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 field. Mike also discusses building resilience through high-stress simulations, developing adaptive leadership skills, and fostering mission readiness for both seasoned CRNAs and students. Listeners gain insight into how these lessons from austere medicine can strengthen everyday anesthesia practice and prepare clinicians for the challenges of modern conflict and disaster response.If you want to reach out to Michael, you can contact him at michael.p.hoess@gmail.com or hoess-michael@cooperhealth.eduArticles:Austere Resuscitative and Surgical Care Teams: Supporting Far-Forward Trauma Care on the Future BattlefieldMilitary and Civilian Surgery Partner for Innovation, EffectivenessA Western trainer says talk of 'golden hour' would be laughable to Ukrainian forces.Want to learn more? Grab our Cardiac Pharm Course --> [HERE]⚛️ CONNECT:🩷 Subscribe to our YouTube channel💜 Follow us on Instagram💙 Follow us on TikTok📥 Have a topic you want to hear? Email Dr. Temmermand at hello@atomicanesthesia.com

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 knowledge, set up realistic support systems, and mentally prepare for the demands ahead. Whether you start in a few months or next year, this episode gives you a clear, actionable plan to transition smoothly from RN to SRNA with confidence and focus.Want to learn more? Grab our Cardiac Pharm Course --> [HERE]⚛️ CONNECT:🩷 Subscribe to our YouTube channel💜 Follow us on Instagram💙 Follow us on TikTok📥 Have a topic you want to hear? Email Dr. Temmermand at hello@atomicanesthesia.com

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 break a student’s clinical experience. Whether you’re just beginning your first rotation or refining your professional presence, this episode equips you with the self-awareness and mindset needed to build strong preceptor relationships and thrive in the clinical setting.If you want to contact Cori, follow her on TikTok @corijamess or IG at @coricrna. You can also email her at coricrna@gmail.com Want to learn more? Grab our Cardiac Pharm Course --> [HERE]⚛️ CONNECT:🩷 Subscribe to our YouTube channel💜 Follow us on Instagram💙 Follow us on TikTok📥 Have a topic you want to hear? Email Dr. Temmermand at hello@atomicanesthesia.com

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 infusion planning and dosing strategies for various cases. Major adverse effects, toxicity including propofol infusion syndrome, allergy and infection‑control practices, and drug synergies are highlighted, with high‑yield clinical pearls on patient selection, hemodynamics, and airway rescue.REFERENCES: Nagelhout JJ, Elisha S, Heiner JS, eds. Nurse Anesthesia. 7th ed. Elsevier; 2022.Flood P, Rathmell JP, Urman RD, eds. Stoelting’s Pharmacology & Physiology in Anesthetic Practice. 6th ed. Wolters Kluwer; 2021.Katzung BG, ed. Basic & Clinical Pharmacology. 14th ed. McGraw-Hill Education; 2018.Want to learn more? Grab our Cardiac Pharm Course --> [HERE]⚛️ CONNECT:🩷 Subscribe to our YouTube channel💜 Follow us on Instagram💙 Follow us on TikTok📥 Have a topic you want to hear? Email Dr. Temmermand at hello@atomicanesthesia.com

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 critically ill patients, and a sneak peek at promising new etomidate analogs. Whether you’re prepping for exams or your next high-stakes induction, this episode helps you make smarter, evidence-based choices in the OR..Want to learn more? Create a FREE account at www.atomicanesthesia.com⚛️ CONNECT:🩷 Subscribe to our YouTube channel💜 Follow us on Instagram💙 Follow us on TikTok📥 Have a topic you want to hear? Email Dr. Temmermand at hello@atomicanesthesia.com

