From the Head of the Bed

This is the final episode of From the Head of the Bed. But wait! There’s more! We’re transitioning to an all new & improved platform & podcast: Anesthesia Guidebook! Anesthesia Guidebook is the go-to guide for anesthesia providers who want to master their craft. If you’re looking to level up, dig deep and go further, Anesthesia Guidebook is for you. Since its very beginning in 2013, From the Head of the Bed has grown into one of the most popular, listened-to podcasts on anesthesia. Anesthesia Guidebook will be even better because it puts the listener in the center of the show, as the hero of the story. Every anesthesia provider is on a journey. Some continue to grow towards greater and greater mastery & expertise. Others – and you know who I’m talking about – stagnate and keep practicing the same way they learned anesthesia in residency with very little variation. As world renowned psychologist and best-selling author on human performance and expertise, Anders Erikson, has said: “Most professionals reach a stable, average level of performance within a relatively short time frame and maintain this mediocre status for the rest of their careers.” (Erickson, 2004) Erickson’s words throw down the gauntlet for anesthesia providers. And the stakes couldn’t be higher. The most vulnerable times in our patients lives often begin when we say “hello.” We have an esteemed responsibility to meet the demand for clinical expertise & assure high functioning systems of care that our patients expect, deserve and entrust their lives to. Anesthesia Guidebook will bring you an even better podcast & platform with compelling stories, e-books and other resources built around pathophysiology, pharmacology, airway management, human performance and team dynamics, all tailored to the high stakes environment you work in. Don’t miss out! SUBSCRIBE to Anesthesia Guidebook today and continue the journey with us towards mastering your craft! References Ericsson, K. A. (2004). Deliberate practice and the acquisition and maintenance of expert performance in medicine and related domains. Academic medicine, 79(10), S70-S81.

Ben Levin, MD recently completed his residency in anesthesiology and is headed to Massachusetts General Hospital for a fellowship in critical care. In this episode, I have the privilege of speaking with Ben Levin, MD on the perioperative management of patients with left ventricular assist devices (LVADs) for non-cardiac surgery. We discuss device function, cardiac physiology, and perioperative management and monitoring of patients with LVADs. This is your podcast if you’re looking for a refresher or quick overview of managing patients with LVADs as an anesthesia provider! Dr Levin received his Master’s of Science in biomedicine and his medical degree from Tufts University Medical School. He just wrapped up his anesthesia residency at Maine Medical Center in Portland, Maine and is currently a fellow in critical care at Massachusetts General Hospital. His clinical areas of interest include cardiovascular surgery and critical care, echocardiography and mechanical circulatory support devices.   Click the above image or PDF link below to download Ben Levin’s presentation on LVADs. LVADs-with-Ben-Levin-PDF-1Download References Rogers, J. G., Butler, J., Lansman, S. L., Gass, A., Portner, P. M., Pasque, M. K., … & INTrEPID Investigators. (2007). Chronic mechanical circulatory support for inotrope-dependent heart failure patients who are not transplant candidates: results of the INTrEPID Trial. Journal of the American College of Cardiology, 50(8), 741-747. Rose, E. A., Gelijns, A. C., Moskowitz, A. J., Heitjan, D. F., Stevenson, L. W., Dembitsky, W., … & Watson, J. T. (2001). Long-term use of a left ventricular assist device for end-stage heart failure. New England Journal of Medicine, 345(20), 1435-1443.

