Atomic Anesthesia

In this episode of the Atomic Anesthesia Podcast, host Dr. Rhea Temmermand speaks with Michael Hoess, CRNA and Lead CRNA for Education at Cooper University Hospital, about the crucial role of CRNAs in austere and tactical medical environments. Drawing on over a decade of trauma and resuscitation experience, Mike shares how CRNAs contribute to training military and government medical teams operating in resource-limited or remote conditions. The discussion explores how core anesthesia principles adapt when blood banks, ventilators, or full surgical teams aren’t available, emphasizing the importance of airway control, hemodynamic management, and damage control resuscitation in the fi...

In this episode of the Atomic Anesthesia Podcast, we’re talking to future nurse anesthetists who’ve just crushed the biggest milestone yet — getting accepted into CRNA school. Between acceptance and day one, there’s often a long waiting period, and this episode is your roadmap for using that time strategically. From tackling financial readiness and creating a solid academic foundation to preparing your family, refining your clinical skills in the ICU, and strengthening your mindset, we cover every step of the “Pre‑CRNA School Survival Checklist.” You’ll learn how to simplify your finances, refresh your physiology and pharmacology kno...

This episode of the Atomic Anesthesia Podcast features guest Cori James, DNP, CRNA, for a candid and practical discussion on what not to do when working with CRNA preceptors. Designed for nurse anesthesia residents, this conversation highlights the most common pitfalls students unknowingly fall into during clinical rotations—from over-socializing and being unprepared to showing poor teachability, lacking situational awareness, or demonstrating unsafe habits in the OR. Cori shares firsthand insights on maintaining professionalism, demonstrating initiative, and developing adaptability across different teaching styles. The episode also explores critical aspects of communication, infection control, and teamwork that can make or brea...

In this episode of the Atomic Anesthesia Podcast, host Dr. Rhea Temmermand provides a detailed pharmacology review of propofol, the main IV sedative hypnotic used for induction, maintenance, and procedural sedation in anesthesia practice. The episode covers propofol’s drug class and chemistry, its lipid emulsion formulation and infection risk, and key physicochemical properties including high lipophilicity and protein binding. Listeners learn the mechanism of action at the GABA A receptor, translating into CNS effects, cardiovascular and respiratory depression, and no analgesia. The discussion walks through pharmacokinetics and context‑sensitive half‑time in a clinically practical way, tying concepts to inf...

This episode of the Atomic Anesthesia Podcast unpacks the real clinical risk of adrenal suppression after a single dose of etomidate, challenging common debates every anesthesia resident faces. Drawing on the latest studies, listeners will discover exactly which patient groups—cardiac, septic, trauma, pediatric, and elective—are actually vulnerable to etomidate’s effects, and when transient adrenal suppression matters for outcomes. The discussion highlights the drug’s unique origins, why its hemodynamic stability often outweighs risks in routine cases, and why infusions are off the table. Tune in for practical guidance on using etomidate safely, tips for steroid coverage in criti...

In this episode of the Atomic Anesthesia Podcast, pediatric CRNA and educator Dr. Becky Motykiewicz presents a comprehensive guide for nurse anesthesia residents preparing for their pediatric anesthesia rotation. From preoperative communication strategies with parents and pediatric patients to practical tips for inhalational induction, airway management, and safe emergence, Dr. Motykiewicz shares her real-world advice. The discussion covers essential topics such as age-appropriate communication, preoperative assessment, differences in pediatric and adult induction, critical emergency drugs and dosages, IV equipment considerations, and safe practices for emergence and extubation. Lists of must-know calculations, including formulas for endotracheal tube size, IV fluids...

In this episode of the Atomic Anesthesia Podcast, we talk with Dr. Hallie D. Evans, DNP, CRNA, APRN, CNE, a nationally recognized nurse anesthesia educator and clinician, about what it takes for CRNAs to step into the world of teaching. Dr. Evans discusses how her journey from clinical anesthesia to academic leadership began, the personal qualities that make an effective educator, and how to determine if you have the right temperament for academia. Listeners will learn the practical steps to becoming a nurse anesthesia educator, essential skills to develop when transitioning from the OR to the classroom, and what...

In this episode of the Atomic Anesthesia Podcast, we tackle the complex reality of caring for patients under the influence of drugs or alcohol, a frequent challenge for nurse anesthesia residents and CRNAs. Covering the physiological effects and anesthetic implications of acute and chronic intoxication with alcohol, benzodiazepines, hallucinogens (such as LSD, PCP, and MDMA), cocaine, and cannabinoids, this episode offers fast, practical guidance for optimizing perioperative care and minimizing patient risk. Listeners will learn how substance use alters anesthetic requirements, impacts drug metabolism, and poses unique airway and hemodynamic risks, while also receiving actionable tips for drug class-specific...

