Transesophageal Echocardiography (TEE) Workshops now offered

MTSA now offers advanced Transesophageal Echocardiography (TEE) training for CRNAs using ultrasound and state-of-the-art HeartWorks simulators. According to instructor John Shields, DNP, CRNA, all participants will perform basic and comprehensive TEE, including image acquisition, cardiac structure identification and pathology recognition.

Upcoming TEE Workshops:

Nov. 15, 2020
Jan. 24, 2021
April 18, 2021

The daylong workshops incorporate the HeartWorks TEE Simulator, a solution for developing cognitive and psychomotor skills for TEE. Users see real-time, seamless ultrasound imaging in synchronization with their movement of the TEE probe, providing a realistic and accurate training experience in preparation for real patient examinations.

Shields said 20 pathologies, including aortic stenosis, mitral regurgitation, biventricular dysfunction and cardiac tamponade, are featured in the training, along with interventional use for transcatheter procedures.

“Ultrasound allows us to see the structures of the heart, the size, whether the heart valve is working efficiently, among other assessments,” Shields said. “We can look at different pathologies of the heart, such as the direction of blood flow, or whether there’s a septal defect. It’s used mainly for cardiopulmonary instability, blood pressure problems, and trouble with oxygenation and saturation.”

Shields points to the fact that TEE has become the standard of care for cardiac surgery, helping to guide the surgeon’s interventions. “CRNAs that practice in cardiac don’t necessarily do TEE because the skill set hasn’t been needed. But we’re leading the way with this state-of-the-art training to expand our scope of practice where it can be utilized. We believe that if you’re not practicing with ultrasound in the next five years, you’ll be way behind. With this training, you’ll be ahead of the curve,” he said.

“Other training programs will do hands-on ultrasound on human models, but you don’t have the ability to assess real pathologies. With a simulator you can. You have every possible pathology that you’re going to find in a real patient, and that’s one of the biggest differentiators of our TEE workshops at MTSA,” Shields added.

Each participant in the workshop will be enrolled in a free 12-chapter TEE course offered by HeartWorks eLearn prior to attending. Online videos and materials will also be made available immediately prior to the workshop.

“It can be intimidating at first, but these workshops are for any CRNA at any experience level – even if they’ve never touched an ultrasound before. The first hour covers the basics, the second hour is application of the basic view and doing certain measurements. After that, we delve into more advanced techniques that will significantly improve their practical skills and give the surgeon what they need,” Shields said.

The program has been prior approved by the American Association of Nurse Anesthetists for 10 Class A credits.

For more information, visit, or contact John Shields at (615) 517-6152,; or

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President’s Message: A Growing Scope of Practice

Chris Hulin

Over the past several months, I’ve continued to see nurse anesthetists push beyond the traditional boundaries of our profession and elevating patient care in a wide variety of settings on the frontlines of the pandemic.

We’re learning that the advanced skills CRNAs possess position us to be called upon to serve in critical situations that have been outside traditional daily practice. This has been particularly evident in the CRNA-only and more rural practices. Some of these demands have been created by the pandemic; however, it appears that the strong efforts by nurse anesthetists across the country will assure that CRNAs continue to solve complex problems and advance patient care throughout the healthcare continuum. MTSA continues – as we always have – to make sure that CRNAs have access to post-graduate educational options they need to remain current within the marketplace.

To that end, MTSA continues its strategic focus on point-of-care ultrasound (POCUS) with expanded modules in the Acute Surgical Pain Management Fellowship as well as Transesophageal Echocardiography (TEE) Workshops. The use of ultrasound as part of mainstream scope of practice is a national trend that will continue to grow, and our goal is to offer the most cutting-edge training available. In addition, the Neuraxiom website represents additional training and continuing education opportunities via an online platform.

Part of our mission at MTSA is to support our alumni by heightening the reputation of nurse anesthesia so that our profession is recognized for the high-quality care it delivers on a daily basis, which is why we’re focused on developing CRNAs’ skill throughout their career. This achieves several objectives: 1) It allows MTSA to be a part of your lifelong learning; 2) It secures a strong application pool for entry-to-practice students; 3) It supports the case to lawmakers for full scope of practice in the operating room and beyond; and 4) It supports the principles on which this School was founded 70 years ago.

