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The University of Cincinnati’s Nurse Anesthesia Program Student Newsletter

The Scope Issue 3

Fall/Winter 2011

Director’s Corner: A Message from Dr. Terry Ray What a great time for our program! Our program was granted a 10 year accreditation review from the Council on Accreditation for Nurse Anesthesia Educational Programs (COA). The program submitted a Self Study document in February, 2011 and was reviewed by two onsite reviewers in April. In July the program had the opportunity to respond to the reviewers’ critique. Then in October the COA Council reviewed all documentation and granted our program the maximum accreditation approval of 10 years. The next review will be 2021. This is back to back 10 year accreditation reviews granted to our program, first in 2001 and now 2011. In my opinion this reflects the top quality of our program and the dedication of the students, faculty, UC Department of Anesthesiology, and our clinical sites and coordinators. Our program remains strong thanks to the commitment and hard work of everyone involved. Also, our program’s pass rates on the National Certification Exam not only exceeded the mandatory pass rate set by the COA but our graduates exceeded the Preferred pass rates as well. Again, this is a great example of the commitment of our students and everyone involved in our program. Other exciting accomplishments of our

Inside this Issue Director’s Corner . . . . . . . .1 Fiberoptic Intubations . . .1, 6 Meet the Class of 2013 . . 2-5 OSANA review


Save the date . . . . . . . . . . . 6

program this year include a Regional Workshop set up and conducted by Jamie Furstein, CRNA, DNAP in June. This eight hour workshop gave the students valuable hands on simulation training with live models and the use of the ultrasound. The workshop will be conducted on an annual basis for each new class. The Fiberoptic Workshop conducted by Jeffrey Ruf, RNSA3 has completed a year of success and all graduating seniors have had fiberoptic experience not only in the simulation lab but in the OR as well. This workshop is ongoing. Mike Rouse, MSN, CRNA and I are working with the UC Department of Anesthesiology developing airway simulation training with new Storz airway equipment for all students. The Storz airway workshops will begin November, 2011. Our program is working with the Cincinnati Shriners’ Hospital to establish an additional clinical rotation. This rotation will be a senior elective and will allow the student to focus on pediatric burn patients. The Affiliation Agreement between the Hospital and the College of Nursing has been signed and the necessary paperwork is being submitted to the

COA. The goal is to have this clinical site ready for students January, 2012. The program has had a very successful year. This year at the National AANA Meeting in Boston our program had three posters accepted in the General Poster Session. I would like to thank everyone for their dedication to the program. I especially want to thank our students for always giving 100% effort in all of their studies and to the faculty and the UC Department of Anesthesiology for supporting our program. I wish the best of luck to our spectacular Senior class. Graduation date is December 10, 2011. I will miss them all and I must say it has been an honor to work with each individual and to witness each person become a well rounded nurse anesthesia professional. Our program looks forward to the New Year and the challenges and opportunities it will bring. We would like to extend a warm welcome to Dean Greer Glazer our new College of Nursing Dean. She will begin her tenure January, 2012. Thanks for a great year. Happy Holidays.

Fiber-optic Intubations: Tips and Techniques to Improve Glottic Visualization Instruction with advanced fiberoptic airway techniques and difficult airway experiences are often very limited. Jeff Ruf RSNA3, has lectured locally as well as statewide on his research into the difficult airway and provides this issue’s educational material. Beginning in 1895 with Gustav

Killian, a German laryngologist who is considered the founder and first to use a bronchoscope to explore the bronchi, many advances have occurred in the field of fiber optic scopes. In 1966 the first fiberoptic bronchoscope was developed. Today, many fiber optic bronchoscopes had been replaced by video chips at the distal end. Frequently many other devices (cont. p.6)

Meet the Class of 2013 Brad Adams

Erin Patrick

Hazard, KY

Atlanta, GA

Eastern Kentucky University

Miami University

SICU at University of Kentucky

SICU at University Hospital

Interests/ Past Time Favorites / Interesting Facts: Watching college football and basketball, live music/ concerts, fishing and hunting