In this episode of the Atomic Anesthesia Podcast, we connected with Dr. David Warren, DNP, CRNA, NP to discuss the unique journey of transitioning from nurse practitioner to nurse anesthesiologist. Dr. Warren shares insights from his clinical practice, case mix, and favorite patient populations while reflecting on how his background as an NP shaped his approach to anesthesia. Listeners will learn how previous advanced practice experience can both prepare and challenge those entering CRNA training, the advantages it can bring to clinical practice, and the mindset needed to succeed in this career shift. Dr. Warren also talks about his...

In this episode of the Atomic Anesthesia Podcast, host Dr. Rhea Temmermand is joined by vascular anesthesia expert Rick Heuermann, DNP, MBA, CRNA, to unravel the complex pathophysiology of peripheral vascular disease (PVD) and its impact on anesthetic management. Together, they break down healthy versus diseased arterial function, highlight why patients with PVD present unique challenges in the OR, and provide practical, evidence-based strategies for optimizing hemodynamics and minimizing perioperative risks in vascular surgery. Whether a seasoned clinician or a student navigating CRNA school, listeners will gain clinical insight and case-based wisdom for safer, more effective care of patients...

In this episode of the Atomic Anesthesia Podcast, host Dr. Rhea Temmermand is joined by vascular anesthesia expert Rick Heuermann, DNP, MBA, CRNA, to unravel the complex pathophysiology of peripheral vascular disease (PVD) and its impact on anesthetic management. Together, they break down healthy versus diseased arterial function, highlight why patients with PVD present unique challenges in the OR, and provide practical, evidence-based strategies for optimizing hemodynamics and minimizing perioperative risks in vascular surgery. Whether a seasoned clinician or a student navigating CRNA school, listeners will gain clinical insight and case-based wisdom for safer, more effective care of patients...

In this episode of the Atomic Anesthesia Podcast, nurse anesthesia residents are guided through the pivotal moments of emergence and extubation—recognized as one of the riskiest steps in the operating room. Listeners will gain practical strategies for timing and executing a safe, efficient wake-up following general anesthesia, including the choice between restoring spontaneous breathing early for extremity and head or neck surgeries, or precisely titrating off anesthetics and using nitrous oxide during abdominal and thoracic procedures. The episode breaks down emergence criteria, ventilatory and hemodynamic parameters, medication effects, and the consequences of mixing techniques, all illustrated with clear, ex...

This is a joint episode recorded with Dr. Chloe Gomez of the My Favorite Learner podcast. This episode explores the foundational concepts of pharmacogenetics and its impact on drug responses during anesthesia, highlighting how genetic, genomic, and epigenetic variations shape individual reactions to commonly used medications in perioperative care. Designed for nurse anesthesia residents, the show walks through the scenarios of variable drug response, the roles of metabolizing enzymes, transport molecules, and molecular targets, as well as the influence of environmental factors and polymorphisms such as single-nucleotide variants and ethnic differences in metabolism. Key topics include disease-specific considerations like...

This episode of the Atomic Anesthesia Podcast explores the emerging role of Suzetrigine, a novel non-opioid NaV1.8 channel inhibitor, in multimodal surgical pain management. Host Rhea and guest JR Phillips, a DNAP student, discuss the science, efficacy, and safety profile of Suzetrigine, its potential for opioid-sparing strategies, and its unique advantages over traditional opioids and sodium channel blockers. Listen in for an evidence-based look at how this new FDA-approved analgesic could reshape perioperative care, improve patient outcomes, and what its current limitations and future possibilities might be for anesthesia professionals and learners.

To take a quiz about...

In the final installment of the Trauma and Burn Anesthesia Series, we explore the unique physiology and management of burn patients, a population that differs significantly from blunt or penetrating trauma. This episode covers the classification and severity of burns, the pathophysiology of burn shock, and essential principles like calculating burn extent using the rule of nines, applying the Parkland formula for fluid resuscitation, and monitoring for fluid creep. We also examine systemic complications affecting the cardiovascular, pulmonary, and metabolic systems, challenges of smoke inhalation injury and carbon monoxide poisoning, and the altered pharmacology that impacts anesthesia care. Finally, w...