Josh Lea, DNP, MBA, CRNA and Kelly Gallant, PhD, MSN, CRNA join me to discuss workplace incivility in anesthesia training. We discuss the role of precepting SRNAs and anesthesia residents, root causes and implications of incivility and processes for improving healthy work environments. Josh Lea, DNP, MBA, CRNA is a professor of anesthesia at Northeastern University’s Nurse Anesthesia Program and staff CRNA at Massachusetts General Hospital in Boston.  He serves on the board of the Anesthesia Patient Safety Foundation and focuses on burnout & creating healthy work environments as his area of research and publication. He has spoken extensively on the topics both nationally and internationally through his work with the Anesthesia Patient Safety Foundation and as a member of the American Association of Nurse Anesthetists (AANA) Health and Wellness Committee.  Kelly Gallant, PhD, SRNA recently completed her anesthesia training at Northeastern University in Boston. She received her Bachelor’s degree from Northeastern in 2010 and spent 8 years working in the surgical intensive care unit as a Registered Nurse while researching pediatric pulmonary hypertension and caregiver reactions as part of her PhD, which she completed at Northeastern in 2017. Kelly then returned to school to study anesthesia completing her Master of Science at Northeastern in May 2020. Kelly was the fiscal year 2019 SRNA Representative to the AANA Health & Wellness Committee. and recently contributed to a podcast here on the show about SRNA Wellness. Resources: SUBSCRIBE to the Anesthesia Patient Safety Foundation Newsletter here! Elmblad, R., Kodjebacheva, G., & Lebeck, L. (2014). Workplace Incivility Affecting CRNAs: A Study of Prevalence, Severity, and Consequences With Proposed Interventions. AANA Journal, 82(6), 437–445. Katz, D., Blasius, K., Isaak, R., Lipps, J., Kushelev, M., Goldberg, A., Fastman, J., Marsh, B., & DeMaria, S. (2019). Exposure to incivility hinders clinical performance in a simulated operative crisis. BMJ Quality & Safety, 28(9), 750–757. Neft, M., Hartgkidek, A., & Lea, J. (2017). Wellness milestone: The road to wellness: Paving the way toward a healthy work environment. AANA NewsBulletin. Mahoney, C. B., Lea, J., Schumann, P., & Jillson, I. (2020). Turnover, burnout, and job satisfaction of certified registered nurse anesthetists in the United States: Role of job characteristics and personality. AANA Journal, 88(1), 39-48. Mahoney, C. B., Lea, J., Jillson, I., & Meeusen, V. (2014). Turnover of nurse anesthetists: The similarities and differences between countries. BioMed Central Ltd. 14(2). Do you want to learn from APSF about patient safety?...

Regional anesthesia is Shane Garner’s passion and in this episode he and I talk about regional from a 10,000-foot view. We cover the fellowship programs available to CRNAs and the NBCRNA’s board certification exam in Non-Surgical Pain Management. We talk about how to dial in your regional anesthesia skills whether you’re a SRNA looking to graduate with a solid foundation or a CRNA who wants to find ways to incorporate more regional anesthesia into your career and the value you bring as an anesthesia provider. It’s all here in this quick run down on the current state of regional anesthesia. Shane Garner, MS, CRNA, NSPM-C is an anesthesia provider in Ripon, Michigan. Shane has a Bachelor of Science in Nursing from the University of Minnesota and graduated from Rosalind Franklin University with his Master of Science in Nurse Anesthesia in 2012. He went on to complete a fellowship in Advanced Pain Management at the University of South Florida before becoming board certified in Nonsurgical Pain Management through the NBCRNA (National Board of Certification and Recertification for Nurse Anesthetists). Shane is an adjunct faculty member at the University of Alabama at Birmingham’s nurse anesthesia program where he teaches on personal finance and regional anesthesia. Shane also enjoys teaching these topics at continuing education conferences for CRNAs, including Twin Oaks Anesthesia, Cornerstone Anesthesia Conferences and others. Links: University of South Florida Advanced Pain Management Fellowship NBCRNA Non-Surgical Pain Management Board Certification Exam

Shane Garner, MS, CRNA, NSPM-C & I discuss what he considers to be five keys for achieving financial independence. The keys are: 1. Set goals to live below your means. 2. Pay yourself first. 3. Avoid debt. 4. Invest in low cost index funds. 5. Educate yourself. Shane Garner, MS, CRNA, NSPM-C is an anesthesia provider in Ripon, Michigan. Shane has a Bachelor of Science in Nursing from the University of Minnesota and graduated from Rosalind Franklin University with his Master of Science in Nurse Anesthesia in 2012. He went on to complete a fellowship in Advanced Pain Management at the University of South Florida before becoming board certified in Nonsurgical Pain Management through the NBCRNA (National Board of Certification and Recertification for Nurse Anesthetists). Shane is an adjunct faculty member at the University of Alabama at Birmingham’s nurse anesthesia program where he teaches on personal finance and regional anesthesia. Shane also enjoys teaching these topics at continuing education conferences for CRNAs, including Twin Oaks Anesthesia, Cornerstone Anesthesia Conferences and others. Resources: The White Coat Investor The Boglehead’s Guide to Investing The Simple Path to Wealth

