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Transcription AA

Dr. Llalando Austin

Before we get started I want to tell you guys that I love an interactive audience ok so if I pose

questions to you feel free to raise your hands or provide feedback. I want to start by asking you

guys how many of you know or can tell me what the job description of an anesthesiologist

entails? Anyone in the audience? Usually the people in the front are the ones that are all over it

and the ones in the back are like I’m here for a reason. Well how about this gentleman back

here? Ok. Alright. Loosely. I’d say that I agree with you 100% but yes an anesthesiologist is

basically a physical. These are people that have gone to medical school, whether it is allopathic

or osteopathic in nature. The went to school for four years. Went further to complete their

residency in anesthesia to be licensed as anesthesiologists. By a raise of hands in here how many

of you have hear of a Certified Nurses Anesthetists, or a CRNA? Alright that’s most of you guys

I’d say, maybe about 50% of the class. Now here’s a big question, how many of you have heard

of an Anesthesiologist Assistant or an AA? Much greater than I anticipated. And we’ll get into

the difference between those three as we move forward but I want to start and open with

basically a little video for you guys.

VIDEO (2:14)

My toes are cold why can I feel them? When does the anesthesia kick in? Wait! Wait a minute!

That burns. Why am I feeling this? Check that out…omg what are you doing? Stop please! I can

feel that! This must have been done with a serrated knife. Stop please! The carver never used a

serrated knife before did he? Doesn’t he like precision? I told you she did this to herself. It looks

like she used a grapefruit knife. Who cares what it was, shit head?! Stop! I can feel it! I can feel

the pain! I can’t take it anymore. Stop please!

END VIDEO (4:15)

Alright. So an episode here of Nip/Tuck. How many of you can maybe point out some

things that you saw in this video just now. Anything you noticed-good or bad? Ok good. The

physicians or whomever these individuals were. Anything else? So this is an example clearly of

something that happens in anesthesia but it happens very infrequently…and that is awareness

under anesthesia. What you learn in a program such as this one is how to effectively manage

your patients in a perioperative environment alright?

Slide 1 [05:21]

So as we mentioned before there are three recognized anesthesia care providers and these

three anesthesia care providers are recognized by CMS for reimbursement purposes and also by

the federal government. The anesthesiologist was the first one I mentioned that individual who

had completed medical school and moved on to complete their residency. Anesthesiology

Assistant, however, which is this specific program, is an individual who has completed an

undergraduate degree, much like you all are doing right now, in some discipline. Now that

discipline doesn’t have to be any specified discipline. However, these individuals do need to go

back and complete the pre-med course work if they have not already done so. And what pre-med

course work am I speaking of? The same coursework that would be required to get into medical

school. So your chemistries, biologies, we’ll get into these as we move forward. And after you

meet the admissions requirements of getting an undergraduate degree, completing the pre-med

coursework, you then go on to anesthesia school which is approximately twenty-seven months of

duration depending on what school you attend. Nurse Anethetists, or Certified Registered Nurse

Anesthetist, I don’t’ know if that’s going to be a test question or not, hopefully if there’s a test

question it will be about AA specifically, CRNA on the contrast is an individual that has a

Bachelor of Science in Nursing, goes on to work in the field of nursing in critical care or at least

one year of critical care experience prior to applying to anesthesia school which is specific to

those individuals that have degrees. Same amount of duration, it’s about 27 or 28 months. Some

as high as 30 months or so but approximately the same. If at any point in time even during the

presentation feel free to ask away.

Slide 2 [07:26]

So an anesthesiologist, or you’ll hear the term ‘anesthesia care team’ and this team is a

model that we follow which basically means that to work in the anesthesia care team model,

there are all three of those anesthesia care providers that you just learned of, so an

anesthesiologist typically does the supervising. They’re usually supervising CRNAs or AA at

about 4 at a time. So you can see how this is a cost-effective practice, right? The cost that it

would take to hire one single anesthesiologist who can only work in one room at a time, for that

equivalent cost you can likely hire at least three CRNAs or AA which can obviously cover three

times the rooms.

Slide 3 [08:20]

But we work under the direction of the Anesthesiologist, meaning he’s our supervisor.

And I guarantee you if any of you guys have already or if you will, and hopefully you won’t, but

if you’re having some sort of surgical procedure or have, more than likely, I’d probably say

there’s about a 90% chance that your anesthesia was provided by a CRNA or an AA. Because

again, like I said, Anesthesiologists do mostly supervisory type work. Programs such as this one

will train you extensively in all things in the peri-operative realm inclusive of effective and

adequate monitoring of a patient during surgery. Well that face looks familiar. This is from an

older brochure, I don't know it looks like somebody knows what they’re doing maybe. But

currently there are a total of ten AA programs. Ten schools that have AA programs. Now I’ll tell

you that the AA concept originally began in the late 60’s and from that point until 2006, there

were only three schools. Since 2006 when Nova brought…err..the concept of a program at Nova.