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, and emergency drugs, are highlighted along with recommendations for trusted resources. Emphasizing preparation, humility, and patient-centered care, this episode equips listeners with actionable steps and practical wisdom to approach pediatric anesthesia rotations with confidence and curiosity.Want to learn more? Create a FREE account at www.atomicanesthesia.com⚛️ CONNECT:🩷 Subscribe to our YouTube channel💜 Follow us on Instagram💙 Follow us on TikTok📥 Have a topic you want to hear? Email Dr. Temmermand at hello@atomicanesthesia.com

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 to expect in terms of salary, schedule, and sacrifices. With over 15 years of anesthesia experience and more than a decade in education, Dr. Evans shares her insights on balancing clinical practice with teaching, building innovative programs, and fostering future generations of CRNAs through mentorship and evidence-based pedagogy.Want to learn more? Create a FREE account at www.atomicanesthesia.com⚛️ CONNECT:🩷 Subscribe to our YouTube channel💜 Follow us on Instagram💙 Follow us on TikTok📥 Have a topic you want to hear? Email Dr. Temmermand at hello@atomicanesthesia.com

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 management like when to use or avoid certain agents, the importance of invasive monitoring, and strategies for handling withdrawal or overdose. Tune in for a high-yield rundown that will help you make safer decisions when handling intoxicated patients in the OR.Want to learn more? Create a FREE account at www.atomicanesthesia.com⚛️ CONNECT:🩷 Subscribe to our YouTube channel💜 Follow us on Instagram💙 Follow us on TikTok📥 Have a topic you want to hear? Email Dr. Temmermand at hello@atomicanesthesia.com

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 own podcast and social media presence, explaining how he uses these platforms to educate and inspire other clinicians. The conversation concludes with valuable advice for NPs considering the leap to anesthesia, making this episode a motivating and practical listen for aspiring CRNAs.Want to learn more? Create a FREE account at www.atomicanesthesia.com⚛️ CONNECT:🩷 Subscribe to our YouTube channel💜 Follow us on Instagram💙 Follow us on TikTok📥 Have a topic you want to hear? Email Dr. Temmermand at hello@atomicanesthesia.com

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 with PVD.Want to learn more? Create a FREE account at www.atomicanesthesia.com⚛️ CONNECT:🩷 Subscribe to our YouTube channel💜 Follow us on Instagram💙 Follow us on TikTok📥 Have a topic you want to hear? Email Dr. Temmermand at hello@atomicanesthesia.com

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 with PVD.Want to learn more? Create a FREE account at www.atomicanesthesia.com⚛️ CONNECT:🩷 Subscribe to our YouTube channel💜 Follow us on Instagram💙 Follow us on TikTok📥 Have a topic you want to hear? Email Dr. Temmermand at hello@atomicanesthesia.com

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, experience-based teaching points drawn from years of practice. CRNAs at all levels are invited to reflect, share their own perspectives, and incorporate these actionable insights to optimize patient safety, comfort, and workflow in the perioperative environment.Want to learn more? Create a FREE account at www.atomicanesthesia.com⚛️ CONNECT:🩷 Subscribe to our YouTube channel💜 Follow us on Instagram💙 Follow us on TikTok📥 Have a topic you want to hear? Email Dr. Temmermand at hello@atomicanesthesia.com

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 G6PD deficiency, acute intermittent porphyria, long QT syndrome, Brugada syndrome, atypical pseudocholinesterase, and malignant hyperthermia, with a focus on clinical implications for personalized medicine, precision dosing, and ethical issues surrounding genetic testing, privacy, and patient equity. Practical advice covers vigilant monitoring, individualized dosing, preoperative assessment for genetic risk, and strategies for documenting and communicating findings for safer anesthesia practice.Want to learn more? Create a FREE account at www.atomicanesthesia.com⚛️ CONNECT:🩷 Subscribe to our YouTube channel💜 Follow us on Instagram💙 Follow us on TikTok📥 Have a topic you want to hear? Email Dr. Temmermand at hello@atomicanesthesia.com

