Episode 07: Anesthesia Management for Anaphylactic Shock

We all experience acute stress. Sometimes on a daily basis. In this episode Jeremy breaks down acute stress and talks about the anatomy and physiology of stress. He reviews a theory on how highly stressful situations can both physiologically and psychologically affect our thinking and performance. He also points out how a certain amount of acute stress is actually helpful.Then Jeremy discusses the meaning of BVM and how breathing, body position, visualizing success, speaking positively and motivating oneself with a mantra can help us deal with acute stress and come out on top. Got stress? BVM it!ReferencesDavid Grossman –On Combat: The Psychology and Physiology of Deadly Conflict in War and in Peace by Lt.-Col. Dave Grossman and Loren W. Christensen, PPCT Research Publications, 2004. A good site to see a representation of Grossmans’ Graph of how stress affects one’s psychological and physiological response: https://emcrit.org/emcrit/on-combat-by-grossman/Marcus, H. et al. “Practice makes perfect? The role of simulation-based deliberate practice and script-based mental rehearsal in the acquisition and maintenance of operative neurosurgical skills.” Neurosurgery vol. 72 Suppl 1 (2013): 124-30. Sanders, CW. et al. “Comparing the effects of physical practice and mental imagery rehearsal on learning basic surgical skills by medical students.” American journal of obstetrics and gynecology vol. 191,5 (2004): 1811-4. Cryder, S. et al. “Guided, motor, and mental imagery adjuncts to teaching central venous access.” AEM education and training vol. 7,2 e10867. 11 Apr. 2023, doi:10.1002/aet2.10867Hatzigeorgiadis, et al. Self-Talk and Sports Performance A Meta-Analysis. Perspectives on Psychological Science. 2011 6(4), 348–356. Tod, D., et al. Effects of self-talk: A systematic review. Journal of Sport and Exercise Psychology. 2011 33(5), 666. About The Nurse AnesthesiaWe are building a commUNITY of learning in anesthesia and critical care. We want to set you up for a successful educational jOURney by providing short, meaningful courses to accelerate your critical care and nurse anesthesia learning. It's Go Time!Sign up for The Nurse Anesthesia CoursesWe’re excited to introduce THE NURSE ANESTHESIA CRISIS MANAGEMENT SERIES! This series is designed to equip you with the tools and strategies to handle high-stakes moments in the OR and ICU. Pick it up at www.thenurseanesthesia.com  Follow us on Instagram @thenurseanesthesiaLegal DisclaimerThe Nurse Anesthesia INC. expressly disclaims any liability in connection with the use of any content in its podcasts, social media posts, and all other published content by any third party.Music by Alex Grohl Mixed & Edited by Next Day [email protected]

In Episode 15 of the Nurse Anesthesia Podcast, Jeremy and Sass dive into the pharmacological world of ketamine. They talk about all the anesthesia situations where it can be useful. They discuss the pharmacology of ketamine, appropriate dosing, what the current evidence really shows about its use with increased intracranial pressure, and how it is frequently used for analgesia. It really is the Swiss army knife of anesthetic meds!ReferencesAleksandrova LR, et al. Antidepressant effects of ketamine and the roles of AMPA glutamate receptors and other mechanisms beyond NMDA receptor antagonism. J Psychiatry Neurosci. 2017 Jul; 42(4): 222–229. Bar-JosephG, et al. Effectiveness of Ketamine in Decreasing Intracranial Pressure in Children With Intracranial Hypertension. J Neurosurg Pediatr. 2009 Jul;4(1):40-6. Farrell A, Bendo D. Perioperative Management of Severe Traumatic Brain Injury: What Is New? Curr Anesthesiol Rep. 2018; 8(3): 279–289. Ghojazadeh M, et al. Using Ketamine and Propofol for Procedural Sedation of Adults in the Emergency Department: A Systematic Review and Meta-Analysis. Adv Pharm Bull. 2019 Feb;9(1):5-11.Hashimoto K. Rapid‐acting antidepressant ketamine, its metabolites and other candidates: A historical overview and future perspective. Psychiatry Clin Neurosci. 2019 Oct; 73(10): 613–627. Jankauskas V, et al. A review of ketamine’s role in ECT and non-ECT settingsNeuropsychiatr Dis Treat. 2018; 14: 1437–1450. Liriano F, et al. Ketamine as treatment for post-traumatic stress disorder: a review. Drugs Context. 2019; 8: 212305. Merelman AH, et al. Alternatives to Rapid Sequence Intubation: Contemporary Airway Management with Ketamine. West J Emerg Med. 2019 May; 20(3): 466–471. Porter S. Perioperative ketamine for acute analgesia and beyond. Rom J Anaesth Intensive Care. 2019 Apr; 26(1): 67–73.  Sign up for The Nurse Anesthesia CoursesWe are currently developing anesthesia content! Learn more about The Nurse Anesthesia at www.thenurseanesthesia.com  Follow us on InstagramWe post about all things anesthesia. Follow us on Instagram @thenurseanesthesiaLegal DisclaimerThe Nurse Anesthesia INC. expressly disclaims any liability in connection with the use of any content in its podcasts, social media posts, and all other published content by any third party.Music by Alex Grohl Mixed & Edited by Next Day [email protected]

