Has anyone attended the Army Phase II interview? Mine is at Ft. Benning on the 8th and I don't know how to prepare. Thanks!
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Army Phase II Interview
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Army Reserve Advice
Hi all,
I am an SRNA graduating in May 2017. I plan to work in NC when I finish but have also always wanted to serve in the Army Reserve for a long time now. I have no prior military experience and am at that stage where it seems now or never. Can anyone shed insight into this role? Are weekends usually spent drilling or actually providing anesthesia or both? What sort of support could a new grad expect to have...for example, is there a possibility of ending up as the only anesthesia provider during an evening on call? What about physician collaboration?
Would it be better to gain experience and then join? On the other hand completing basic officer training in between school and starting work seems ideal.
Also, any updated information on deployment frequency/duration (most info I have read is several years old). Thank you
I am an SRNA graduating in May 2017. I plan to work in NC when I finish but have also always wanted to serve in the Army Reserve for a long time now. I have no prior military experience and am at that stage where it seems now or never. Can anyone shed insight into this role? Are weekends usually spent drilling or actually providing anesthesia or both? What sort of support could a new grad expect to have...for example, is there a possibility of ending up as the only anesthesia provider during an evening on call? What about physician collaboration?
Would it be better to gain experience and then join? On the other hand completing basic officer training in between school and starting work seems ideal.
Also, any updated information on deployment frequency/duration (most info I have read is several years old). Thank you
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Bio chem
Hi!! Curious if those that have applied to Northeastern/USAGPAN recently took organic or biochem and where you took it? I have my packet in..did my application to Northeastern..Have my GRE over 300..CCRN..and 9 years ICU experience. Just missing that biochem/organic chem requirement. It says either will be accepted but I read that they prefer the biochem. If anyone has any feedback on that it would be greatly appreciated! Also, can they schedule me for my phase II interview if only thing I am missing is the Chem class? Thanks everyone!!
Kate
Kate
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USAGPAN Board
My recruiter just emailed me saying it is only showing 10 more slots available for USAGPAN program. However, I read an article on the USAGPAN site that they don't turn away any qualified candidates due to the shortage of CRNA's in the ARMY right now. Anyone else hear this??
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Mil after CRNA school
I am in the second year of my DNP program with graduation May 2018. I have a great desire to join the military and serve after graduation. My, former Army, school adviser recommended contacting the healthcare recruiters approximately one year prior to graduation. Has anyone gone through this process that might be able to offer advice or a timeline? When should I expect to be submitting my packet? Do I need to pass boards and complete credentialing prior to submitting a packet? Is a year an accurate time frame of how long this process might take?
Thank you
Thank you
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How often do Army CRNAs change duty stations?
I am hoping someone can give me some clarification on this question: How often do Army CRNAs change duty stations? My older brother is an officer and he gets moved every 2-3 years and my younger brother is enlisted and he is being moved for the first time in 5 years. Any active duty CRNAs on here what has been your experience?
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Enjoy - This Cover Virtually Everything Around Informa
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Combat Lessons Learned
For the new Army CRNAs going downrange without this background.
Patient is carried in on a litter after multiple penetrating wounds to the chest, abdomen, and extremities. You cannot get a pulseox or NIBP, especially if they don't have upper limbs. Tighten all tourniquets. Assess breath sounds, put in a needle chest decompression or chest tube if absent breath sounds. Look at the patient and put your fingers on the carotid pulse. Look at your watch and estimate the BPM based on a 15 second count. If above 120 estimate they are in Class III shock, understanding that the animal models of shock were based on animals under anesthesia that weren't in pain and terrified that they were going to die (awake patients will compensate even for severe hemorrhage with catecholamines). Place a central or IO line.
If you are going to OR and their pressure is less than 80mmHg, DO NOT INDUCE ANESTHESIA. You will kill them.
If the GCS is 7 or less you can give IM paralytics and intubate.
Strip the patient of clothes, armor, and weapons. Administer TXA on a 10 gtt/mL infusion set if it is less than 3hrs since they were wounded and extracted. Give 250mL of Tromethamine (THAM). Give Cryo. Give PRBCs as indicated. Give FFP when it thaws in 20 minutes, or fresh liquid plasma if available. IN THAT ORDER.
RATIONALE: You have limited resources. The patient is dying because they are bleeding. They are in an anaerobic metabolic state producing lactic ACID (decreasing pH) because their body is shunting blood to the central circulation at the expense of the peripheral circulation. Tourniquets have been applied as needed. Strengthen the clots with TXA. THAM is not available in the field. Hemorrhagic shock patients have already shunted blood centrally and are in metabolic acidosis. With a pH < 7.1, most of their clotting factors are ineffective. Therefore, reverse the acidosis with THAM so the clotting factors you subsequently administer will work (it permanently binds H+ unlike NaHCoO3-). Now you have stable clots and can administer acidotic PRBCs to increase oxygen carrying capacity to the vital organs. You have to do this in order. Keep the patient warm.