In part 9 of the Trauma Anesthesia Series, we dive into the critical topic of mass casualty events—what defines them, how hospitals respond when resources are overwhelmed, and the principles of patient triage that determine who gets treated first. Using real-world examples, we explore common triage algorithms, the color-coded tagging system, and the difficult but necessary decisions providers must make to save the greatest number of lives. The episode also addresses the emotional toll of these crises, highlighting second victim syndrome and the importance of resilience, mental health support, and teamwork for healthcare providers navigating these high-stakes situations.

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Welcome to part 8 of the Trauma & Burn Anesthesia Series. In this episode, we take a broad look at special populations in trauma anesthesia—pregnant, pediatric, and geriatric patients. Each of these groups presents unique physiologic challenges, risk factors, and perioperative considerations that require anesthesia providers to adapt their trauma management strategies. From managing airway swelling and aspiration risk in pregnant patients, to balancing fluid resuscitation and minimizing radiation exposure in children, to mitigating postoperative delirium and cognitive dysfunction in older adults, this episode offers a high-level overview of principles you can apply in clinical practice. Because each of these pop...

This episode of the Trauma and Burn Anesthesia Series explores the acute management of spinal cord injury, from mechanisms like motor vehicle accidents and falls to the growing impact on older adults. Key topics include early recognition, imaging strategies, spinal precautions, maintaining supranormal mean arterial pressure for cord perfusion, and the use of methylprednisolone to reduce inflammation. We break down injury types—including Brown-Séquard, anterior, posterior, and central cord syndromes—along with crucial anesthesia pearls for airway management and safe patient transfer. The episode also highlights complications like neurogenic shock and autonomic dysreflexia, detailing when succinylcholine can be used...

In this episode of the Trauma and Burn Anesthesia Series, we examine traumatic brain injury, the leading cause of trauma-related death in the U.S., affecting over a million people annually and leaving millions with long-term disability. We discuss the importance of the Glasgow Coma Scale, the types of primary injuries such as subdural, epidural, and intraparenchymal hematomas as well as diffuse axonal injury, and how these lead to increased intracranial pressure, herniation, and neurological decline. We explore secondary brain injury from hypotension, hypoxemia, hypercapnia, and hyperthermia, emphasizing the need to maintain adequate perfusion and oxygenation while balancing damage c...

In this episode of the Trauma and Burn Anesthesia Series, we take a deep dive into one of the most critical moments in trauma care: the induction and maintenance of anesthesia in hemodynamically unstable patients. We break down the principles behind choosing the right agents, why dose reductions and careful titration are essential, and how rapid sequence induction sets the standard in trauma. You’ll hear about the role of etomidate and ketamine, why propofol is dangerous in unstable patients, and when vasopressors may actually be appropriate to support induction. We also cover strategies for managing volatile anesthetics, why nit...

In part 4 of the Trauma and Burn Anesthesia series, we turn to the critical steps of securing the airway, establishing reliable vascular access, and safely transitioning the patient from the trauma bay to the operating room. This episode highlights the challenges of airway management in unstable and severely injured patients, including techniques for rapid sequence induction, surgical airways, and strategies to minimize the risks of hypoxemia and aspiration. Intravenous and arterial line placement are discussed in the context of urgent access for fluid resuscitation, vasoactive support, blood sampling, and continuous hemodynamic monitoring. The episode also examines the logistical and ph...

In part 3 of the Trauma and Burn Anesthesia series, we focus on blood product administration and fluid resuscitation, exploring how transfusions are tailored to support oxygen delivery, coagulation, and hemodynamic stability in critically injured patients. The episode examines the indications and composition of packed red blood cells, platelets, plasma, and cryoprecipitate, as well as the role of crystalloids and colloids in resuscitation. Key complications of transfusion—including transfusion related acute lung injury (TRALI) and transfusion associated circulatory overload (TACO)—are highlighted with emphasis on recognition, prevention, and management. Listeners are also guided through the principles of massive transfusion protocols (MTPs...

In part 2 of the Trauma and Burn Anesthesia series, we discuss hemorrhage management in trauma, covering the causes and treatment of trauma-induced coagulopathies and the significance of essential lab values such as thromboelastography (TEG), blood gases and PT/INR/PTT. The discussion integrates key concepts from trauma anesthesia, including the lethal triad and diamond of death, underscoring how hypothermia, acidosis, coagulopathy, and hypocalcemia interact to worsen outcomes. Listeners are introduced to advanced diagnostics like TEG for real-time assessment of coagulation, and learn best practices for addressing hyperfibrinolysis with antifibrinolytics such as tranexamic acid to optimize resuscitative care and reduce mo...