In this episode Jeremy and Mark focus on the cricothyroid membrane. They discuss the anatomy, sizing, vasculature and orientation of this important airway landmark. They then highlight techniques for palpating the cricothyroid membrane, and finish up with a discussion that explains how to use Point of Care Ultrasound (POCUS) to mark where exact position of this membrane is on the neck. This is an episode you won’t want to miss!ReferencesLin J, Bellinger R, Shedd A, et al. Point-of-Care Ultrasound in Airway Evaluation and Management: A Comprehensive Review. Diagnostics (Basel). 2023;13(9):1541. Published 2023 Apr 25. doi:10.3390/diagnostics13091541 Kristensen MS, Teoh WH, Rudolph SS. Ultrasonographic identification of the cricothyroid membrane: best evidence, techniques, and clinical impact. Br J Anaesth. 2016 Sep;117 Suppl 1:i39-i48. doi: 10.1093/bja/aew176. Epub 2016 Jul 17. PMID: 27432055. Rai Y, You-Ten E, Zasso F, De Castro C, Ye XY, Siddiqui N. The role of ultrasound in front-of-neck access for cricothyroid membrane identification: A systematic review. J Crit Care. 2020 Dec;60:161-168. doi: 10.1016/j.jcrc.2020.07.030. Epub 2020 Aug 13. PMID: 32836091. Journal of Anaesthesia, Volume 117, Issue suppl_1, September 2016, Pages i39–i48, https://doi.org/10.1093/bja/aew176Hung KC, Chen IW, Lin CM, Sun CK. Comparison between ultrasound-guided and digital palpation techniques for identification of the cricothyroid membrane: a meta-analysis. Br J Anaesth. 2021 Jan;126(1):e9-e11. doi: 10.1016/j.bja.2020.08.012. Epub 2020 Sep 28. PMID: 32896429.Kristensen MS, Teoh WH. Ultrasound identification of the cricothyroid membrane: the new standard in preparing for front-of-neck airway access. Br J Anaesth. 2021 Jan;126(1):22-27. doi: 10.1016/j.bja.2020.10.004. Epub 2020 Oct 31. PMID: 33131758.Siddiqui N, Arzola C, Friedman Z, Guerina L, You-Ten KE. Ultrasound Improves Cricothyrotomy Success in Cadavers with Poorly Defined Neck Anatomy: A Randomized Control Trial. Anesthesiology. 2015 Nov;123(5):1033-41. doi: 10.1097/ALN.0000000000000848. PMID: 26352376. About The Nurse AnesthesiaWe are building a commUNITY of learning in anesthesia and critical care. For anyone who wants to learn or review anesthesia concepts…we will set you up for a successful educational jOURney by providing short, meaningful courses to accelerate your nurse anesthesia learning, tackle your training, and become the successful CRNA you have always dreamed of. Let's do this together. It's Go Time!Sign up for The Nurse Anesthesia CoursesWe are currently developing anesthesia content! Learn more about The Nurse Anesthesia at www.thenurseanesthesia.com  Follow us on InstagramWe post about all things anesthesia. Follow us on Instagram @thenurseanesthesiaComments or Suggestions?We’re here to help you improve your anesthesia learning and practice, and we want to make sure our content is relevant for you. Please contact us on Instagram with suggestions.Legal DisclaimerThe Nurse Anesthesia INC. expressly disclaims any liability in connection with the use of any content in its podcasts, social media posts, and all other published content by any third party.Music by Alex Grohl Mixed & Edited by Next Day [email protected]

