My First Trauma in CRNA School

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Experiences Once You Get Into CRNA School

Wow where do I start? The clinical portion of CRNA school is insane! You will have so many unique experiences, it becomes hard to remember them all. Each experience helps mold you into an experienced anesthesia student that one day will graduate from CRNA school and become a Certified Registered Nurse Anesthetist. At the time it may seem stressful, but every case becomes easier and easier (Yes even the craniotomies and big cardiac cases). You really need to do a lot of these cases while you are in CRNA school, because once you’re graduated and on your own there won’t be a CRNA there to double check you. Enjoy all of these experiences even if its at 4 AM, you’re on call, and you have a Pharmacology final the next day that is worth 20% of your grade. 😉


My First Trauma in CRNA School

I still remember my first major trauma while in the clinical portion of my anesthesia program. I was on call and at home asleep, when all of a sudden my phone rings. It was the Anesthesiologist that was on call with me telling me to come in, because we have a case. We were allowed to go home after all the cases were done, which is nice, and they would just call us if they needed us come in. The MDA wouldn’t call in the CRNA late at night for a case, so it was usually just the anesthesia student and the Anesthesiologist. This was nice, because they would leave you alone to do your own things as long as the case wasn’t too bad. (You’ll see in a minute thats not always the case. Haha)

Where was I… ok so I arrived at the OR and immediately went to the main board to see what room the case was going to be in. Room 17… GREAT thats the trauma room! Normally, I would have had to come set up whichever room the case was going to be in, but since it was the trauma room I didn’t have too. We always made sure that the trauma room and C-section rooms were set up before we went home for the day. While I was walking over to OR 17, I see the Anesthesiologist, surgeon, and nurses pushing the stretcher into the OR. I still remember seeing the patient as I entered the room. He was in a motor vehicle accident, and was in pretty bad shape. His right arm and leg were completely crushed, and his left side wasn’t much better. He had lacerations all over his face, broken teeth, and was in a C collar for neck immobilization. To top it off he was awake and hadn’t been intubated by paramedics. A lot of people would freeze in this type of situation, but you have to stay focused, and do what you’ve been taught in school. I immediately switch over his oxygen to our anesthesia circuit and begin placing him on our monitors. Pulse oximeter first followed by blood pressure cuff, and finally EKG.

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After he is all hooked up, it is time for me to do my anesthesia induction. I will never forget hearing, “Better have your suction ready its going to be bloody in there.” I never thought in a million years that the Anesthesiologist was going to let me intubate this patient, due to the severity of the case. I mean I had only been in clinical for 5 months! So I push aside any nervousness I had, double checked my equipment, and grabbed my induction drugs. I used Etomidate (Amidate) instead of Propofol, because it is more cardiac stable, and doesn’t drop the blood pressure like Propofol will, especially in a hemodynamically compromised patient like this one.

Traumas like this one are considered “full stomachs” and require a Rapid Sequence Induction (RSI) and cricoid pressure to prevent any aspiration. That is something you’l learn after you get into CRNA school. Once all my medications go in, I grabbed my laryngoscope and proceeded with my intubation. The Anesthesiologist was right the patient’s mouth was very bloody. I grabbed my suction with my free hand and suctioned out the patient’s mouth, and guess what I see… VOCAL CORDS!!! It was the most beautiful site to see, because then I knew that this intubation wouldn’t be a problem. I passed the ETT through the vocal cords, checked for end tidal CO2, inflated the cuff, and placed the patient on the ventilator. “Job well done!” is what the Anesthesiologist said to me, which is always nice to hear in clinical.

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“Call Me if You Need Anything”… Wait What?

Now the patient is intubated, and I have placed him on Sevoflurane (anesthetic gas) to keep him asleep. The next thing I need to do is start a 2nd IV, place an arterial line, and check labs. I figured this would be a team effort between me and the Anesthesiologist, because thats how we have always done it. I was wrong haha! The next thing I see is him walking out of the room and saying “Call me if you need anything.” He was an older gentleman and has been doing anesthesia for over 40 years, so he is a little old school and not a lot of things rock him. This plus the fact I have proven myself to him in the past is why he felt comfortable leaving me alone in the case for awhile. So again, I push away the nerves and go back to what I learned in CRNA school.

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I placed an arterial line, so that I could keep a better eye on the patient’s blood pressure. This also allowed me to draw an arterial blood gas and other important labs that I needed. I then placed a 2nd IV so I could give blood, vasopressors, fluids, or anything else the patient needed. After about 15 minutes the results from my lab draw came back and my patient’s hemoglobin was 6 mg/dl. I wasn’t too surprised to see that it was low, because the stretcher he came up on was saturated from his injuries. The next step was to give the patient blood products, and make him more hemodynamically stable. Another indicator that he was going to need blood was that I was having to battle to keep his blood pressure up. He was very volume depleted, so I had my IV fluids wide open the entire time. This helps, but what he really needs are blood products. To help buy some time I give the patient albumin which helps act as a volume expander and pull fluid back into his intravascular space.

The blood arrives, and I immediately give him 2 units through the Level 1 blood infuser. After the 2 units are complete I drew another H&H, and it showed that his hemoglobin had come back up to 9 mg/dl. This is good news, because it means that we are heading in the right direction. I knew the patient would be losing more blood during the surgery, so I went ahead and gave two more units of PRBCs. As a result of the increase in circulating blood volume his blood pressure was starting to level out become more stable.

ICU My Old Stomping Ground

Now the surgery was finishing up, and it was time for me to call report to the ICU. After talking to the nurse that will be receiving my patient, I began to prepare the patient for transfer. I made sure that I had all my rescue medications, monitors, oxygen, ambu bag, etc. We moved the patient off the OR table onto a ICU bed and headed out. When we arrive in ICU with a patient, I made sure to help out by placing the patient on their monitors, untangling lines (lines have a mind of their own I promise!), and answering any questions the nurse had. The Anesthesiologist was with me at this point, and he had checked in on me throughout the case. We finished up any last minute charting, and finally its time to go home!

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4 AM and I’m Going Home… So I Thought.

So its 4 AM, and after a 3 hour case to say I was tired would be an understatement. The Anesthesiologist told me “Good job tonight.” and that I can go home, but after I set up the trauma room, haha! I finish up the trauma room, and walk out to my car with the only thing on my mind being my bed. I get in my car, and before I even put the keys in the ignition my phone rings. A phone call this time of night only means one thing… another case! I answer and I hear, “Come on back we have a stat c-section.” I guess my bed is going to have to wait a little while longer. So I get out of my car and head back to the OR for a stat C-section, which was another crazy case… but thats another story. 😉

C. Thomas CRNA
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Interested in Getting Into CRNA School?

If this anesthesia student’s story has inspired you to get into CRNA school and become a Certified Registered Nurse Anesthetist, then please check out You Want to Be a Certified Nurse Anesthetist.” Everything you need to know about applying to CRNA school can be found on our website. CRNA Career Pro continues to be the leading resource for CRNA school applicants. If you have any questions please contact us.

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