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 this topic, check out this link: [HERE]For references for this episode, click [HERE]Want to learn more? Create a FREE account at www.atomicanesthesia.com⚛️ CONNECT:🩷 Subscribe to our YouTube channel💜 Follow us on Instagram💙 Follow us on TikTok📥 Have a topic you want to hear? Email Dr. Temmermand at hello@atomicanesthesia.com

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, we discuss perioperative considerations such as blood loss, temperature control, and multimodal pain management, emphasizing why burn patients require such specialized care and preparation from anesthesia providers.Want to learn more? Create a FREE account at www.atomicanesthesia.com⚛️ CONNECT:🩷 Subscribe to our YouTube channel💜 Follow us on Instagram💙 Follow us on TikTok📥 Have a topic you want to hear? Email Dr. Temmermand at hello@atomicanesthesia.com

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.Want to learn more? Create a FREE account at www.atomicanesthesia.com⚛️ CONNECT:🩷 Subscribe to our YouTube channel💜 Follow us on Instagram💙 Follow us on TikTok📥 Have a topic you want to hear? Email Dr. Temmermand at hello@atomicanesthesia.com

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 populations deserves a deeper dive, we’ve included links in the show notes to key articles and guidelines so you can explore further on your own. In future episodes, we’ll dedicate entire discussions to each special population for a more detailed breakdown. Join us as we highlight essential principles and considerations for trauma anesthesia providers caring for these vulnerable groups.ADDITIONAL RESOURCES:Pregnant Patients:Guidelines for the Management of Pregnant Trauma Patients (Jain, 2015)Trauma in the Obstetric Patient: A Bedside Tool (ACEP)Pediatrics:Initial assessment and management of pediatric trauma patients (McFadyen, 2012)Geriatrics:Perioperative Management of the Geriatric Trauma Patient (Muldowney, 2025)Trauma in the elderly patient (Atinga, 2018) Want to learn more? Create a FREE account at www.atomicanesthesia.com⚛️ CONNECT:🩷 Subscribe to our YouTube channel💜 Follow us on Instagram💙 Follow us on TikTok📥 Have a topic you want to hear? Email Dr. Temmermand at hello@atomicanesthesia.com

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 safely and practical steps for treating hypertensive crises in chronic cord injuries.Want to learn more? Create a FREE account at www.atomicanesthesia.com⚛️ CONNECT:🩷 Subscribe to our YouTube channel💜 Follow us on Instagram💙 Follow us on TikTok📥 Have a topic you want to hear? Email Dr. Temmermand at hello@atomicanesthesia.com

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 control resuscitation. Key management strategies include hyperosmolar therapy, ICP monitoring, CSF drainage, hyperventilation, mannitol use, steroids, seizure and infection prophylaxis, and cautious fluid therapy. We also cover practical intraoperative considerations, avoiding excessive anesthetics, carefully managing CSF drains, and adjusting ventilation, while highlighting the added complexity when TBI patients also present with massive hemorrhage.Want to learn more? Create a FREE account at www.atomicanesthesia.com⚛️ CONNECT:🩷 Subscribe to our YouTube channel💜 Follow us on Instagram💙 Follow us on TikTok📥 Have a topic you want to hear? Email Dr. Temmermand at hello@atomicanesthesia.com

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 nitrous oxide should be avoided, and how to prevent intraoperative recall in patients at extremely high risk. From heating strategies to avoid coagulopathy, to lung-protective ventilation in the face of pulmonary injury, and even emergency interventions like thoracotomy and REBOA, this episode takes you through the challenges and nuanced decision-making of trauma anesthesia. If you’ve ever wondered how to balance unconsciousness, perfusion, and safety in critically injured patients, this is the episode for you.Want to learn more? Create a FREE account at www.atomicanesthesia.com⚛️ CONNECT:🩷 Subscribe to our YouTube channel💜 Follow us on Instagram💙 Follow us on TikTok📥 Have a topic you want to hear? Email Dr. Temmermand at hello@atomicanesthesia.com