I’m grateful to everyone who has provided feedback as we strive to be a resource for alumni near and far. As we continue to navigate these challenging times, my hope and prayer is that you and your loved ones stay safe and healthy!

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MTSA to launch Neuraxiom website

MTSA is preparing to launch a new iteration of, a website of practical resources to help anesthesia providers learn ultrasound for regional nerve blocks, announced Bill Johnson, DNAP, CRNA, Director of the MTSA Acute Surgical Pain Management Fellowship and DNAP Completion program.

The site—originally developed by Jack Vander Beek—will include free content as well as opportunities for special access to fee-based continuing education modules. “We’re continuing to add new content, including eight new blocks that represent 80% of the blocks anesthesia providers are doing today,” Johnson said. “In addition, we’ve included detailed illustrations by Jack Vander Beek, along with multiple associated videos.”

Johnson said that the website will include interactive anatomy illustrations, creating a refresher for CRNAs who want to do the vast majority of blocks useful in clinical practice. In addition, the site will feature a range of content on subjects such as ultrasound, pharmacologic agents and local anesthetics.

“We’re also including multiple videos on opioids and how CRNAs can combat the crisis using acute surgical pain management, as well as the lecture Dr. Serge Marchand presented at our Regional Cadaveric Workshop. And soon we’ll be posting some open-access journal articles,” Johnson said.

The Neuraxiom website will also feature continuing education for CRNAs, including current information on acute pain management with options to take a quiz and receive AANA credit.

According to Johnson, MTSA is also working on the next edition of The Neuraxiom Playbook of Essential Nerve Blocks textbook, which Vander Beek first published in 2009. The School is aiming for a publishing date next year.

Vander Beek developed the Neuraxiom textbook by documenting and illustrating a compendium of Ultrasound-Guided Regional Anesthesia (USGRA) techniques that have been successfully adopted by a countless number of regionalists over the years. It applies an evidence-based approach in updating the vast amount of knowledge that has been published in USGRA in the last decade.

For more information, visit

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MTSA alum elected president-elect of AANA

Dina Velocci, MS, CRNA

MTSA alumna Dina Velocci, MS, CRNA, has been elected as president-elect of the American Association of Nurse Anesthetists. She previously had served as AANA Region 2 Director and co-chair of the State Organizational Development Committee (SODC).

Her work on the SODC included managing the Association’s reserve funds, which are used to conduct strategic initiatives in states large and small as well as nationwide efforts to support nurse anesthesia practice in a variety of settings.

“A large portion of the AANA membership are eager for change and innovation, for pushing the envelope,” Velocci said. “I’ve spent my career doing exactly that, so I’m excited to apply that mindset to my new position on the board while always balancing the needs of the entire membership, which has many diverse voices.”

As co-chair of the AANA’s SODC, Velocci restructured her team’s approach on how they processed applications for grants and loans as well as changed the bylaws to alter the Association’s financial policies. She said her time in the role provided her with additional critical experience to be able to serve effectively as president.

“We’re an organization and a profession that operates within a very large medical industrial complex. We have to learn to be agile and work smarter to keep progressing within the healthcare system. It comes down to the fact that CRNAs deliver anesthesia care in a safe, cost-effective way. So we need to keep using the evidence that shows ours is a very good business model in a wide variety of settings,” she said.

Velocci pointed out MTSA’s strong relationship with the AANA, saying the School has always supported students going to the state and national association. Many MTSA graduates that have gone to other states have served on boards and committees, building a network of advocacy for the profession and serving as leaders and chief CRNAs.

“MTSA played a big part in my interest in advocacy work on behalf of nurse anesthetists. I was part of the first student group that [MTSA Dean Emerita] Ikey DeVasher, PhD, CRNA, helped bring into TANA leadership,” Velocci said. “What many people may not know is [MTSA founder] Bernard Bowen was a big advocate for CRNAs at Tennessee’s state legislature. He helped protect our profession and keep it progressing in Tennessee for a long time.”