In today’s podcast Jeremy and Mark review several anesthesia concepts that were covered in previous episodes…specifically Malignant Hyperthermia, Pulse Oximetry, and Adrenal Crisis. As educators we know it’s important to revisit and review anesthesia concepts in order to help with long term memory retention. There’s actually a learning technique called spaced learning (or spaced repetition) where information is reviewed at increasing intervals over time, instead of being crammed in a single session. This method leverages the psychological spacing effect, where learning and retention are more effective when study sessions are spread out. And in the context of learning anesthesia concepts, spaced learning helps learners more efficiently memorize and deeply understand complex topics by reinforcing the material at various intervals, allowing for better long-term retention.Also, since all CRNAs will need to recertify their credential in the future with the NBCRNAs new MAC questions…these episodes will help with that too! ReferencesBruder EA, Ball IM, Pickett W. 2015. Single induction dose of etomidate versus other induction agents for endotracheal intubation in critically ill patients. Cochrane Database Syst Rev. doi 10.1002/14651858. Chabre O, et al. 2017. Epidemiology of primary and secondary adrenal insufficiency. Ann Endocrinol. 78(6):490-494.Chan ED, et al. Pulse oximetry: understanding its basic principles  facilitates appreciation of its limitations. Respir Med. 2013 Jun;107(6):789-99. Elisha, S., Heiner, J. S., & Nagelhout J. J. (2023). Nurse Anesthesia (7th ed.) Elsevier Saunders.Elshal MM, et al. Perfusion Index: Could It Be a New Vital Sign? Front Med (Lausanne). 2021 Oct 1;8:651909. Liu M., 2017. Perioperative steroid management. Anesthesiology, 127(1), 166-172.www.mhaus.org Yamamoto LG, et al. Nail polish does not significantly affect pulse oximetry measurements in mildly hypoxic subjects. Respir Care. 2008 Nov;53(11):1470-4. Resources/information discussed in podcastAbout The Nurse AnesthesiaFor anyone who wants to learn or review anesthesia concepts…we will set you up for a successful educational jOURney by providing short, meaningful courses to accelerate your nurse anesthesia learning, tackle your training, and become the successful CRNA you have always dreamed of. Let's do this together. It's Go Time!Sign up for The Nurse Anesthesia CoursesLearn more about The Nurse Anesthesia at www.thenurseanesthesia.com  Comments or Suggestions?We’re here to help you improve your anesthesia learning and practice, and we want to make sure our content is relevant for you. Click here to share your comments and suggestions. Legal DisclaimerThe Nurse Anesthesia INC. expressly disclaims any liability in connection with the use of any content in its podcasts, social media posts, and all other published content by any third party.Music by Alex Grohl Mixed & Edited by Next Day [email protected]

In today’s episode Jeremy and Sass start by diving into normal physiologic function of the Hypothalamic-Pituitary-Adrenal (HPA) Axis. They then review how it’s regulated and the pathology/medications that can alter the HPA Axis. After that, it’s all about the adrenal glands, and Jeremy and Sass differentiate between Acute Adrenal Crisis and Adrenal Insufficiency. They talk about why chronic steroid use puts patients at risk for Adrenal Crisis and why cortisol is necessary for proper cardiovascular function and a whole lot more. This is definitely the nuts and bolts of “What you need to know”! References1. Bruder EA, Ball IM, Pickett W. 2015. Single induction dose of etomidate versus other induction agents for endotracheal intubation in critically ill patients. Cochrane Database Syst Rev. doi 10.1002/14651858. 2. Chabre O, et al. 2017. Epidemiology of primary and secondary adrenal insufficiency. Ann Endocrinol. 78(6):490-494.3. Liu M., 2017. Perioperative steroid management. Anesthesiology, 127(1), 166-172.  About The Nurse AnesthesiaFor anyone who wants to learn or review anesthesia concepts…we will set you up for a successful educational jOURney by providing short, meaningful courses to accelerate your nurse anesthesia learning, tackle your training, and become the successful CRNA you have always dreamed of. Let's do this together. It's Go Time! Sign up for The Nurse Anesthesia CoursesLearn more about The Nurse Anesthesia at www.thenurseanesthesia.com Comments or Suggestions?We’re here to help you improve your anesthesia learning and practice, and we want to make sure our content is relevant for you. Click here to share your comments and suggestions.  Legal DisclaimerThe Nurse Anesthesia INC. expressly disclaims any liability in connection with the use of any content in its podcasts, social media posts, and all other published content by any third party.Music by Alex Grohl  