Interests /Past Time Favorites / Interesting Facts: Running, cycling, working with Habitat for Humanity, traveling

Jeanne Childers

Kristi Thompson

Fort Wayne, IN

Lebanon, OH

Indiana University

Miami University

Experience: SICU at Indiana University Hospital for 5 years

Telemetry at Mercy Fairfield and CVICU at Saint Joseph Hospital in Lexington KY

Interests /Past Time Favorites / Interesting Facts: enjoy music of all kinds, just completed my first sprint triathalon, hanging out with friends, and traveling

Angela Dressman

Interests /Past Time Favorites / Interesting Facts: Spending time with my husband, family, and dog; reading; going to movies; hiking and camping

Indianapolis, IN

Jana Brocious

Xavier University

Hometown: New Orleans, LA and Louisville KY

Experience: MICU at University Hospital

Undergraduate: University of Louisville

Interests /Past Time Favorites / Interesting Facts: I am one of six children and I love to travel

Hayley Hemm Piqua, OH University of Cincinnati Neuro ICU at University Hospital Interests /Past Time Favorites / Interesting Facts: movie nights, volleyball, hanging out with my family, roadtrips, chocolate, meals with family, watching the Bearcats

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Experience: SICU and ER Interests /Past Time Favorites / Interesting Facts: Taught dance at University of Louisville, my daughter Lily, and trained classical pianist

Ashley Cornell Hometown: Waverly, OH Undergraduate: Eastern Kentucky University Experience: SICU at University of Louisville Hospital Interests /Past Time Favorites / Interesting Facts: Volleyball, Dave Matthews ( I have been to 33 concerts), got married July 8th

Meet the Class of 2013 Nathan Williams

Mark Gordon

Gallipolis, OH

Lexington, KY

Cedarville University

Bluegrass Community and Technical College and University of Kentucky

Firefighter/ Paramedic for 8 yrs; ICU and ER nurse at Miami Valley Hospital

Experience: ICU at Saint Joseph Hospital

Interests /Past Time FavorInterests /Past Time Favorites ites / Interesting Facts: trav/ Interesting Facts: family, eled overseas on medical sports, hunting, fishing, missions (spent 6 summers in spending time with my wife and 4 daughters (all under Zimbabwe), motorcycles, the age 6) camping, North Carolina basketball, cycling

Jason Childress Independence, KY

Kathy Kirkpatrick

Undergraduate: Northern Kentucky University

Johnson City, TN

Experience: ER and SICU at University Hospital

Experience: MICU at University Hospital

Interests /Past Time Favorites / Interesting Facts: spending time with my wife and dog, sports

Interests /Past Time Favorites / Interesting Facts: traveling, spending time with friends and family

University of Tennessee

Brittany Utter Andrew Palassis

Cincinnati, OH

Cincinnati, OH

University of Cincinnati

The Christ Hospital School of Nursing and University of Cincinnati

SICU Interests /Past Time Favorites / Interesting Facts: traveling, cooking, reading, running

Experience: CVICU at The Christ Hospital and VA Hospital Interests /Past Time Favorites / Interesting Facts: spending time with my wife and 3 dogs, running, watching Netflix, hope to complete a full iron man

Ryan Daniels Nashville, TN Indiana University Experience: CVICU Interests /Past Time Favorites / Interesting Facts: Live music, comedy, skydiving (200 jumps)

Tom Minges Cincinnati, OH College of Mount Saint Joseph CVICU at The Christ Hospital and clinical instructor for Mount Saint Joseph Interests /Past Time Favorites / Interesting Facts: spending time with my wife and 2 year old, riding motorcycles, I am an Eagle Scout and PADI scuba dive master

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Meet the Class of 2013 Grant Goodall

Tony Wehby

West Chester, OH

Cincinnati, OH

University of Cincinnati

Xavier University and College of Mount Saint Joseph

MICU at University Hospital Interests /Past Time Favorites / Interesting Facts: hiking, painting, Reds baseball, Bengals football, bowling (bowled a 299 during league play)