After graduating from MTSA in 2005, Velocci joined the board of the Tennessee Association of Nurse Anesthetists (TANA) and continued serving within Tennessee for 12 years. She joined the AANA board for the first time in 2016. Her educational background is in political science.

“I sincerely thank the Middle Tennessee area and Tennessee nurse anesthetists for always supporting me in this advocacy work at the AANA. They helped elect me to this position, and I’ll be forever grateful for what I’ve learned from them. They are close to my heart,” Velocci added.

Velocci will serve as AANA president-elect from 2020-21 then as president from 2021-22.

About Dina Velocci

Before moving to Michigan, Velocci was a staff CRNA at Jackson-Madison County General Hospital in Jackson, Tenn., as well as an independent contractor. Prior to that, she held a staff CRNA position at Vanderbilt University Medical Center in Nashville and worked PRN for Southern Tennessee Medical Center in Winchester, Tenn.

Velocci began her higher education at the University of Central Florida in Orlando, where she earned her B.A. From there she went on to receive her B.S. in Nursing from Austin Peay State Univ. in Clarksville, Tenn. In 2004, she graduated from MTSA’s Master of Science program and went on to earn her DNP from Vanderbilt University School of Nursing.

In her clinical practice, Velocci specializes in general anesthesia for neurosurgical, vascular, thoracic, trauma, obstetrics, pediatric and cardiovascular surgery. She is also proficient in conscious sedation for interventional cardiology procedures, electrophysiology procedures and transesophageal echocardiography.

Since receiving her degree from MTSA, Velocci has returned year after year as a clinical and didactic instructor, transferring her real-world experience into critical learning for students. She has taught a wide range of topics, including ANPA 500 Professional Aspects I and II, Path Management, Pediatric Anesthesia, and Anesthesia for Vascular Surgery.

Velocci has dedicated considerable time and effort to sharing her knowledge outside the classroom as well. She regularly delivers presentations in a variety of settings nationwide, including speeches for the American Association of Nurse Anesthetists (AANA), MAC Anesthesia Seminars, Med City Seminars, American Society of Anesthesia Technicians, and others.

She was awarded MTSA’s Ikey DeVasher Distinguished Service Alumni Award in 2017.

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2020 DNAP graduation ceremony and President’s Medal winners

During MTSA’s DNAP commencement ceremony in August, President Chris Hulin, DNP, MBA, CRNA, awarded the President’s Medal to three graduates: (pictured l to r) Ron Bell, MS, CRNA, Ryan Hill, MS, CRNA, and Walt Lee, MS, CRNA.

The award was presented for their scholarly project, Do Novice Providers Benefit from the Use of a Video Laryngoscope When Intubating the Trachea? The project was focused on determining the appropriate airway management techniques to assist the novice provider in identifying airway structures and laryngoscope options for a successful intubating experience.

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17th Annual MTSA Golf Classic

MTSA announced the winners of the 17th Annual Golf Classic, presented by Cumberland Wealth Planning Group of Raymond James, held at the Hermitage Golf Course in September.

1st Flight
First Place (55) Harold Greene, Carl Freeman, Kevin Hughes, Sam Rhoten
Second Place (56) Chris Bishop, Claus Thormaehlen, Jack Shofner, Whit Shofner
Third Place (57) Aaron Jones, Jim Ingersoll, Carlyle Ingersoll, Chadd Watkins

2nd Flight
First Place (65) Ruth Hawk, Dan Knowles, Howard Yellen, Rusty Gentry
Second Place (65) David Deffendall, Adam Curtis, Zach Mcminn, Tom Wiggers
Third Place (65) William England, David Eldridge, Doug Neff, Brian Winfree

Special Contests
Closest to the Pin #3 — Howard Yellen
Closest to the Pin #5 — Corland Daws
Closest to the Pin #13 — Jeff Laidig
Closest to the Pin #17 — Brett Clayton
Long Drive #2 — Whit Shofner

