilt their head to the side, one side or the other. If they’re laying straight ahead, they might obstruct, but if you tilt their head to the right or left, they will usually start fogging.

A nurse anesthetist and another nurse looking at surgical tools on a table
Nurse Anesthesia Resident: As soon as you put the mask on the patient, make sure you see fogging. Look at your machine, make sure you see tidal, and, if they’re not breathing, bag them and assist the patient until they can start breathing.

After that, the stretcher comes in. You move the patient over and then off to PACU you go. We would then do the same thing. After we got to PACU, we would get the patient hooked up to the monitors in PACU, get a set of vital signs in PACU, document that, and then give a report. The report would look something like this. Usually, the OR nurse would be like, “This is such and such patient. They had XY laparoscopic cholecystectomy and four incisions.” The nurses would look at the incisions and then the anesthesia provider would give our report.

That would be something like, “This is an otherwise healthy patient. No past medical history. She was a general ET tube, easy mask, easy tube, paralyzed, and reversed with Sugammadex. She got 100 of fentanyl. She got some Precedex and some ketamine. A gram of Tylenol and fifteen of Toradol.” You would say the times of what you gave. “She got a liter of crystalloid, 20 EBL. No urine in any questions.” That’s what a simplified version of a report would look like.

Obviously, if there’s something pertinent that happened in the procedure, then you would mention that, or if there’s some weird crazy medical history, you would mention that as well. Otherwise, that’s what the report looked like. We would also talk about regional bilateral tap blocks or bilateral QL blocks. That’s what the first case would look like from start to finish. After leaving PACU, we would go right back to pre-op and see the next patient.

If the next patient hadn’t been pre-oped, I would go through that same thing. I’ll go through all those questions again, come up with a plan, and then go to the OR and quickly get things set up. Sometimes, I would set up for the next case in the first case. After the first case gets started, we’re in that maintenance phase, then I would get things set up for the next case. Get drugs drawn up and airway equipment laid out. By the time I went to go see the patient, I would come back in the room, lay everything out, and it was good to go there.

That’s what a day in the life of a nurse anesthesia resident looks like for a first or second-year nurse anesthesia resident, completing my first clinical rotation. That’s an example of a general surgery day. At this particular rotation, I did a lot of general surgery, ortho, and pediatrics. That was the mainstay of that rotation. I feel like it was a very good first rotation because we had those exams that I talked about. We had those care plans. We also had good support. Everybody was super nice, very welcoming, and very willing to teach. They wanted to teach. The CRNAs, physicians, and anesthesiologists wanted to teach. They wanted to be there. It was an overall welcoming, good environment. I had a really good experience.

That’s what my first rotation was like and what a day in the life of a nurse anesthesia resident was like. It’s what day-to-day things I did in that rotation. Thank you so much for tuning in. I hope to bring you more content in the future. My plan is to bring you experiential content like this but also to bring you some science-based content on physiology, pharmacology, and that thing as well. If you found this particular episode helpful, please comment below. Let us know what you think of it. If you have any questions, feel free to reach out to me. Thank you and I’ll see you next time.

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