PICU, CICU, NICU at Cincinnati Children's Hospital and PACU at Palmetto Richland Hospital, Columbia, SC

Lexington, KY

Interests /Past Time Favorites / Interesting Facts: Reds baseball, I have been to all but 6 baseball parks, playing guitar, I have been a social worker, teacher, researcher, and nurse. I have lived in Ohio, California, North Carolina, South Carolina, and Kentucky

University of Kentucky

Cory Speakman

SICU at University of Kentucky

New Orleans, LA

Interests /Past Time Favorites / Interesting Facts: hanging out with my husband and family, UK sports, and working out

Open Heart and CVICU

Carly Brehm

University of Cincinnati

Allison Baker

Interests /Past Time Favorites / Interesting Facts: shooting, politics and my family

Union, KY

Ryan Waters

Northern Kentucky University

Cold Spring, KY

MICU and SICU at St Elizabeth Interests /Past Time Favorites / Interesting Facts: Spending time with my 2 great danes, friends, family, spinning class

Amy Nye Cincinnati, OH Xavier University Experience: 14 years in open heart ICU and medical ICU Interests /Past Time Favorites / Interesting Facts: running, reading, college football, NFL, spending time with my husband, daughter (9 years old) and son (12 years old)

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University of Oklahoma CT and Neuro units at Oklahoma University Hospital and MICU at University Hospital Interests /Past Time Favorites / Interesting Facts: hanging out with friends and my dogs, working out, golf, and watching family guy and history channel

Noah Westfall Troy, OH Wright State University SICU at Kettering Medical Center Interests /Past Time Favorites / Interesting Facts: baseball, football, working out, and going to concerts

Meet the Class of 2013

Fall OSANA meeting review

Mike Voyles Louisville, KY Murray State University OHU Interests /Past Time Favorites / Interesting Facts: strength training and conditioning

Tips to Improve Success with Fiber-Optic Intubations If you stay away from tissue and aim for the Black Hole, you will eventually reach identifiable anatomy Always try to keep your target or the object of interest (the glottic opening/carina) in the center of the camera Very small movements with the scope (centimeters at a time), this will help identify tissue as it comes into view Know your anatomy and recognize where you at all times Know your position (even if this means coming out of the airway) Knowledge of orientation of the camera Tension on the scope preventing slack (allows the user to manipulate the scope in all planes Credit: material and instruction for this edition has been obtained courtesy of Jeffrey Ruf, RSNA3, University of Cincinnati, College of Nursing, Nurse Anesthesia.

The fall OSANA meeting was held at the Hilton Columbus/Polaris over the weekend of October 7-9, 2011. The Difficult Airway was the main topic of the Fall Conference. The conference kicked off Friday afternoon with the Board of Directors meeting. Saturday morning started with Dr. Anthony Chipas PhD CRNA presenting talks entitled “Anesthesia and the Difficult Airway Awake Intubation” and “Anesthesia and the Difficult Airway Interventions below the cricothyroid membrane”. Dr. Chipas is the Program Director of the Nurse Anesthesia program at the Medical University of South Carolina in Charleston, SC. Ms. Amber Root MSN CRNA presented One Lung Ventilation and Double Lumen Tubes. Ms. Stephanie Chalikonda MSN CRNA spoke on Anesthesia in the Interventional Bronchoscopy Suite. Ms. Chalikonda is an Assistant Professor at Cleveland Clinic. Dr. John Doyle, MD presented the topic “What’s Old and New in Airway Toys”. Mr. Jeffrey Ruf BSN presented “Fiber-optic Intubations: Tips and Techniques to improve glottic visualization”. Mr. Ruf is a third year student in the Nurse Anesthesia Program at the University of Cincinnati. Saturday also included the chance to renew ACLS and PALS certifications. The OSANA business meeting and state government relations meeting were also held that afternoon. The conference concluded on Saturday with a Wine Tasting Fundraiser. The conference continued on Sunday with Ms. Maribeth Massie PhD(c) MSN CRNA presenting “The Pediatric Difficult Airway: Small Mouths, Big Problems”. Ms Massie is the Program Director at the University of New England School of Nurse Anesthesia. Following the presentation, there were airway stations with hands on demonstrations for difficult airways. Stations included a fiber-optic workshop with Jeff Ruf and Dr. Jeffrey Parker to practice fiber-optic oral and nasal intubations on mannequins, Kathy Meuti Fowler CRNA held a station using the Glidesope, double lumen tube placement station, and cricothyroidotomy using pigs’ tracheas with Tony Chipas.