I’m joined on the show today by Kelly Gallant, PhD, SRNA and Adrienne Chavez, BSN, SRNA to talk about Student Registered Nurse Anesthetist (SRNA) wellness in light of the COVID19 pandemic. Kelly and Adrienne are the immediate past and current SRNA Representatives to the American Association of Nurse Anesthetists’ Health and Wellness Committee, with Kelly serving in 2019 and Adrienne in 2020. I caught up with them to discuss how SRNAs are facing the challenges and concerns of the COVID19 pandemic as well as advice for maintaining a positive mental attitude and resources that Kelly and Adrienne created, along with the rest of the Health & Wellness Committee, that are available on aana.com. Kelly Gallant, PhD, SRNA is wrapping up her training this spring at Northeastern University in Boston. She received her Bachelor’s degree from Northeastern in 2010 and spent 8 years working in the surgical intensive care unit as a Registered Nurse while researching pediatric pulmonary hypertension and caregiver reactions as part of her PhD, which she completed at Northeastern in 2017. Kelly then returned to school to study anesthesia and will graduate from Northeastern’s Nurse Anesthesia program with her Master of Science in May 2020. Kelly was the fiscal year 2019 SRNA Representative to the AANA Health & Wellness Committee. Adrienne Chavez, BSN, SRNA is currently training at the University of Maryland. Adrienne received two Bachelor’s of Science degrees from the University of Maryland, one in psychology and the other in nursing. She is currently enrolled in the University of Maryland’s Doctor of Nursing Practice program with an anticipated graduation date of May 2021. Most recently she worked at the National Institutes of Health as a critical care Registered Nurse. She is the fiscal year 2020 SRNA Representative to the AANA Health & Wellness Committee. Resources from the AANA Health & Wellness Committee: aana.com/covid19 – AANA developed this great resource which has answers to questions SRNAs and CRNAs are asking. The website is constantly updated to include the latest news & information relevant to the current pandemic, with topics including clinical practice, critical care management, COVID-19 employment issues, the SRNA experience and more. AANA COVID19 Well-being. This site includes CRNA-produced content on wellness related to the current pandemic, including other From the Head of the Bed podcasts and Aly McLean, CRNA’s “Mindfulness while wearing an N95 mask” video, which is also linked here. aana.com/thriveThe THRIVE initiative provides resources for the general public and AANA members in regards to career transitions related to the CRNA role. RNs looking to become nurse anesthesia students, new graduate CRNAs looking for their first job, transitioning in mid- to late-career, and retirement are all covered with a multitude of resources.  AANA COVID19 Infographic: https://www.aana.com/docs/default-source/marketing-aana-com-web-documents-(all)/2020_ppr02...

In this post, I speak to the SRNA’s who’ve been furloughed from clinical during the SARS-COV-2 pandemic. I offer advice for how to maximize down time and stay focused on moving forward towards graduation, boards and a rewarding career in anesthesia. Edmond Eger NYTimes Tribute: Grady, D.  (20 September 2017).  Dr. Edmond Eger II, 86, Dies: Found Way to Make Anesthesia Safer.  The New York Times.  Retrieved from https://www.nytimes.com/2017/09/20/obituaries/dr-edmond-eger-ii-86-dies-found-way-to-make-anesthesia-safer.html.