Presenting Sponsor – Cumberland Wealth Planning Group of Raymond James
Lunch Sponsor – Anesthesia Medical Group
Driving Range Sponsor – Valley Anesthesia
Holes-in-One Sponsor – D. Harold Greene, RHu, Mass Mutual

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MTSA pivots to virtual simulations

Ginger Miller, DNP, CRNA
Director, Center for Clinical Simulation

Facing the challenges posed by the pandemic, Ginger Miller, DNP, CRNA, Director of MTSA’s Center for Clinical Simulation, pivoted to new instructional methods for students in her obstetrics class, which had previously been an in-person collaboration with midwife students from Vanderbilt University. This year she and her colleagues facilitated virtual simulations using video and online discussion.

“In past years we would do a combined in-person simulation of a hemorrhage during delivery. Not only does it allow the midwife students to learn the skills of how to handle a hemorrhage, but it also provides them guidance on when to ask for help and bring in an anesthesia provider,” Miller said.

She pointed out that typically neither the midwives nor the SRNAs have a depth of knowledge about each other’s scope of practice, including the fact that nurse anesthetists can handle the patient’s vital signs, drawing blood, etc. As a result of the class collaboration, the students learn that there are additional resources to help during delivery and that good communication is key.

During this year’s virtual collaborations, Miller and the Vanderbilt team spliced together video segments to provide a simulated storyline of different problems that can occur with a patient during delivery. They brought the class together via video conferencing and played portions of the video, pausing occasionally to ask the students for their assessment and how to handle the unique scenarios. Miller said 19 MTSA students participated during the virtual case scenarios, with 25 midwife students from Vanderbilt.

In a separate online simulation, the groups engaged in dialogue regarding quick assessments during an epidural procedure. The collaboration included five online sessions in which one student explained the role of a CRNA, another was a scribe who watched the scene and assessed what the students could do better and what type of communication worked well, and another educated the midwife on pertinent patient information to report before the CRNA places the epidural.

“We received great feedback from the students,” Miller said. “I plan to formalize the experience by writing a case study to be published in a nursing education journal, and we already have IRB approval to do so.

“As we continue this new instructional method, I’m looking forward to seeing how the midwife students’ confidence grows in terms of calling in the CRNA to help manage the patient. The whole purpose is to help different disciplines understand each other’s roles, especially when the SRNA must assess an emergent situation and use that knowledge to problem-solve. Sometimes when you get thrown into a clinical setting with strangers, it is hard to discern who orders what, who speaks up, who’s the one in charge. It’s a difficult skill to learn, but that’s why we focus on closed-loop communication between disciplines to improve patient care. So far, doing so in this new virtual setting has been very successful,” Miller said.

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Application period for ASPM Fellowship closes Nov. 30

The application period for the next cohort of MTSA’s Acute Surgical Pain Management (ASPM) Fellowship closes Nov. 30, with classes beginning in January 2021.

The ASPM Fellowship is a component of the AANA Pain Management Curriculum. According to Bill Johnson, DNAP, CRNA, Director of the Fellowship and DNAP Completion program, the primary goal is to advance the knowledge and skills of CRNAs in acute surgical pain management and prepare them to help meet the growing need for this evidence-based approach.

The Fellowship curriculum includes special focus on perioperative point-of-care ultrasound (POCUS), which is the use of portable ultrasonography at a patient’s bedside for diagnostic and therapeutic purposes. Along with its use for pain management, heart, lung and abdominal ultrasound scanning may reveal sources of hypotension, hypoxemia and other presentations of cardiopulmonary instability.

According to instructor John Shields, DNP, CRNA, POCUS is a major component of perioperative care, vital to independent CRNAs practicing to the full scope of their training. MTSA’s ASPM Fellowship offers advanced POCUS training for nurse anesthetists using online modules and hands-on workshops for Focused Assessed Transthoracic Echocardiography (FATE), Focused Assessment using Sonography for Trauma (FAST) and Rapid Ultrasound for Shock and Hypotension (RUSH) protocols.