DO NOT use a Belmont to rapidly increase blood pressure. Your patient does not have the blood distribution to survive this if there is a defect in the vasculature. They also have shunted blood from their extremities, so the total perfused compartment is much smaller with the brain taking up more of the perfusion than normal. This is why any drug administered to the CNS has a much larger effect, and why sudden increases in BP have such significant effects on clots. This is why you don't administer a normal induction or maintenance dose of anesthesia in a trauma patient. Especially when using TIVA.
Slowly bring up the blood pressure until the surgeons identify hemorrhagic sites. Then when those sites are controlled, slowly increase the blood pressure until they identify more sites. This should be a step-wise progression unless the patient has a subsequent brain injury. In these cases, you must keep the map at least at 70mmHg at the level of the Circle of Willis despite bleeding elsewhere.
If the patient has a head injury, don't even think of practicing hypotensive anesthesia. Keep their MAP above 70. Vasopressin works the best. Administer 3% hypertonic saline and titrate to the urine output and Cushing's response. Atropine works well to counteract the bradycardia, but the skull must be open either by injury or craniectomy.
Don't give succinylcholine to a patient that has a quick clot type impregnated bandage without a dose of non-depolarizing paralytic. The fasciculations may cause the dressing to break free and the patient to bleed out before the surgery can start.
Hope this is a tool for you to use in the future.
Patient is carried in on a litter after multiple penetrating wounds to the chest, abdomen, and extremities. You cannot get a pulseox or NIBP, especially if they don't have upper limbs. Tighten all tourniquets. Assess breath sounds, put in a needle chest decompression or chest tube if absent breath sounds. Look at the patient and put your fingers on the carotid pulse. Look at your watch and estimate the BPM based on a 15 second count. If above 120 estimate they are in Class III shock, understanding that the animal models of shock were based on animals under anesthesia that weren't in pain and terrified that they were going to die (awake patients will compensate even for severe hemorrhage with catecholamines). Place a central or IO line.
If you are going to OR and their pressure is less than 80mmHg, DO NOT INDUCE ANESTHESIA. You will kill them.
If the GCS is 7 or less you can give IM paralytics and intubate.
Strip the patient of clothes, armor, and weapons. Administer TXA on a 10 gtt/mL infusion set if it is less than 3hrs since they were wounded and extracted. Give 250mL of Tromethamine (THAM). Give Cryo. Give PRBCs as indicated. Give FFP when it thaws in 20 minutes, or fresh liquid plasma if available. IN THAT ORDER.
RATIONALE: You have limited resources. The patient is dying because they are bleeding. They are in an anaerobic metabolic state producing lactic ACID (decreasing pH) because their body is shunting blood to the central circulation at the expense of the peripheral circulation. Tourniquets have been applied as needed. Strengthen the clots with TXA. THAM is not available in the field. Hemorrhagic shock patients have already shunted blood centrally and are in metabolic acidosis. With a pH < 7.1, most of their clotting factors are ineffective. Therefore, reverse the acidosis with THAM so the clotting factors you subsequently administer will work (it permanently binds H+ unlike NaHCoO3-). Now you have stable clots and can administer acidotic PRBCs to increase oxygen carrying capacity to the vital organs. You have to do this in order. Keep the patient warm.
DO NOT use a Belmont to rapidly increase blood pressure. Your patient does not have the blood distribution to survive this if there is a defect in the vasculature. They also have shunted blood from their extremities, so the total perfused compartment is much smaller with the brain taking up more of the perfusion than normal. This is why any drug administered to the CNS has a much larger effect, and why sudden increases in BP have such significant effects on clots. This is why you don't administer a normal induction or maintenance dose of anesthesia in a trauma patient. Especially when using TIVA.
Slowly bring up the blood pressure until the surgeons identify hemorrhagic sites. Then when those sites are controlled, slowly increase the blood pressure until they identify more sites. This should be a step-wise progression unless the patient has a subsequent brain injury. In these cases, you must keep the map at least at 70mmHg at the level of the Circle of Willis despite bleeding elsewhere.
If the patient has a head injury, don't even think of practicing hypotensive anesthesia. Keep their MAP above 70. Vasopressin works the best. Administer 3% hypertonic saline and titrate to the urine output and Cushing's response. Atropine works well to counteract the bradycardia, but the skull must be open either by injury or craniectomy.
Don't give succinylcholine to a patient that has a quick clot type impregnated bandage without a dose of non-depolarizing paralytic. The fasciculations may cause the dressing to break free and the patient to bleed out before the surgery can start.
Hope this is a tool for you to use in the future.
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USAGPAN
Hello everyone, hopefully this is a simple question. I am looking at applying to the USAGPAN program in september. The only catch is, unless I can find accelerated courses this summer, I will be bio/organ chem this fall. Will the program accept an application and go through the process with the understanding that I would submit a final transcript in december? Or do they require that all requirements be completed at the time of admission? I emailed the contact person, but she is out for a few weeks, according to her auto reply.