In this podcast, Matt Zinder, MS, CRNA, CH walks us through a fifteen-minute guided relaxation session. You need this. We need this. You should try this at home or on your lunch break at work.  But not while you’re driving.  Get to a safe place where you can close your eyes and tune out distractions.  You might fall asleep so be sure you’re in a safe place.  You might also find yourself relaxed and refreshed, ready to move forward with renewed energy and hope. Matthew Zinder, MS, CRNA, CH has worked in some level of healthcare for close to 25 years, starting as an EMT in a volunteer fire station. Matthew owns and operates the Maryland-based mobile anesthesia practice Zinder Anesthesia, LLC, that has been in business since 1984. It consists of 20 practitioners and covers 50 locations throughout the state of Maryland. Matthew speaks at many professional conferences, both nationally and internationally, involving topics such as stress management, business of anesthesia, hypnosis, and the practice of anesthesia. Matthew also has an active hypnotherapy practice that caters mainly to healthcare providers. He is the founder and director of Maryland Emergency Response, a disaster relief 501(c)(3) non-profit organization that works to aid victims following natural and/or man-made disasters. Matthew is currently the District IV director for the Maryland Association of Nurse Anesthetists. Check out Episode 60 where Matt and I talk about the stress management and mindfulness for healthcare providers in more detail. There, he also provides links to an array of resources and apps that you may find useful. Be well!

This podcast was recorded on Saturday, 21 March 2020 and is a quick run down of the Imperial College London report that was published 16 March 2020. This report dramatically shifted the public policy of the United States and Great Britain last Monday concerning the COVID19 pandemic. The Imperial College in London is one of the world’s top research universities and houses a highly regarded epidemiology research center, which produced the report, called the MRC Centre for Global Infectious Disease Analysis (MRC GIDA).  Neil Ferguson is the lead author of the report and an influential voice in the international epidemiology community… who, also this week, contracted COVID19 – more on that in a minute. The MRC Centre for Global Infectious Disease Analysis advises governments and organizations, like the World Health Organization, on global epidemiology.  They describe themselves this way:  “The MRC Centre for Global Infectious Disease Analysis (MRC GIDA) is an international resource and centre of excellence for research and capacity building on the epidemiological analysis and modelling of infectious diseases.  [We] undertake applied collaborative work with national and international agencies to support policy planning and response operations against infectious disease threats. We undertake a wide range of innovative world-class research that can make a demonstrable economic and social impact; carrying out research on emerging and endemic diseases and has a focus on ensuring modelling is translated into practical policy guidance for planning and responding to infectious disease threats.” Ferguson, N. M., et. al. (16 March 2020). Impact of non-pharmaceutical interventions (NPIs) to reduce COVID-19 mortality and healthcare demand. Imperial College. Retrieved from https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-fellowships/Imperial-College-COVID19-NPI-modelling-16-03-2020.pdf Financial Times reports on Neil Ferguson contracting COVID19 the week Imperial College’s report came out here. Wang, C., Horby, P. W., Hayden, F. G., & Gao, G. F. (2020). A novel coronavirus outbreak of global health concern. The Lancet, 395(10223), 470-473. Retrieved from https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30185-9/fulltext Lander, M., Castle, S. (17 March 2020). Behind the Virus Report That Jarred the U.S. and the U.K. to Action. New York Times. Retrieved from https://www.nytimes.com/2020/03/17/world/europe/coronavirus-imperial-college-johnson.html. van Elsland, S. L., O’Hare, R. (17 March 2020) COVID-19: Imperial researchers model likely impact of public health measures. Imperial College London News. Retrieved from https://www.imperial.ac.uk/news/196234/covid19-imperial-researchers-model-likely-impact/

CLICK THE LINK ON THE IMAGE FOR THE YOUTUBE VIDEO POWERPOINT PRESENTATION: In this episode I discuss the coronavirus pandemic with pediatric cardiac anesthesiologist, Jonathan Meserve, MD.  The audio podcast will be Dr Meserve walking us through his powerpoint presentation which is timed with the audio and can be found on the website linked in the show notes.  At the end of his presentation, we candidly discuss the impact both professionally and personally of the unfolding pandemic. You’ll here Dr Meserve walk us through the origin of the virus, common terms used to describe it, how it compares to previous Severe Acute Respiratory Syndrome or SARS viruses, its worldwide spread, signs/symptoms and treatment of active COVID19 disease, recommended containment measures for individuals and organizations, and the macroeconomic implications of the worldwide pandemic.  Dr Jonathan Meserve completed medical school at Oregon Health and Science University in 2010.  He completed a double residency program in pediatrics (Boston Children’s Hospital, 2015) and anesthesiology (Brigham and Women’s Hospital, 2015), prior to his fellowship in pediatric anesthesiology at Boston Children’s Hospital.  He currently serves as a pediatric, cardiac anesthesiologist with Spectrum Health Partners in Portland, Maine, providing care at Maine Medical Center and Scarborough Surgery Center.   Links to key resources are provided below. New England Journal of Medicine’s Coronavirus Coverage (FREE). Centers for Disease Control and Prevention Coronavirus Content. World Health Organization Coronavirus Content. Journal of American Medical Association Coronavirus Content. Grasselli, G., Pesenti, A., & Cecconi, M. Critical Care Utilization for the COVID-19 Outbreak in Lombardy, Italy: Early Experience and Forecast During an Emergency Response. JAMA.

