Judgement Day!

According to a new study published in the Journal of Neuroscience, our brains determine how trustworthy a face is before it’s fully perceived. This supports the notion that we judge people very quickly. We anesthesia folks, often judge people subconsciously by the numbers showing on the monitor when we walk in other rooms to give anesthesia providers’…

Should We Mask Ventilate Before Giving Muscle Relaxant?

Have you ever wondered whether we should mask ventilate before giving muscle relaxant? I know we were taught that we should attempt to mask ventilate first. But is this evidence based?  The answer is that this practice is really not evidence-based. There is a growing body of evidence suggesting that the NBD should be given…

Anesthesia Apps

We can’t live without our smartphones these days. There are several good apps I really like. The apps are particularly helpful for cases I don’t do on a regular basis. So this post is dedicated to the smart phone apps. First and for foremost, my favorite app is Vargo app, which provides case tips (it is…

Do We Administer Too Much Oxytocin?

Pitocin is the drug we love and hate.  If a laboring patient on pitocin for a long time end up in cesarean section, you often find that pitocin infusion after the baby is born is less effective in giving you the firm uterine tone. Your surgeon may ask you to give more pitocin in the…

Post Dural Puncture Headache, True or False?

Haven’t we all experienced the common blame game in OB? Patient may not even have an epidural but the nurse would still call you to evaluate thinking automatically the post-dural puncture headache. If patients have epidural placed, the assumption of PDPH is even higher. However, we the OB anesthesia providers know the headache of an OB…

The Use of Ondansetron in Reducing Hypotension After Spinal.

Often times, we have to deal with HOTN after spinal placed in obstetric patients. Patient may feel nauseated and throw up due to HOTN. Besides co-loading of crystalloid, ondansetron can be given 5-15mins prior to spinal placement to reduce the extend of HOTN. It is a cheap and readily available drug in our anesthesia cart….

How To Deal With Difficult Preceptors?

Recently, someone asked me for tips on how to deal with difficult preceptors. I have previously posted one titled Bad Chemistry: It Is not You; It Is Them.“, but I may not have specifically discussed the strategies of dealing with the difficult preceptors. We will face this type of situation everywhere we go whether at workplace…

Clinical Update on Amniotic Fluid Embolism

AFE is a rare but serious obstetric emergency. We all wish we don’t have to experience this during our career. For those of you who provide obstetric care to patients, it is crucial that we need to know what to do and how to optimize the patient when it happens. The new mortality rate is…

First Intubation

I got a comment from Ashley regarding preparing for the first clinical rotation, this post is for those of you who just started school and are going to their first clinical rotation soon. The first clinical rotation is always sweet and bitter in a sense that you are excited to start the real anesthesia training but scared…

Part II: What’s Your Differential?

I called my attending to be in the room as SpO2 dropped to 90%. We did our differential and treated according to what we thought it was the case. But SpO2 was still hovering low 90’s. BP was borderline low. Patient was young and healthy and no medical history. Good thing is that it was a…

The Attitude — the Key to Becoming A Superstar

I hope this blog finds you well. This is a lessen I learned albeit a little too late in my clinical training. I am sharing this with you hoping that you can become the superstar that I once wanted to become as a SRNA. Most of CRNAs to be are type A people, a very few…

Journey to CRNAdom

I love being a CRNA.  The journey has been long and hard.  No one told me it was going to be easy.  And no one told me how hard it’s going to be either.  One cannot fully appreciate how difficult until being in the program. I became a nurse because truthfully, I didn’t know what…

What Is Your Differential?

This is the topic I thought I knew so well, yet I failed my test. Let’s see if you can get it right. I had a lumpectomy and lymph node dissection case scheduled under MAC yesterday. We were not able to get an IV in a timely manner. My attending decided that it might be the best to do…

Bad Chemistry: It Is not You; It Is Them.

  There are always some preceptors whom you don’t look eye to eye throughout your training. They give you lots of grieves and make your life miserable.  The purpose of their existence is a test to see if you can go through the program besides the didactic part. They make you question yourself and your…

Why Am I not Getting That Specialty Rotation????!!!!

  This is the topic I have always wanted to discuss. I feel that there is a great need to let you know my experience so that you can take your stress off. As a student, we all wanted to have the best clinical rotations where we can get all those speciality rotations such as…

NCE Preparation

  Now we are finally there to take the NCE Preparation. This is THE EXAM. How do you study to pass the exam? First of all, calm yourselves. Tell yourself that you have survived the past two years in school and you are still here. You know what that means? That means you can pass…

I can see the light at the end of tunnel!!!

  I can not believe how fast time flew. It was our last semester! I can see the light at the end of the tunnel finally. Wahoo!!! No more exams from school!!! You know what that means, my friend! Sleep in on weekend and do some fun stuff with family. No more cramming for exam except preparing…

Using LMA for Preoxygenation in Morbidly Obese Patients

  When you have a morbidly obese patient that you have to induce, even with 5 minutes preoxynation, the SpO2 can drop quickly after you induce with propofol and succinylcholine. The fasciculation makes patient desaturate even quicker. The proseal laryngeal mask can be used as a conduit prior to DL in morbidly obese patients to minimize…

Ditch the Needle – Teach the Knife!

“In life-threatening airway obstruction, … an emergency cricothyrotomy is much quicker, easier, safer and more effective than any needle-based technique. I can state with confidence that there is no place in emergency airway management for needle-based attempts to establish ventilation.” This is the statement from Dr. Larson, a professor at Stanford University. You may ask…

Apneic Diffusion Oxygenation (NODESAT): A Quick Recap

We all have taken care of morbidly obese patients with BMI greater than 50 and some sick frail ICU patients who has no FRC. We all have experienced the low pitch sound of pulse oximetry immediately after induction even with adequate pre oxygenation. What can do we do about that? How can we maximize pre…

Career Longevity!

I can’t believe that I am feeling this already — tired of working?!?! I just graduated last year and joined the workforce this January. Let me count out loud: January, February, March, April, May, June, July, August, September and October. ONLY TEN MONTHS SO FAR! What is wrong with me??? I talked to a classmate…

Welcome to Behind The Drapes!

This blog site has been long in the making for a while since I started anesthesia school. I read a few blogs sites before and during I was in school where they shared their experiences as nurse anesthesia students. It was great to learn how other fellow students went through as they were on this career…