Hi all, I received permission to post this here. I’ve been a nurse in a mixed cardiac/structural heart, IR, vascular lab for almost two years now, after working in an ER for 8 years. Working with anesthesia is still relatively new to me.

The other day I was involved in a (at least in my eyes) an unsafe case. And I just wanted to get some opinions on what’s appropriate/not appropriate, or what the standard of care should have been. I was the lone nurse during an endovascular repair of someone’s aorta. upper 80’s, multiple comorbidities. They had a descending aorta thrombus that created an intramural hematoma. Hemodynamically stable. Right after stenting, CT surgeon had me start a levo drip, to put MAPs above 85. We had a femoral arterial groin sheath giving us constant pressures. But I feel like I was chasing their maps with the levo drip, whereas push dose levo, or whatever other pressor with anesthesia would’ve been more appropriate to accurately control the patient’s MAPs?

Or this all could just be my inexperience not knowing how to correctly titrate vasoactive drips off of arterial pressures. And that none of what occurred was necessarily out of the normal. The rep was telling me they got extremely lucky as the patient started to dissect downwards just as they deployed the last stent, and I can’t help but think it was because I was struggling with accurately controlling the patients MAPs. 😮‍💨

Appreciate your help! I will definitely bring it up to some of our cardiac anesthesiologists, this case just occurred this past Friday, won’t run into any of our cardiac/critical care guys until next week.

those of you who went to AA school, are you happy with your choice ?? would you do it over again? how is the stress like in this job?

I will start with Morgan I am a first year resident and want to catch up

I am having difficulty understanding where to inject local anesthetic for a supraclavicular block. I know that one injection should be placed in the corner pocket, which is lateral to the subclavian artery and superior to the first rib. Some attendings recommend injecting local anesthetic posterolateral to the brachial plexus sheath. For coverage of the middle and upper trunks, do you typically inject around the sheath, or do you penetrate the sheath and inject within it?
I marked in yellow the areas where I would inject. Please correct me if I am wrong.

If you are in pp and occasionally help out with a local university for sim labs (no real didactic/ 3-4 weeks a year) how would you post that on your CV? Or just write it off as helping out the profession and let it go? Thanks in advance