MTSA now incorporates the BodyWorks Eve patient simulator for interactive POCUS scenario training. With more than 100 real patient scans and over 10,000 pathology variations across cardiac, lung, transabdominal and pelvic ultrasound, use of the BodyWorks Eve simulator is designed to expand training for CRNAs into emergency medicine and critical care applications, as well as pain management interventions.

Fellows’ Perspective on Chronic vs. Acute Pain Management

Kellon Smith, DNAP, MHS, CRNA, NSPM-C (pictured right), has been practicing nurse anesthesia for seven years and regional anesthesia and pain management for five years. After completing an earlier fellowship in chronic pain management, he is scheduled to finish MTSA’s Acute Surgical Pain Management Fellowship this fall.

Smith, who practices at a rural critical-access hospital in Keyser, W.V., has a unique perspective on how CRNAs can approach the continuum of pain management – from acute surgical pain to chronic pain.

“I’ve been in a multitude of settings, including ambulatory surgery centers and Level I and II trauma centers,” Smith said. “I’ve always had a strong interest in regional anesthesia, but there weren’t many clinical sites for CRNAs to do regional techniques. So it was my own personal endeavor to dive into the study of regional anesthesia and gain as much exposure and knowledge as I could. That led to researching chronic pain management and some of the interventions for patients that suffer long-term pain conditions.”

Smith completed the year-long Advanced Academic Fellowship for Chronic Pain Management at the University of South Florida in 2019. It included a clinical practicum covering some assessment maneuvers, interventions at a cadaver lab, and a simulation experience. After that, he entered MTSA’s Fellowship.

“The biggest thing I learned by doing both programs is that pain management, and even painful conditions, are part of a continuum. Transitioning from acute pain to chronic pain can happen rapidly for different patients. The chronic pain program provided interventions to combat pain once it sets in. It was beneficial to have that background knowledge coming into MTSA’s acute pain program, which focuses on surgical approaches, trauma approaches for broken bones, block techniques with regional anesthesia, and medications to add to the interventions,” Smith said.

He added that something as simple as a hernia can lead to a life of long-term persistent post-surgical pain. “If I perform a nerve block before the operation, I’ll not only decrease the pain during that stay and short-term recovery, but studies have also shown that I decrease the likelihood of that developing into a chronic painful condition. A lot of the chronic pain interventions are being blended into the acute side and a lot of the acute interventions are preventing the pain conditions that would require the long-term chronic pain interventions. So we’re really able to tackle it from both sides,” he said.

The opioid crisis is another element of pain management that Smith is focused on, especially since West Virginia leads the nation in overdose deaths. He believes CRNAs need to be better equipped to employ multi-modal anesthesia and different kinds of interventions to combat the problem.

“Where I’m located, there are no pain clinics or pain treatment facilities nearby. A lot of patients on state-funded insurance have to travel a minimum of 100 miles to the nearest pain facility. So I saw this as an opportunity to help my community,” Smith said. With assistance from a Health Resources and Services Administration (HRSA) grant, he has opened a CRNA-driven service line for chronic pain management that is non-opioid-based. And his training from MTSA has prompted him to start the process of developing an acute pain service at his hospital. Interventions will include placement of catheters, advanced blocks, and adding medications to the blocks to reduce or even eliminate opioid medications.

“The online format and flexibility of MTSA’s Fellowship really helped. As far as the content is concerned, I learned so much. I had some baseline experience in regional anesthesia, but this program really dove into the depths of anatomy, sonoanatomy, ultrasound scanning techniques, knowledge about the ultrasound itself, and the business aspects developing a CRNA-focused acute pain management service,” he said.

“I can’t say enough about the cadaver lab – it was truly remarkable to be able to do those blocks on cadavers and to have the anatomist show you exactly what you’re looking at on the ultrasound image. The entire program was truly a rewarding experience from start to finish,” Smith added.