Matthew Zinder, MS, CRNA, CH has worked in some level of healthcare for close to 25 years, starting as an EMT in a volunteer fire station. Matthew owns and operates the Maryland-based mobile anesthesia practice Zinder Anesthesia, LLC, that has been in business since 1984. It consists of 20 practitioners and covers 50 locations throughout the state of Maryland. Matthew speaks at many professional conferences, both nationally and internationally, involving topics such as stress management, business of anesthesia, hypnosis, and the practice of anesthesia. Matthew also has an active hypnotherapy practice that caters mainly to healthcare providers. He is the founder and director of Maryland Emergency Response, a disaster relief 501(c)(3) non-profit organization that works to aid victims following natural and/or man-made disasters. Matthew is currently the District IV director for the Maryland Association of Nurse Anesthetists. In this podcast, we discuss techniques for stress management and mindfulness for healthcare providers in light of the current COVID19 pandemic.  To say these are trying times for healthcare providers is an understatement.  Healthcare systems and providers have found themselves overwhelmed with COIVD19 patients in areas already hit hard or they are preparing for staff, supply and ICU bed shortages that may come as a result of the rapidly spreading pandemic.  The timeliness of Matt’s talk on stress management can’t be better and the techniques he shares are things we can start doing today to take better care of ourselves and our families. Tune in to hear Zinder walk us through techniques for stress management to help create peace of mind in these trying times. Matt Zinder has made his email address public for questions, comments or speaking engagements: zinderllc@gmail.com Meditation apps: 10% Happier – healthcare providers get a free 6 month membership in light of the pandemic. 10% Happier has guided meditation and stress management content. Email care@tenpercent.com, let them know you’re a healthcare provider and they will give you instructions for accessing the content. Insight Timer – 35,000 free guided meditations. Books (for your self-quarantined downtime): Why We Sleep by Matthew Walker, PhD 10% Happier by Dan Harris Meditation for Fidgety Skeptics by Dan Harris

Hey yall – this episode is geared to help you think about where you are and where you’re headed. I pull in some perspectives from leading psychologists, authors and explores that have helped me triangulate where I am and were I’m headed on an ongoing basis. Here’s some links to some of the resources I mention: Carol Dweck’s Growth Mindset is definitely worth reading. Anders Ericsson’s Peak is where he unpacks the concepts around deliberate practice. Here’s a link to Ray Dalio’s Principles. Check out Jeremy Jones’ Ode to Progression here. Drop in on what Dave Kalama is up to here. Listen to the whole My, Myself and I poem by G-Eazy & Bebe Rexha here.

In this episode Dr Cynthia Farina and I talk about what it means to be in the mid-to-late phase of your career as a CRNA.   Dr Farina is a CRNA from Michigan who currently serves as chair of the American Association of Nurse Anesthetists Health and Wellness Committee and the Michigan Association of Nurse Anesthetists Wellness Committee. Dr Farina completed her Bachelor of Science in Nursing at the University of Michigan, Ann Arbor and then her Master of Science in Nursing in the anesthesia track from Oakland University in 1996.  She then returned to the University of Michigan to complete her Doctor of Nursing Practice degree. Cindy currently practices full-time at a large suburban teaching hospital, where she also serves as a clinical and didactic instructor in the Oakland University-Beaumont Graduate Program of Nurse Anesthesia.  Cindy has a strong interest in creating and sharing educational material on personal and workplace wellness for CRNAs and SRNAs. In her most recent work, she has explored the topic of career phases and transitions for nurse anesthetists. You may contact Cynthia Farina, DNP, CRNA, CNE at: cindy.farina@icloud.com or via her LinkedIn profile at www.linkedin.com/in/cynthiafarina AANA Thrive: Resources for Career Stages