From 2006 to today, an eight year span, there has been a 200% increase of growth in AA

programs. So currently there are ten AA schools. There are two that affiliated with the school

that I’m speaking to you from. Nova Southeastern University has their main campus in Ft.

Lauderdale and also where our original AA program was established. Then we also have this

program which is actually located in the Brandon/Tampa area. So there’s only two schools in

Florida, lucky for you there’s one that’s pretty much in your backyard. We have one school in

Connecticut, we have a school at the University of Colorado, there are two schools in Georgia;

Emory and South, there is one school in Missouri-University of Missouri Kansas City and a few

others. All ten of these schools are CAAHEP accredited programs and also accredited by a

subset of CAAHEP, which is the ARCAA or the Accreditation Review Committee for AA

programs. So our roles as anesthesia care providers is basically to manage a patient

perioperatively, which is surrounding the operative environment, perioperatively. So we will

obviously monitor patients preoperatively, entraoperatively, and postoperatively. Now I pose a

question to you or multiple questions. Anyone tell me maybe what an anesthesia care provider or

an AA do in a preoperative realm? One back here-I love the back. Ok absolutely. We want to

assess when the patient last had something to eat. Do you know why that may be important? No?

Ok absolutely…anything in the stomach can obviously come out of the stomach and there are a

number of reasons why that may happen. There was one comment back here as well. Say that

again? Mmkay. So we definitely in the preop environment we will assess multiple things that

will delineate exactly how much anesthesia we can give to a patient. So we want to know the

patient’s height, weight, how sick they are, how healthy they are, to know if they have any

allergies, which would obviously forbid us from using certain types of drugs and anesthetics. The

patient has an IV placed usually we conduct the preop interview which gives us all of this

information. Alright. Anyone have any idea of what we would di intra operatively? Which is

during the procedure? This side of the room? Ok so you’re monitoring the amount of anesthesia

a patient is receiving and you’re also monitoring a number of other things. Vital signs tells us

everything we need to know about the patient. And I think you had a comment. Same thing.

Right. Very good. And there’s a number of things obviously that can point us in the direction of

whether that patient is having some discomfort or not. Postoperatively. What we do as anesthesia

care providers post-operatively, after surgery. Pain management is a big one. So yes the residual

anesthetic, whatever it may be, needs to be eliminated from their system via some means. And

this depends on how we give it to them. If we give them an IV drip, then it just has to be

redistributed. If they get it in a gas, then we eliminate it the same way we gave it to them via

them breathing it in they need to expire it out. And that is approximated by many things. For

instance, that individuals’ respiratory rate. So you guys seem to have a pretty good understanding

so far of what things would be expected in these various phases. Now the intraoperative phases

has three phases itself. There is induction, there is maintenance and there is emergence. And this

usually you’ll hear some people describe this as like flying a plane. So there’s a takeoff where

it’s a lot of busy work, usually. And then when you reach altitude, or the maintenance phase, and

if everything goes well we do absolutely well….we do minimal to our patients. We monitor our

patients and if you’re perfect we’re on cruise control. Then there’s the landing for us, which is

emergence, or waking the patient up from anesthesia. And much of our titration and control of

many of the things we use in anesthesia, you will really see requires art. Similar art that you

would expect to see while flying a plane

Slide 4 Video Two [02:37]

So where do we work? As AAs we can work basically anywhere in the hospital. Anywhere and

everywhere. And you’ll find that this is one fo the areas in anesthesia that I feel that is maybe

one of my preferred options or areas is that I can come in to work, do pediatrics one day I can do

cardiac case one day, neurosurgery another day…and even if you work in the same area of

anesthesia or surgery, no two patients are alike. So that, in and of itself, mandates, you treat each

patient with their own individual considerations. So that is one of the benefits and things that I

loe so much about my job is that there’s so much variety. It’s not like a call center, it’s not like I

can establish a routine of everything I’m going to do with my day because that can easily be

thrown off by one or two different things. Areas that we can work in: general surgery, pediatrics.

General surgery is going to be like if a patient comes in to have their gallbladder or appendix

removed or any type of laparoscopy or something of that nature. Pediatrics are kids. Anything 18

and under is a kid. SO some of them are really big. Obstetrics and Gynecology, you can also

work in open heart surgical procedures, ENT procedures which is otolaryngology, and

neurosurgery which would be inclusive of spine procedures and anything to do with the brain or

skull for various reasons, maybe tumor, bleeding, further, we can work in orthopedics which is a

very popular area of anesthesia because you get to do a lot of different things. Not only do you

get to provide general anesthesia, which is what you guys generally think of when you think

about anesthesia: put the patient to sleep, wake the patient up, and take them to recovery. But in

this area, you can also do peripheral nerve blocks which is just numbing one extremity or

specified body parts. We can do epidurals, we can do spinals. All of that would be taught in a

program like this one. And actually for the past three weeks we’ve been teaching our current first

year students neuraxial anesthesia which are epidurals and spinals and they’ve already gone into

clinical rotation and had the opportunity to do them so they’re leaning very quickly. General

ophthalmology are your general eye procedures, vascular surgery, thoracic surgery. I love

thoracic surgery and after I finished anesthesia school this was pretty much my specialty.