Similar to Smith’s experience, Louise Scudieri, MS, CRNA, also brought her unique knowledge and experience into MTSA’s ASPM Fellowship. Scudieri is chief CRNA in an all-CRNA group at Kell West Regional Hospital in Wichita Falls, Texas, a division of YPS Anesthesia Services.

“My current practice is heavily loaded with neuro, spine and orthopedics, most having chronic pain issues,” Scudieri said. “I had introductory chronic pain education, having attended the Jack Neary Advanced Pain Management Workshop in 2010, which planted a seed, but my practices since then had only included acute pain and acute-on-chronic pain. This led me to look for advanced education and to find the University of South Florida’s and Dr. John Maye’s Simulation Based Chronic Pain Management Certificate Course in 2017.

“Upon finishing the USF coursework, I looked for advanced ultrasound courses. I have enjoyed providing regional anesthesia whenever I have had the privilege to do so, ever since the days of landmark and nerve stimulator techniques, but especially assessing the patient’s anatomy and seeing the needle and deposition of agents. This brought me to MTSA’s Advanced Ultrasound Cadaver workshop where I also learned about the Fellowship. This coursework and practice is better suited to the bedside anesthesia I do today. I commend Dr. Bill Johnson and the MTSA faculty for creating this necessary content and fostering research and sharing. Networking with these colleagues is invaluable to me, and I enjoy sharing the skills and knowledge with CRNAs one patient and one block at a time,” Scudieri added.

For more information about the ASPM Fellowship, visit

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Sporting Clay Tournament

MTSA invites alumni and friends to the 4th Annual MTSA Sporting Clay Tournament.

Friday, Nov. 6
8:30 a.m. – Registration
10:00 a.m. – Tournament Starts (all equipment provided)
Location: Nashville Gun Club

MTSA’s popular Sporting Clay Tournament returns for its fourth year, allowing marksmen and novices alike to hit moving targets at multiple shooting stations at the Nashville Gun Club. Lunch will be provided, and prizes are awarded for participants who hit the most clays.

The event benefits MTSA’s opioid-reduction initiative. For more information, visit or call (615) 732-7674.

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Regional Cadaveric Workshops open through 2021

MTSA announced its schedule of Cadaveric Ultrasound-Guided Regional Anesthesia workshops through 2021.

During the workshops, participants receive the benefits of small-group “live” scanning and needling stations, low faculty-to-attendee ratios, and an individualized learning plan that suits the attendee’s needs in regional anesthesia, according to Bill Johnson, DNAP, CRNA, Director of the MTSA Acute Surgical Pain Management Fellowship and DNAP Completion program. Information presented is highly practical and immediately useful to the attendee’s daily clinical practice.

2021 Regional Cadaveric Workshop schedule:

Basic Course — Feb. 21
Basic Course — March 21
Advanced Course — July 25
Advanced Course — Oct. 17

Workshops feature anatomists (trained PhDs and DPTs) presenting during the lunch hour, focusing on neuromuscular assessment of nerves, mapping of nerve lesions, and documentation of these findings.

Johnson said that the following blocks will be taught and demonstrated: PECs I/II, erector spinae, infraclavicular, serratus anterior, costoclavicular, RAPTIR, quadratus lumborum, TAP (iliohypogastric/ilioinguinal, transversalis, and posterior TAP), suprascapular (anterior and posterior approaches), and paravertebral nerve blocks. Advanced approaches to upper and lower extremity will also be taught, to include axillary at the circumflex artery, distal upper/lower USGRA blocks, and anterior sciatic.

Instructors for the daylong workshop include Johnson; Stace Dollar, MS, CRNA; John M. Edwards, III, MS, CRNA; Kelly Martin, MS, CRNA; and MTSA Acute Surgical Pain Management Fellows.

Participants can earn up to 16 Class A CE credits by completing the pre-course content and the course content combined. In addition, the AANA designates this program as meeting the criteria for up to 2 CE Credits in pharmacology/therapeutics.

Registration is available at For more information contact Bill Johnson at (615) 732-7846,; or

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Be part of the Fellowship

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