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Maximum age of CRNA's for military reserves
Does anyone know the current maximum age of acceptance for CRNA's (experienced) in the US military reserve? (any branch)
Any info is welcomed. I am 51 so I am guessing I don't have a chance, but I have been told they grant waivers for CRNA's in times of need.
Thanks,
Mike CRNA
Any info is welcomed. I am 51 so I am guessing I don't have a chance, but I have been told they grant waivers for CRNA's in times of need.
Thanks,
Mike CRNA
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"Choice" retirement
Good evening,
I was wondering if there were any active duty 66F here that would be able to give their insight as to which retirement is best for them and why? I'm lucky to be able to pick either the traditional retirement or the 401k style retirement, but do not know to what extent, my earning potential would be as a civilian. I look forward to getting your input.
I was wondering if there were any active duty 66F here that would be able to give their insight as to which retirement is best for them and why? I'm lucky to be able to pick either the traditional retirement or the 401k style retirement, but do not know to what extent, my earning potential would be as a civilian. I look forward to getting your input.
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Military CRNA Programs Available to Civilians
Does anyone know if the Air Force or Navy offers a direct accession CRNA program like the Army? I plan to apply to the USAGPAN program next year but would like to know all military options available to me.
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Question to the US Army folks
Hi there.
Currently wrapping up my ADN with aspirations of CRNA via the Army USAGPAN.
I'll keep it brief. Can the Army folks give insight as to if there is any benefit to commissioning as a reserve nurse (CC or ED), then applying to USAGPAN from reserves?
Essentially what I'm trying to do is make myself a more ideal candidate to the USAGPAN admission board by entering into the military earlier, not to mention, I do wish to join the Army for many reasons, nonetheless.
I know an Air Force CRNA through a friend and advised against this due to likelihood of being neck-deep in paperwork and likelihood of needing authorization to be released by my current command as a reserve nurse, but I'd much rather hear a no from those already in, and with respect to the correct branch!
Currently wrapping up my ADN with aspirations of CRNA via the Army USAGPAN.
I'll keep it brief. Can the Army folks give insight as to if there is any benefit to commissioning as a reserve nurse (CC or ED), then applying to USAGPAN from reserves?
Essentially what I'm trying to do is make myself a more ideal candidate to the USAGPAN admission board by entering into the military earlier, not to mention, I do wish to join the Army for many reasons, nonetheless.
I know an Air Force CRNA through a friend and advised against this due to likelihood of being neck-deep in paperwork and likelihood of needing authorization to be released by my current command as a reserve nurse, but I'd much rather hear a no from those already in, and with respect to the correct branch!
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USAGPAN 2019
Hello everyone,
I hope that 2018 will bring joy and a letter of acceptance to USAGPAN!! I certainly hope that. Please post any updates on this forum for FY19. I hope to hear from you all.
I hope that 2018 will bring joy and a letter of acceptance to USAGPAN!! I certainly hope that. Please post any updates on this forum for FY19. I hope to hear from you all.
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Enemy Combatants and the Military CRNA
I had a high school student and a USAF LPN observing me this week. The student asked some interesting questions.
"Do you ever get enemy soldiers that need surgery?"
This was an important question, because in all of my training this was never a topic we discussed. If the Army is preparing us to go to war, this should be a topic breached and solutions offered.
The first time I experienced the management of an enemy prisoner of war (EPW) was in Serbia in 2002. He admitted he was an enemy and spit at me as I tried to render aid.
The second time was in Afghanistan as a CRNA 8 years later with a combatant that was on the operation that I knew killed American Soldiers. He behaved in exactly the same way. Two theaters, years apart, same behaviors from the patients.
With our knowledge and access to medications it would be easy to simply render one of these enemy combatants into a state where they could not survive. However, when I was trying to keep this patient alive during surgery under enemy attack, I put my own body armor on him during a rocket and mortar barrage. I figured that I had taken the EPW's ability to protect himself away so it was my responsibility to protect him.
These are things that are not written in any standard publications. I only present them so that you have a reference when these situations happen to you.
"Do you ever get enemy soldiers that need surgery?"
This was an important question, because in all of my training this was never a topic we discussed. If the Army is preparing us to go to war, this should be a topic breached and solutions offered.
The first time I experienced the management of an enemy prisoner of war (EPW) was in Serbia in 2002. He admitted he was an enemy and spit at me as I tried to render aid.
The second time was in Afghanistan as a CRNA 8 years later with a combatant that was on the operation that I knew killed American Soldiers. He behaved in exactly the same way. Two theaters, years apart, same behaviors from the patients.
With our knowledge and access to medications it would be easy to simply render one of these enemy combatants into a state where they could not survive. However, when I was trying to keep this patient alive during surgery under enemy attack, I put my own body armor on him during a rocket and mortar barrage. I figured that I had taken the EPW's ability to protect himself away so it was my responsibility to protect him.
These are things that are not written in any standard publications. I only present them so that you have a reference when these situations happen to you.
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