Episode SummaryNitrous oxide is one the OG of anesthesia gases and is one of three gases pipped into our anesthesia gas machine. It’s known on the anesthesia workstation by the color blue. In this episode Jeremy and Mark discuss the current use of nitrous oxide and both it’sdesirable and undesirable effects. Gear up to review or learn about the “Original Blue Gas”!Resources/information discussed in podcastYou can pick up a copy of Emergency Management in Anesthesia and Critical Care (EMACC) on Amazon, or from Elsevier:https://evolve.elsevier.com/cs/product/9780443106934?role=student     About The Nurse AnesthesiaFor anyone who wants to learn or review anesthesia concepts…we will set you up for a successful educational jOURney by providing short, meaningful courses to accelerate your nurse anesthesia learning, tackle your training, and become the successful CRNA you have always dreamed of. Let's do this together. It's Go Time! Sign up for The Nurse Anesthesia CoursesWe are currently developing anesthesia content! Learn more about The Nurse Anesthesia at www.thenurseanesthesia.comFollow us on InstagramWe post about all things anesthesia. Follow us on Instagram @thenurseanesthesiaComments or Suggestions?We’re here to help you improve your anesthesia learning and practice, and we want to make sure our content is relevant for you. Please contact us on Instagram with suggestions.Legal DisclaimerThe Nurse Anesthesia INC. expressly disclaims any liability in connection with the use of any content in its podcasts, social media posts, and all other published content by any third party. Music by Alex Grohl

This is a special episode where Jeremy & Sass talk with the one and only Dr. John Nagelhout, PhD, CRNA, FAAN. They talk with him about what it was like when he first went to anesthesia school, his transition into academics, how he gathered a group of CRNAs together to write the very first Nurse Anesthesia textbook, and the thousands of lives he’s influenced with his pharmacology lectures. There’s a reason we call him the “Grand Master of Nurse Anesthesia Education” and this is a piece of history you won’t want to miss!About The Nurse AnesthesiaFor anyone who wants to learn or review anesthesia concepts…we will set you up for a successful educational jOURney by providing short, meaningful courses to accelerate your nurse anesthesia learning, tackle your training, and become the successful CRNA you have always dreamed of. Let's do this together. It's Go Time! Sign up for The Nurse Anesthesia CoursesLearn more about The Nurse Anesthesia at www.thenurseanesthesia.com   Comments or Suggestions?We’re here to help you improve your anesthesia learning and practice, and we want to make sure our content is relevant for you. Click here to share your comments and suggestions.  Legal DisclaimerThe Nurse Anesthesia INC. expressly disclaims any liability in connection with the use of any content in its podcasts, social media posts, and all other published content by any third party. Music by Alex Grohl Mixed & Edit by Next Day podcast 

