3/11/14: Great start to a wonderful meeting. 12 inches of fresh snow. Tim presented some wonderful lectures this morning and we are gearing up for the ultrasound session. Please consider registering for next year. We are planning on returning to Big Sky  in 2015. This is a CRNA group dedicated to giving back. Remember a portion of your registration is donated to the foundation and charity. Visit us at

Photo: I think it's going to be a GREAT meeting here in Big Sky Montana

This page will be used for both conference updates as well as current information related to clinical practice.

This ultrasound is unique. We teach all the major blocks to include but not limited to: ISB, Supra and infraclavicular, axillary, femoral, popiliteal, saphenous and TAP block. We also teach venous, arterial access. This includes both peripheral venous access and central access. We also teach the new and exciting ULTRASOUND AIRWAY ASSESSMENT.  This will be a rewarding and exciting class.

At Trollway Anesthesia we believe in family time and getting a great CE conference and a low cost per CE. We keep our cost per CE as close to $25 as possible. Today, we are including conference shots as well as a list some amazing locations and attractions you and your family can do even if your not into skiing….remember Big Sky also has world famous snow tubing and a zip line adventure. The lectures were some of the best pediatrics information available. Next year our conference is moving towards meeting all the continuing profession certification goals as well as enhancing pharmacology, obstetrics and ultrasound and regional anesthesia. We are also considering bringing ACLS, PALS, BLS and possible Neonate Resuscitation. We would like to hear from you if that workshop would be of a beneficial. We will continue to bring you cutting edge information and topics. Our hopes are to have an additional weekend meeting this fall in Michigan. Please visit us at for the most current conference information. We thank you for all you do for our patients and our profession. Thanks, Trollway Anesthesia.

All Day Wilderness Area Tours Horseback Riding Old Fashioned Sleigh Ride Dinner Sled Dog Adventure Snowmobile Tours Snowshoeing Yellowstone Snowcoach Cross-Country Tour Winter Fly Fishing  East Slope Outdoors Gallatin Riverguides Lone Mountain Ranch


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New Anticoagulants recommendations from journals for Spring 2014 click on link for journal article

Do you know your dosing for Acetaminophen. It is found in over 600 drugs. Visit the web page to get more information:

Effect of dexamethasone on the duration of interscalene nerve blocks with ropivacaine or bupivacaine. Web address for link is:

Dexamethasone with bupivacaine increases duration of analgesia in ultrasound-guided interscalene brachial plexus blockade. Web address link is:

Coronary artery stents: II. Perioperative considerations and management

Perioperative management of patients with drug-eluting stents. Web address:

Lipid Emulsion Infusion – The Global Regional Anesthesia Website

Here is brief write up from the AANA journal about the flipped classroom principle:

“A Flipped Classroom: Now or Never?” AANA Journal; August 2014 Volume 82 number 4; ISSN 0094-6354; Sharon J. Hawks, CRNA, MSN, DNP

Purpose: The purpose of this article was to provide a better understanding of the principle of the flipped classroom. It strives to show us that the traditional paradigm of education is changing and that if we as a profession and as educators are to bring our students to a new level of education we should consider making these changes. The principles that are discussed focus on a new level of education standards and the idea that new and innovative tools for educating our students need to be employed. This stems from the 2001 IOM report and the article in medical education by Cooke et al titled: Educating Physicians: A Call for Reform of Medical School and Residency.

Background: In 2001 the IOM report discussing the need for change in current medical education was introduced. It demonstrated that we needed to change our thought pattern to produce better providers and a better educated workforce. Although the article does not discuss the education principle of the Rosenthal Effect, I believe it is addressed in concept. The idea of the flipped classroom is not new, but as we approach a new style of learner and the ability of the current student to learn better and faster we must also use a new style of education to meet these needs.

Methodology: This is not a study or double blinded random controlled study. It is an introduction to a new concept. Like all new concepts, a paper must be written that introduces the concept. During this meta-analysis we see reference to several studies done in different health care professions related the principle of the flipped classroom. The studies cited are an excellent beginning and have positive results from other professions. Many will argue that we need more studies to justify such a change in our own profession. If we discard the other relevant material in other health care professions we may miss the educational revolution that is occurring and find our profession lagging in many areas.








Results: During the cross profession review of the current information available we find great outcomes related to the flipped classroom. Students come to class active and ready to learn. They are able to better focus and participate in class. The research also found that students in the flipped classroom did better than the traditional classroom. Hake et al found that the flipped classroom student significantly outperformed traditional students. The studies also found that the students learned to work better collaboratively in this environment. The use of case studies, scenarios, small group discussion and other interactive material prepared them better for class. The information also showed that faculty could spend more time on problem of misunderstood information during class.  The studies also found that 70% of students found this style of education to be more effective.

Conclusions: An interesting principle of this topic is a few key points to education. During the flipped classroom we should not allow the online work to replace all lecture material or direct student interaction. Online work should be used to augment and support the classroom experience. We must be strong enough as educators to seek student review but not use a single student review to adjust our whole plan. Education is a marketing product and if we bend to the unprofessional or personal opinion of a single student we will not provide the best product for our students. We must also provide the evidence to the students that this change is what is in the best interest for them. There are several pre-class preparation aspects for the student to achieve to get the best from the class. The topics must be provided early and with plenty of time for the student to be prepared for class. This pre-class material should not be limited to just lectures or power points. There are multiple different media tools available to be used and utilized in the flipped classroom principle.

Comment: This is a very worthwhile article and concept. There must be a hybrid approach, we should not lose the traditional methods, but rather bring what is best in those principles and meld them with the flipped classroom approach. I would encourage us all to read it and understand the flipped classroom concept more. We are at a crossroads in our profession of educating our students. Dr. Robert Rosenthal argued that if we demand the very best from our students then they will perform at their very best. The negative can also be said, if we expect little of them the will perform at that level. We do not need to be in a formal classroom setting to use the flipped classroom model. The bulk of nurse anesthesia education is done in the one on one role in the operating room. Our ability to mentor and foster the next generation of students hinges on embracing new models of education. The interesting cross reference for this is the study of how our new students learn different and better than we did, they are able to assimilate far greater amounts of information and less amount of time.  If we are going to keep up, we as nurse anesthesia need to set a new pace in education. We must demand the very best from our students and they will give us the very best. We are building a generation of students to promote our profession




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