In this episode, Tracy Young, CRNA, MBA & CEO of YPS Anesthesia Services, provides a run down of the business of anesthesia. He discusses the origin and mission of his business, YPS Anesthesia Services, which manages staffing 450 anesthesia providers for nearly 60 endoscopy & ambulatory surgery centers and hospitals across six states in the southern US. Tracy Young, CRNA, MBA, CEO of YPS Anesthesia Services Tracy earned his Master of Science in Anesthesia (MSNA) from Texas Wesleyan University and went on to earn a Master in Business Administration (MBA) from George Washington University. The majority of his time is spent managing and growing his business. Leading YPS Anesthesia Services for nearly 20 years has provided Tracy a wealth of first hand experience in the anesthesia business world. Tracy enjoys giving back to the anesthesia community through teaching on business related issues for SRNAs at several anesthesia programs and for CRNAs through private conferences across the United States. Tracy also enjoys exploring investing in venture capital opportunities with non-anesthesia related businesses. Tracy has been a long-time active member of the Louisiana State Association of Nurse Anesthetists, serving 2-terms as the president of the association. All of this experience, coupled with Tracy’s easy-going Louisiana style, makes him one of the most sought-after expert presenters on the business of anesthesia. You don’t want to miss this podcast, which just barely scratches the surface of business topics. If you want to hear more from Tracy, check out this link to a podcast he did with Jason Duprat of the Healthcare Entrepreneur Academy. And if you can catch Tracy at one of the many conferences he presents at, you won’t be disappointed!

I had the pleasure of speaking with Dr April Bourgoin recently about vaping related lung injury. Dr Bourgoin joined us on the podcast to discuss OR Fires under her maiden name, April Ritter, back in February 2019. She recently married and has changed her name to April Ritter Bourgoin. I’m stoked she’s back to unpack the evolving epidemic of vaping associated lung injury. The Centers for Disease Control and Prevention (CDC) is referring to this as “e-cigarette, or vaping, product use associated lung injury (EVALI).” Dr Bourgoin completed both her Masters of Nursing Science (MSN) and Doctorate of Nurse Anesthesia Practice at Virginia Commonwealth University. Dr Bourgoin is also a Major in the United States Army Reserves. Prior to becoming a CRNA, she served for eight years as an active duty commissioned officer in the Army with experience as a critical care Registered Nurse and flight nurse with the 82nd Airborne Dustoff medevac team. She served two combat tours prior to transferring to the Army Reserves and returning to school for her master’s and doctorate degrees in anesthesia. In 2019, there’s been a dramatic increase in hospitalizations and numerous deaths from e-cigarette and vaping associated lung injury (EVALI). Below are links Centers for Disease Control and Prevention (CDC) pages with up-to-date information and statistics related to the outbreak as well as other resources. Resources: CDC EVALI Outbreak Website: https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease/healthcare-providers/index.html CDC Update: Interim Guidance for Health Care Providers Evaluating and Caring for Patients with Suspected E-cigarette, or Vaping, Product Use Associated Lung Injury — United States, October 2019 Walley, S. C., Wilson, K. M., Winickoff, J. P., & Groner, J. (2019). A public health crisis: electronic cigarettes, vape, and JUUL. Pediatrics, 143(6), e20182741. Maddock, S. D., Cirulis, M. M., Callahan, S. J., Keenan, L. M., Pirozzi, C. S., Raman, S. M., & Aberegg, S. K. (2019). Pulmonary lipid-laden macrophages and vaping. New England Journal of Medicine, 381(15), 1488-1489. Layden, J. E., Ghinai, I., Pray, I., Kimball, A., Layer, M., Tenforde, M., … & Haupt, T. (2019). Pulmonary illness related to e-cigarette use in Illinois and Wisconsin—preliminary report. New England journal of medicine. CDC-EVALI-Fact-SheetDownload National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Atlanta (GA): Centers for Disease Control and Prevention (US); 2014. Figure 2.1, Adult* per capita cigarette consumption and major smoking and health events,