What did this SRNA learn in Semester #1?

by admin

You guys! I’m not dead.  My CRNA Program HAS been busy, but the real reason I haven’t posted is because I’ve been doing social things with my free time and have become lazy with blogging.  So where am I?  I’m in my second semester Week 6 and I’ve been doing 2 clinical days per week at a large Level I Trauma Center.  I absolutely love it.  Yes, I feel stupid now and again, but I know that I am not expected to be an expert or else I would be getting paid.

Being in clinical is just like being a brand new nurse all over again- oh joy!  How well your day goes is pretty much determined by who you are working with and what types of cases you are doing.  Luckily, I have not had a bad day yet.  Most of my fellow students enjoy clinical but there are a few that dread it.  The worst part of clinical is the Care Plans that we have to complete the night before.  They are helpful for learning about our patients, the surgical procedure, and the Anesthesia Plan but they are very time consuming at first.

This blog is per request (from reader Dennis) who wanted to know what we covered first semester and to what depth.  Here we go!  It sounds like a lot but it’s manageable.

Advanced Physiology

  • Cell physiology and Homeostasis

    • Cell structure (bi-lipid membrane), intracellular signaling, types of receptors, cellular transport, homeostasis of intracellular/extracellular environment, positive and negative feedback, membrane potentials, ion pumps & channels.

  • Neurophysiology

    • Organization of central nervous system, peripheral nervous system, spinal cord neuroanatomy, cranial nerves, neuron action potential signalling, skeletal muscle anatomy, skeletal muscle contraction, neuromuscular junction, motor cortex pathway, smooth muscle anatomy, smooth muscle contraction, fight or flight vs rest and digest responses on a cellular level, sensory & motor pathways, and pain pathways.
  • Respiratory Physiology

    • Respiratory control (DRG/VRG/Pneumotaxic Center), chemoreceptor response to PCO2, pH and PO2, anatomy of the upper and lower respiratory tract, muscles of inspiration, muscles of expiration, lung volumes and capacities, dead space, lung wall compliance, chest wall compliance, elastic recoil, surfactant, Law of Laplace, Poiseuille’s Law, dynamic compression, transpulmonary pressure, transmural pressure, work of breathing, closing volume, gas exchange, pulmonary circulation, hypoxic pulmonary vasoconstriction (HPV), zones of the lungs, and pulmonary capillary dynamics

  •  Cardiovascular physiology

    • Cardiac muscle, valves, coronary arteries, cardiac cycle, volume-pressure curves, cardiac function curves, regulation of heart pumping, Frank Starling, pacemaker cells, sympathetic and parasympathetic innervation to the heart, arterial and venous function, vascular distensibility, vascular capacitance, blood flow through vessels (Pouiselle’s Law again), total peripheral resistance, mean systemic filling pressures, local control of circulation, humoral control of circulation, vasomotor center, baroreflex, bainbridge reflex, atrial chemoreceptors, cerebral blood flow, the Cushing Reaction, microcirculation and the lymphatic system.
  • Renal Physiology

    • Autoregulation of renal blood flow, tubuloglomerular feedback, stimuli for release of ADH, angiotensin II, ANP and aldosterone, renal sympathetic nerve, osmoreceptors, pressure diuresis, pressure natriuresis, regulation of osmolarity, electrolyte absorption/filtration/excretion, renal handling of HCO3- and H+ and acid/base balance.
  • Hematology

    • Blood coagulation cascade, hemostasis, and immune response.

Pharmacology of Anesthetic Agents

  • Introduction: Receptor theory, dose response curves, drug interaction, receptor regulation, pKa, drug tolerance, Phase I and II drug metabolism, enyzme induction and enzyme inhibition, pharmacokinetics and protein binding.
  • Inhalation Anesthetics: signs and stages of anesthesia (stage I-IV), MAC (minimal alveolar concentration), blood gas solubility, Sevoflurane, Isoflurane, Desflurane, Nitrous Oxide, and how the inhalation agents affect every organ system.
  • Induction Drugs: Benzodiazepines, barbituates: main drugs are Versed, Flumazenil, Propofol, Thiopental, Methohexital, Ketamine, Etomidate, and Dexmedetomidine
  • Pain: Opiates like Morphine, Meperidine, Fentanyl, Sufentanil, Alfentanil, Remifentanil, Naloxone, Naltrexone, Nalmafene and other agents like NSAID’s.
  • Muscule Relaxants: Non-depolarizing, depolarizing, reversal agents, and nerve stimulation monitoring (Train of Four, Tetanic)

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Basic Principles of Anesthesia

  • Anesthesia Gas Machine
  • Preoperative Evaluation
  • Patient positioning, fluid management, basic monitoring
  • Airway management
  • General Anesthesia vs Regional Anesthesia vs MAC Anesthesia
  • Malignant Hyperthermia
  • Crisis Scenarios (Laryngospasm, bronchospasm, anaphylaxis, etc.)

Chemistry & Physics for Anesthesia

  • Matter, mass, moles, gravity, weight, Avogadros number
  • pK and pH, Henderson-Hasselbalch Equation, acid/base disorders
  • Pressure, flow, boiling point, vaporization pressure
  • Solutions, surface tension, Fick’s Law, Henry’s Law, Graham’s Law, Law of Laplace, Poiseueille’s Law and Reynold’s number
  • Gas Laws: Dalton’s, Boyle’s, Charles’, Henry’s, Gay-Lussac’s, Ideal Gas Law
  • ECG, pulse oximetry, and end tidal CO2 monitoring
  • Electricity, radiation and LASER technology
  • Organic chemistry: bonds, chirality, naming of organic molecules

Clinical Anesthesia Practicum- Pass/Fail Course in the Simulation Lab

  • Anesthesia Gas Machine equipment check
  • Intubation using MAC and Miller blades
  • Induction sequence
  • Preoperative interview
  • Crisis Scenarios

Can you believe we learned all that in 5 months?  Whew!

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