Last week’s forum discussions were rich with practical insights and shared experiences from the CRNA community. Members delved into the intricacies of EPIC hard stops, shared strategies for pre-induction pauses, and debated the recalibration of intraoperative MAP targets. The exchange of ideas on effective pre-induction checks and the challenges posed by last-minute schedule changes also featured prominently. There’s a continuing focus on how educational initiatives can tangibly reduce error rates.
This Week’s Hot Topics
I now dream in EPIC hard stops
EPIC hard stops are a reality for many, and this thread explores how they impact daily workflow and patient care. Read more here
Pre-induction pause that actually helps
Members discuss the value of a well-executed pre-induction pause and how it can improve patient outcomes. Read more here
Pre-induction checks you never skip
A conversation about the critical checks that CRNAs consider non-negotiable before induction. Read more here
Are we recalibrating intraop MAP targets
This thread questions whether our current MAP targets during procedures need an update. Read more here
The add-on fairy strikes at 0659
A light-hearted yet serious look at how last-minute add-ons affect the start of our day. Read more here
Syringe labels vs. a 0700 start
Balancing the need for accurate syringe labeling with the pressure of early starts. Read more here
Max lidocaine dose: IBW or TBW
A technical discussion on whether to use ideal or total body weight for lidocaine dosing. Read more here
Hands-on pediatric ultrasound blocks CE
Exploring the benefits and practical aspects of hands-on CE in pediatric ultrasound techniques. Read more here
CE that measurably lowers error rates
An ongoing dialogue about continuing education programs that effectively minimize mistakes. Read more here
AIMS device feeds: time saved, noise added
The pros and cons of automated information management systems in the OR. Read more here
Have a great week ahead, and thank you for being an engaged part of our community.
I’ve stopped treating “MAP 65” as a religion and, for chronically hypertensive patients, aim for within about 20% of their clinic baseline; during the pre-induction pause we pull the last BP, set NIBP q2 min for the first 15 min, and have phenyl/vaso ready. I still default to at least 65 for low-risk, but tighten to 75–80 in CAD/CKD or head/neck cases. Would love to see an EPIC hard stop or smartphrase that auto-populates a patient-specific target.
Quick example: for carotid or elderly HTN cases I level the A-line to the tragus and set a ‘MAP floor’ at that reference, which makes the cuff read about 10 higher, so I’ll start low-dose norepi early rather than chase phenyl boluses; @m_jones91 do you adjust targets for leveling or stick with cuff MAP?
For HTN patients I pull the last three clinic BPs and aim to stay within about 15–20% of that median, rechecking the reference after any big position change, and if PPV/SVV is high I correct preload before dialing up norepi… I’ll add cerebral oximetry for beach-chair or carotids as a sanity check — “don’t chase 65 blindly” only works if the brain agrees, which feels more like Waze than cruise control. @Guide, curious if anyone has an EPIC flowsheet calc that shows % deviation from baseline in real time.