On The Cover

Kristina Milosevski, CRNA (right), discusses case management of a craniotomy for a frontal lobe tumor under the guidance of Phil Kleinschmidt, CRNA. Milosevski was a student at Michigan State University College of Nursing (MSU), Nurse Anesthesia Program, Lansing, Michigan when the photo was taken. Kleinschmidt is a member of the Sparrow Hospital anesthesia department and a preceptor for MSU students at Sparrow Hospital, Lansing, Michigan. (Photo by Henry Talley, CRNA, PhD)

Articles

  • Alternative Use of an Oral Endotracheal Tube Fastener in a Patient with Junctional Epidermolysis Bullosa This case report describes the alternative use of an oral endotracheal tube fastener in a pediatric patient with junctional epidermolysis bullosa. The oral endotracheal tube fastener was used in a nontraditional manner to avoid contact of the oral tube and tape with the epidermis and thus prevent blistering. Postoperatively the patient exhibited minimal blistering secondary to intubation and dental treatment.
    Keywords: Epidermolysis bullosa, intubation, oral endotracheal tube fastener.
    Version: 2015;83(5):326-328. Authors: Lauren Mummert, DDS, MSD, James Jones, DMD, MSD, EdD, PhD, John Christopher, RRT
  • The Noncompete Clause and the Nurse Anesthetist: An Assessment of Knowledge, Perception, and Experience Many student registered nurse anesthetists and Certified Registered Nurse Anesthetists (CRNAs) are unaware of noncompete clauses (NCCs) in employee contracts. Business-minded CRNAs with a practical knowledge of key terms, concepts, and legal implications of NCCs are in a better position to bargain and negotiate against objectionable provisions.
    Keywords: Contractual obligations, economic pressures, noncompete agreement, noncompete clause, restrictive covenants.
    Version: 2015;83(5):329-335. Authors: Briana K. Meseroll, CRNA, DNP, MS, Nathaniel M. Apatov, CRNA, PhD, MSN, MHS, Carolyn M. Rutledge, FNP, PhD, MS
  • Far Forward Anesthesia and Massive Blood Transfusion: Two Cases Revealing the Challenge of Damage Control Resuscitation in an Austere Environment Since the beginning of Operation Enduring Freedom and Operation Iraqi Freedom, the United States military has treated more than 51,000 casualties and sustained more than 6,600 deaths. The past decade of conflict has solidified major advances in the use of blood component therapy and the liberal use of fresh whole blood during damage control resuscitation. This resuscitation strategy, combined with other strategies, has led to a 90% to 92% survival rate in US casualties.
    Keywords: Damage control resuscitation, Forward Surgical Team, fresh whole blood.
    Version: 2015;83(5):337-343. Authors: David Gaskin, CRNA, MHS, Nicholas A. Kroll, CRNA, Alyson A. Ochs, RN, Martin A. Schreiber, MD, Prakash K. Pandalai, MD
  • What to Consider Before Beginning Graduate Education: A Pilot Study The literature supports a general theme that college students lack metacognitive awareness about learning. This pilot study focused on a specific subset of learners: graduate students in a nurse anesthesia program. The study goals were to provide students with evidence-based information about wellness factors that influence learning. Additionally, the study provided the framework for future research.
    Keywords: Academic success, learning strategies, metacognitive awareness, neuroscience.
    Version: 2015;83(5):345-350. Authors: F. Scott Imus, CRNA, MSN Shari Burns, CRNA, EdD
  • Process Improvement: Addressing Attrition from the Uniformed Services University of the Health Sciences Nurse Anesthesia Program This study examined the Uniformed Services University of the Health Sciences Registered Nurse Anesthesia program to identify reasons for high attrition rates. This investigation indicated students who completed the program were younger, earned higher GPAs while completing their undergraduate bachelor of science in nursing, and achieved higher analytic and total GRE scores than did students who withdrew or were dismissed. Based on these findings, a number of important changes were made in the admission process to the USUHS RNA program.
    Keywords: Academic progression, attrition, military health system, process improvement, registered nurse anesthesia program.
    Version: 2015;83(5):351-356. Authors: LTC John Tyler Wilson, CRNA, PhD, ANC, USA, Susanne W. Gibbons, PhD, C-ANP, C-GNP, CDR Kenneth Wofford, CRNA, PhD, USN
  • AANA Journal Course: Update for Nurse Anesthetists—Part 4—Ultrasound-Guided Ankle Blocks: A Review of Current Practices Ankle blocks are routinely indicated for surgical anesthesia and postoperative analgesia of procedures involving the foot. Traditionally, ankle blocks have been performed by relying on landmark identification of nerves. The literature regarding the performance and efficacy of ankle blocks is inconsistent. This can be attributed to several variables, such as provider technique, differences in patient populations, and the type and volume of local anesthetics administered. This article provides a clarifying review of current practices.
    Keywords: Ankle blocks, landmark nerve identification, ultrasonography, ultrasound, ultrasound-guided blocks.
    Version: 2015;83(5):357-364. Authors: Christian R. Falyar, CRNA, DNAP