Thoracic and neuro surgery. Which I like is because there was this ability for us to use this

specific airway adjunct which allowed us to ventilate only one lung while not ventilating the

other so that the surgeon can work on the lung that we’re not ventilating and we can still breathe

for the patient with one lung so this is very exciting stuff. Transplants, trauma, you name it.

Pretty much anything that comes into the ER, at some point, if it’s severe enough, probably will

be required to come to the operating room. OK if it’s a car accident, or someone’s shot or

someone’s stabbed or any of these things

Slide 5 VIDEO TWO [06:13]

So as I mentioned before the requirements for our program are that tyou have a

bachelor’s degree. And this bachelor’s degree is not a specified concentration as I mentioned. It

can be in anything. Food Science. Engineering. Biology…any of these things. However,

regardless of your undergraduate degree, you need the necessary pre-med prereqs. And here they

all are. These are our required pre-reqs, but in additional to the required prereqs, we have

recommended. GRE, well if you’ve been on top of it you’ll know that the formatting for the

grading of the GRE has changed, so therefore you need an approximate score of 310-somewhere

in there is going to be a competitive score or you can take the MCAT. Either one of these exams

you definitely have to take. Oftentimes I get the question of which one should I take? Well that’s

an easy question-if you have a remote interest in going to medical school, take the MCAT. If you

do not, then I would spare myself all the stress and I would take the GRE.

Slide 6 VIDEO TWO [07:43]

You’ll find that all of their varied backgrounds. These are usually or typically the most

popular degrees of people that apply to our program have. And the reason is that many

individuals that apply to our programs were those that maybe at one time considered anesthesia

school and then they kind of looked at things and said you know status of healthcare today and

eight years of school and who knows how much debt and twenty-seven months and you

know…salaries as they are I think it’s a better choice to go to anesthesia school. Me it was

exactly the same. I had no knowledge of what an AA was and I worked in health care and I was a

respiratory therapist. I worked at the time at University Community Hospital right up the street,

now it’s Florida Hospital Tampa and I still work there I just work in Anesthesia. But you know I

was working and getting ready to apply to medical school and completed all of my prerequisites

and then a fellow RT who I was working with came past this information that there was some

new program in Florida, I’m going to check it out-why don’t you do the same thing? So I did and

the minute that this was offered to me, I decided that I wasn’t even going to fill out an

application to medical school. I’m going to do this. So you can see many individuals have that

same sort of entry to the AA profession. Sometimes we receive individuals or applicants that

have some sort of clinical or healthcare experience. Is it required? No. But I’m going to tell you

right now that the current class of first year students that we have, none of them have clinical

experience. They’re a relatively young group, most of them right out of undergrad. If you

contrast them to maybe the class that I was in when the program at NSU was established I’d say

about 40% of us had healthcare experience. Three of us were Respiratory Therapists, we had a

physical therapist, physician assistant, nurse practitioner, we had a guy that went to medical

school but didn’t complete his anesthesia residency in the allotted time, we had some other

individuals with healthcare experience as well. So these are just some of the healthcare clinical

work that you will see that maybe some of our students will present with.

Slide 8VIDEO TWO [10:12]

Now our curriculum and our program itself is a 27 month program which basically broken into

largely two units. The first year where you’re learning most of your didactic, very little clinical.

Second year is where there is heavy emphasis on clinical training and almost no didactic training

at that point. In the second year students are on clinical rotations 40-50 hours per week learning

various ways of practicing different types of anesthesia. This is just an example of one semester.

I like the sigh. The timing was impeccable. This is just an example of one semester. This being

the second semester. So we admit students annual and we admit them so they start the end of

May or the beginning of June and they run for twenty-seven consecutive months. Semester two

starts in September. All the courses you see in the darker writing is basically what you’d see as a

first year students. So for any student that started in June and this is thei second semester. They

would be taking these courses, the darker courses. Now I put other courses up here, the lighter

ones, like Anesthesia 3 because you’ll see that our second year students are in full time clinical

rotations and you can see the difference in the load there. Now I will tell you again, these

studnets are doing 40-50 hours a week with clinical rotations and when they come out they’re

really sharp anesthesia care providers. So anesthesia lab this is basically where we expose our

studnets to a siginicant amount of high fidelity simulation training. As Dr. Cooperman had

mentioned, if you came to our actualy campus, you will find that we heavily utilized high fidelity

simulation training. Now who knows what high fidelity means? Someone knows. This guy?

Very precise. That’s a very good definition, gery accurate too. So I’d so that basically it’s

representative of simulation materials that very, very closely mimic what would be expected in a

real s

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