In this first installment of the Trauma and Burn Anesthesia series, we dive into the critical foundations of caring for severely injured patients in the perioperative setting. Designed for nurse anesthesiologists and nurse anesthesia residents, this episode reviews the guiding principles of Advanced Trauma Life Support (ATLS) and explores how these frameworks shape anesthetic decision-making. We also walk through the concepts of damage control surgery and damage control resuscitation, emphasizing their role in stabilizing critically ill trauma patients, optimizing outcomes, and prioritizing life over limb. Listeners will gain a deeper understanding of how resuscitation strategy, surgical timing, and anesthetic managem...

This episode delivers a high-impact overview of maternal cardiac arrest—a rare but profoundly challenging emergency that demands rapid intervention and seamless multidisciplinary teamwork. Listeners will learn about the recognizable causes, unique pregnancy physiology, and critical modifications for resuscitation, including when to implement perimortem cesarean delivery. The discussion highlights the anesthesia provider’s leadership role, the value of simulation training, and actionable strategies to improve outcomes for both mother and baby. Whether in anesthesia, obstetrics, or nursing, this episode provides concise, evidence-based insights to prepare you for one of the highest-stakes situations in clinical practice.

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Discover the future of pain management on this episode of Atomic Anesthesia as we explore a major breakthrough: the FDA approval of suzetrigine, a first-in-class, nonopioid pain medication. Guided by cutting-edge research and expert editorial insight from Anesthesiology, we dig into how suzetrigine works—targeting the NaV1.8 sodium channel in peripheral nerves—and what this means for patients and providers facing acute pain. You’ll hear about the pivotal NAVIGATE clinical trials, real-world patient experiences, and the medication’s advantages over traditional opioids, including fewer side effects and no risk of addiction. Whether you’re a healthcare professional, patient, or someone...

In this live webinar, we discuss pain pathways in extreme detail, which is a foundational topic for anyone in anesthesia or in the ICU. We explore the four stages of pain—transduction, transmission, modulation, and perception—breaking down complex neurophysiology into manageable segments. We also look at how acute pain transitions into chronic pain, covering nociceptive, neuropathic, and nociplastic pain, and explaining the key roles of nociceptors, ion channels, and neurotransmitters. Whether you're new to this topic or reviewing for boards, this session offers clear explanations of difficult material, including referred pain and the gate control theory. Stick around unti...

In this episode, with CRNA Kerrie Klein, we discuss the essential but often misunderstood role of certified anesthesia technicians and technologists. We break down the differences between uncertified techs, certified technicians, and certified technologists—and why this matters for anesthesia providers. We explore their training, scope of practice, and how these professionals can be an untapped asset in improving efficiency and patient safety in the OR. We also talk culture, advocacy, and practical ways CRNAs can elevate the role of these team members. Listen until the end to learn a surprising skill that certified technologists are trained to perform—one...

In this episode, we discuss the crucial role emotional intelligence (EI) plays in the journey of becoming a CRNA. We explore what EI really means—understanding and managing your emotions and those of others—and why it’s essential in both the classroom and clinical settings. We unpack how skills like self-awareness, communication, and stress management directly impact your performance, especially during high-stakes situations. You’ll hear how EI can be developed through self-assessment, mentorship, and even simulation training. We also explore real-world strategies for handling difficult preceptors, building trust with OR staff, and maintaining your emotional resilience over the long...

In this episode, Pediatric CRNA Dr. Becky Motykiewicz dives into the most critical pediatric anesthesia complications you need to know—whether you're just starting out or already deep into practice. We break down airway issues like laryngospasm and bronchospasm, and explain how to manage these high-stakes situations effectively. We also touch on common postoperative concerns like stridor and emergence delirium, and why pediatric patients desaturate and destabilize faster than adults. You'll learn how to prevent and treat hypotension, bradycardia, and even hypoglycemia. Most importantly, we emphasize the life-saving importance of precise drug dosing and early recognition of emergencies. Stay tu...

In this episode, Professor T discusses something at the top of everyone's minds when going to CRNA school - how am I going to pay for this?!

We break down the smart, intentional decisions that made this possible—from qualifying for Public Service Loan Forgiveness and maximizing a 401(k), to avoiding lifestyle inflation and strategically investing in a surgery center. We also touch on practical tips like using 0% interest loans for home repairs, maintaining excellent credit, and leveraging employer benefits like HSA and childcare accounts.

If you're navigating your own financial futu...