Episode SummaryThe pulse oximeter is a primary anesthesia and critical care monitor. Not only does it help identify hypoxemia, but it provides several other pieces of essential information when monitoring a patient during anesthesia and surgery. In this episode, we go over how the pulse oximeter functions, the current advantages and disadvantages, and other practical considerations that make pulse oximetry monitoring simple awesome!ReferencesWilkins MC. Residual bacterial contamination on reusable pulse oximetry sensors. Respir Care. 1993 Nov;38(11):1155-60. PubMed PMID: 10145923.Yamamoto LG, et al. Nail polish does not significantly affect pulse oximetry measurements in mildly hypoxic subjects. Respir Care. 2008 Nov;53(11):1470-4. PubMed PMID: 18957149.van Genderen ME, et al. Peripheral perfusion index as an early predictor for central hypovolemia in awake healthy volunteers. Anesth Analg. 2013 Feb;116(2):351-6. PMID: 23302972.Elshal MM, et al. Perfusion Index: Could It Be a New Vital Sign? Front Med (Lausanne). 2021 Oct 1;8:651909. doi: 10.3389/fmed.2021.651909. PMID: 34660615 Chan ED, et al. Pulse oximetry: understanding its basic principles  facilitates appreciation of its limitations. Respir Med. 2013 Jun;107(6):789-99.  PMID: 23490227Abdelnasser A, et al. Predicting successful supraclavicular brachial plexus block using pulse oximeter perfusion index. Br J Anaesth. 2017 Aug 1;119(2):276-280. doi: 10.1093/bja/aex166. PMID: 28854539. About The Nurse AnesthesiaFor anyone who wants to learn or review anesthesia concepts…we will set you up for a successful educational jOURney by providing short, meaningful courses to accelerate your nurse anesthesia learning, tackle your training, and become the successful CRNA you have always dreamed of. Let's do this together. It's Go Time!Sign up for The Nurse Anesthesia CoursesLearn more about The Nurse Anesthesia at www.thenurseanesthesia.com  Comments or Suggestions?We’re here to help you improve your anesthesia learning and practice, and we want to make sure our content is relevant for you. Click here to share your comments and suggestions. Legal DisclaimerThe Nurse Anesthesia INC. expressly disclaims any liability in connection with the use of any content in its podcasts, social media posts, and all other published content by any third party.Music by Alex Grohl 

This is our second Q&A episode and in this one, we review the anesthesia gas machine! We go over all the different pressure systems, variations in some of the anesthesia machines, we talk about some monitoring issues, and review content that falls within the anesthesia technology category…basically we talk about the stuff you will be tested on. There are sure to be some pearls you won’t want to miss!About The Nurse AnesthesiaFor anyone who wants to learn or review anesthesia concepts…we will set you up for a successful educational jOURney by providing short, meaningful courses to accelerate your nurse anesthesia learning, tackle your training, and become the successful CRNA you have always dreamed of. Let's do this together. It's Go Time!Sign up for The Nurse Anesthesia CoursesLearn more about The Nurse Anesthesia at www.thenurseanesthesia.com  Comments or Suggestions?We’re here to help you improve your anesthesia learning and practice, and we want to make sure our content is relevant for you. Click here to share your comments and suggestions. Legal DisclaimerThe Nurse Anesthesia INC. expressly disclaims any liability in connection with the use of any content in its podcasts, social media posts, and all other published content by any third party.Music by Alex Grohl Mixed & Edited by Next Day [email protected]

Episode SummaryIn today’s episode Jeremy and Sass talk about the anaphylactic shock state. They discuss the most common triggers for anaphylaxis, how it occurs at the cellular level, the signs and symptoms associated with anaphylaxis, and most important…how to manage this critical event. ReferencesMacy E. Penicillin and B-lactam allergy: Epidemiology and diagnosis. Curr Allergy Asthma Rep. 2014;14(11):476.Sadleir PHM, et al. Anaphylaxis. To neuromuscular blocking drugs: Incidence and cross reactivity in Western Australia from 2002-2011. British Journal of Anaesthesia. 2013;110(6):981-87.Dewachter P, et al. Anaphylaxis and anesthesia: controversies and new insights. Anesthesiology. 2009;111:1141-50. APSF Newsletter, June 2018.Tazazawa T, et al. Sugammadex and rocuronium induced anaphylaxis. J Anesth. 2016;30:290-97.Reber LL, et al. The pathophysiology of anaphylaxis. J Allergy Clin Immunol. 2017;140:335-48. About The Nurse AnesthesiaFor anyone who wants to learn or review anesthesia concepts…we will set you up for a successful educational jOURney by providing short, meaningful courses to accelerate your nurse anesthesia learning, tackle your training, and become the successful CRNA you have always dreamed of. Let's do this together. It's Go Time!Sign up for The Nurse Anesthesia CoursesLearn more about The Nurse Anesthesia at www.thenurseanesthesia.com  Comments or Suggestions?We’re here to help you improve your anesthesia learning and practice, and we want to make sure our content is relevant for you. Click here to share your comments and suggestions. Legal DisclaimerThe Nurse Anesthesia INC. expressly disclaims any liability in connection with the use of any content in its podcasts, social media posts, and all other published content by any third party.Music by Alex Grohl Mixed & Edited by Next Day [email protected]