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Fiber-optic Intubations: Tips and Techniques to Improve Glottic Visualization

Save The Date January 22-28, 2012 National Nurse Anesthesia Week March 3-4, 2012 KyANA Spring Meeting March 23-25, 2012 INANA Spring Meeting April 15-18, 2012 AANA Mid-Year Assembly Washington, DC May 4-6, 2012 OSANA Spring Meeting 2012 Niagara, New York August 4-8, 2012 AANA National Meeting

can be of assistance such as the Glidescope, C-mac, Fast Track LMA, or even an Eschmann. Many times a difficult airway can be anticipated by a comprehensive preprocedure anesthesia history and evaluation that may note trauma to the airway as well as anatomy that predisposes a patient to difficulty with intubation and mask ventilation while asleep. The necessity of a thorough preoperative airway evaluation and history of past intubations cannot be underestimated. Thorough patient preparation and education with the use of antisialogogues as well as mucosal vasoconstrictors at least 30 minutes preprocedure are warranted. The path to oral intubation includes preloading the endotracheal tube onto the scope handle. Insertion of the scope while maintaining tension and full extension allows for tight control and maintenance of true movement. After manipulation of the scope through the glottic opening, advance until proximal to the carina while maintaining visualization of the carina at all times. With nasal intubations, after advancement of the scope past the turbinates, the remainder of placement is similar to the oral approach. Frequently encountered problems include excessive secretions which can be decreased by early antisialagogue administration at least 30 to 45 minutes prior to procedure. Inability to keep the bronchoscope midline, loss of visualization of anatomy and landmarks by bouncing up against tissue, or even abnormal anatomy can be problematic. Many times with induction of anesthesia we create our own problems. Upper airway structures displace antero-posterior with extension and flexion of the head that follows the direction of the mandible. Soft (flaccid) tissue collapse occurs at points of narrowing producing significant airway sites of obstruction. The velopharynx is the most common site of the airway collapse during sleep. This occurs as a result of loss of central

drive by decreased cortical influences and decreased chemosensitivity. Increased propensity of airway collapse may be anticipated in the obese, in cases of macroglossia and micrognathia, neuromuscular disorders, lesions of the upper airway, as well as many others. Structural displacement maneuvers impact the anesthetist’s ability to maintain a patent airway and to visualize the glottic opening during fiberoptic nasal intubation. The jaw thrust and chin lift maneuvers have been identified as effective in improving airway patency by displacing the upper airway structures anteriorly. The jaw thrust is applied with both hands displacing the jaw upwards and anteriorly with the mouth open (Esmarch maneuver). The chin will be lifted with one hand without causing the mandible to protrude or changing head position. The teeth are in slight contact and the lips will remain open. Both chin lift and jaw thrust maneuvers displace the mandible anteriorly thereby lifting the epiglottis and exposing the glottic opening. Improved airway patency may increase visualization of the glottic opening increasing the odds of successful intubation of the trachea. Credit: material and instruction for this edition has been obtained courtesy of Jeffrey Ruf, RSNA3, University of Cincinnati, Nurse Anesthesia.

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Nurse Anesthesia Student Newsletter  
Nurse Anesthesia Student Newsletter  

Created by students in the University of Cincinnati College of Nursing Nurse Anesthesia MSN program.