This episode is a replay of a live webinar by cardiac CRNA, Alex Gorman, who gives an excellent presentation on Cardiac Anesthesia. He explores the essentials for managing complex heart cases in the OR. We walk through the entire process—from pre-op evaluations and cath report interpretation to hemodynamic management and weaning off bypass. Whether you're a CRNA, resident, or ICU nurse, you'll gain valuable insight into real-world decision-making, including drug selection, TEE basics, and how to collaborate effectively with perfusionists and surgeons. 

This episode is packed with tips to help you feel more prepared and confident in...

In this episode, we dive into the game-changing drug sugammadex—a powerful agent that rapidly reverses neuromuscular blockade caused by rocuronium and vecuronium. We explore its unique mechanism of action, pharmacokinetics, and pharmacodynamics, along with how it differs from traditional reversal agents like neostigmine. You'll gain clarity on proper dosing strategies across populations, including pediatrics, obese patients, and those with renal impairment. We also break down important administration details, adverse effects, and drug interactions—especially the one that could compromise hormonal contraceptives. If you want to know how to avoid recurrent paralysis and make the most of this revolutionary medi...

In this episode featuring Jeremy Heiner (Editor of the Nurse Anesthesia textbook), we dive into rapid-fire differential diagnosis and crisis management, tackling some of the most intense and high-stakes scenarios nurse anesthesia providers can face. From airway fires and venous air embolisms to anaphylaxis, malignant hyperthermia, and local anesthetic systemic toxicity, we break down ten real-time clinical situations, analyzing clues, discussing pathophysiology, and outlining critical management strategies. 

Whether you're a student learning to recognize subtle cues or a provider refining your response to emergencies, this episode sharpens your diagnostic instincts and clinical confidence. We also share practical i...

In this episode, we dive deep into the basics of anesthesia pharmacology—perfect for ICU nurses starting CRNA school or senior residents needing a solid refresher. We break down foundational topics like pharmacodynamics, pharmacokinetics, and pharmacogenomics, and explain why understanding physiology is key to mastering pharmacology. You’ll learn about drug targets like GABA and NMDA receptors, and the real mechanisms behind anesthetics, opioids, local anesthetics, and muscle relaxants. We also walk through “top drawer drugs” in the OR, including quick quizzes to reinforce your understanding of real-time drug decisions—like when to choose ephedrine over phenylephrine. This is a science...

In this episode, Rhea Temmermand and Jeremy Heiner (editor of the Nagelhout Nurse Anesthesia textbook) dive deep into the under-discussed but vital topic of cognitive aids and crisis checklists in anesthesia. You'll learn how tools like the Stanford Emergency Manual and the Nurse Anesthesia Crisis Checklists can sharpen clinical decision-making during high-stress scenarios like anaphylaxis or hypotension.

The episode explores how our brains make decisions under pressure, the difference between intuitive and deliberate thinking (System 1 vs. System 2), and how to develop better clinical heuristics. Plus, they walk through a real-world case of intraoperative anaphylaxis, using a step-by-step...

In this episode of "Resident's Corner," we discuss the universal challenge of falling behind in didactics, particularly in demanding programs like CRNA school. Our anonymous resident shares her personal insights on recognizing the problem, managing overwhelm, and strategies for getting back on track. From creating concise calendars and prioritizing study time to adopting a mindset that treats quizzes like finals, we explore practical tools for recovery. We also discuss the emotional struggles of being behind, the importance of dedication and discipline, and how to prevent future setbacks by working ahead and embracing the learning journey. Tune in for a...

PART 2/2: In this must-listen episode, Professor Temmermand shares strategies for thriving during clinical rotations. Transitioning from didactics to clinicals can be challenging, so in this live webinar replay, we outline what to expect when beginning this new phase of your training, provide tips for success, and explore how to navigate this challenging but exciting phase of your journey.

🎉 FREE RESOURCES:

[FREE DOWNLOAD] FOR THE SRNA: GRAB YOUR FREE SEE/NCE STUDY PLAN HERE

[FREE DOWNLOAD] FOR THE RN: GRAB YOUR FREE ICU DRUG CHART HERE

Check out our other free resources at...

PART 1/2: In this must-listen episode, Professor Temmermand shares strategies for thriving during clinical rotations. Transitioning from didactics to clinicals can be challenging, so in this live webinar replay, we outline what to expect when beginning this new phase of your training, provide tips for success, and explore how to navigate this challenging but exciting phase of your journey.

🎉 FREE RESOURCES:

[FREE DOWNLOAD] FOR THE SRNA: GRAB YOUR FREE SEE/NCE STUDY PLAN HERE

[FREE DOWNLOAD] FOR THE RN: GRAB YOUR FREE ICU DRUG CHART HERE

Check out our other free resources at...