The original Anesthesia Nerd, Tasha McNerney, is back on the podcast! In this pearl-packed episode, Tasha runs through her anesthesia crash cart and breaks down what she has ready to go and why. This is an excellent refresher for anyone who wants to cement their emergency anesthesia drugs into memory.
You can also listen to this episode on Apple Podcasts, Google Podcasts, Amazon Music, Soundcloud, YouTube or wherever you get your podcasts!
LINKS
Veterinary Anesthesia Nerds: https://www.veterinaryanesthesianerds.com/
Recover Initiative Drug Chart: https://acvecc-recover.org/
Uncharted Veterinary Conference – April 20-22 – https://unchartedvet.com/uvc-april-2023/
Dr. Andy Roark Exam Room Communication Tool Box Course: https://drandyroark.com/on-demand-staff-training/
Dr. Andy Roark Swag: drandyroark.com/shop
All Links: linktr.ee/DrAndyRoark
ABOUT OUR GUEST
Tasha McNerney obtained her CVT in 2005 and has worked clinically in the areas of anesthesia and surgery ever since. Tasha obtained her CVPP (certified veterinary pain practitioner) designation in 2013 and became a veterinary technician specialist in anesthesia in 2015.
Tasha has been a featured speaker on various anesthesia and pain management topics at several international veterinary conferences. Tasha is the author of many articles and blogs on anesthesia and pain management related topics.
In 2013 Tasha created the Facebook group Veterinary Anesthesia Nerds, which has over 65,000 members taking part in education and exchange of ideas from all over the world!
Tasha is crazy and bought a 1920’s fixer upper and is now obsessed with home improvement tutorials on YouTube. She lives in Philadelphia with her husband, son, one perfect cat, and one jerk cat. Trust me that cat is a jerk.
EPISODE TRANSCRIPT
This podcast transcript is made possible thanks to a generous gift from Banfield Pet Hospital, which is striving to increase accessibility and inclusivity across the veterinary profession. Click here to learn more about Equity, Inclusion & Diversity at Banfield.
Dr. Andy Roark:
Welcome everybody to The Cone of Shame Veterinary Podcast. I am your host, Dr. Andy Roark. Guys, I am here with my dear friend, Tasha McNerney. We are running through the crash cart. This is such a great episode. This is the most stripped down, practical, just refresher on Anesthesia crash carts, that I’ve ever seen.
Honestly, I say at one point in this episode, I wish that they’d broken this down like this for me in vet school, because this is a beautiful thing. If you’re a student, a tech student, a vet student, just bookmark this one, because this is great. If you are like me, been a while since I ran through the crash cart and really was, I know exactly what this does and why it does it and how it does it and how much I use. Man, this is a great episode for you. So, quick to the point, Tasha’s amazing. Let’s get into this episode.
Kelsey Beth Carpenter:
(Singing) This is your show. We’re glad you’re here. We want to help you in your veterinary career. Welcome to The Cone of Shame with Dr. Andy Roark.
Dr. Andy Roark:
Welcome to the podcast, Tasha McNerney, how are you?
Tasha McNerney:
I’m good. How are you?
Dr. Andy Roark:
I am so good. It is so good to see your face again. You are one of my favorite people. You and me go way back, way back.
Tasha McNerney:
Way back.
Dr. Andy Roark:
You were here visiting my house when the pandemic hit and I’ll never forget-
Tasha McNerney:
Yes.
Dr. Andy Roark:
You and I started the pandemic together.
Tasha McNerney:
Yes. I have great memories of visiting four different stores, looking for canned goods and then finally buying all the beans at a CVS in some random South Carolina town.
Dr. Andy Roark:
I still have those beans, a 100%. I’m, these are my survival beans. My wife’s [inaudible 00:01:48].
Tasha McNerney:
Yeah, well just save them.
Dr. Andy Roark:
She was, we’ll never eat these. And I’m, look, as long as they’re there, I’ll sleep well at night, but as soon as you throw away my emergency beans, I’m going to be, what are we going to do if society ends?
Tasha McNerney:
Yeah. It was a good time.
Dr. Andy Roark:
When the world went sideways, you and I took action. That’s all I’m going to say. And most people-
Tasha McNerney:
Oh, 100%.
Dr. Andy Roark:
Did not, but we did.
Tasha McNerney:
No. People were, is this happening? And we both looked at each other and were, oh, we’d better stock up this pantry. Even though it wasn’t my pantry. I was, I’ll help you stock up this pantry.
Dr. Andy Roark:
Oh, you were with me.
Tasha McNerney:
I had gotten a call from my husband at home saying everything is off the shelves. It’s pandemonium here. And at that same CVS I bought two boxes of pasta and took them back in my luggage with me, because I was so worried that I wouldn’t be able to find pasta when I went home.
Dr. Andy Roark:
Yeah.
Tasha McNerney:
Yeah.
Dr. Andy Roark:
Oh man. It’s great to be with an anesthesia specialist because when the world goes haywire, they take action. And I felt that was instinctual for you.
Tasha McNerney:
Oh, 100%. I always joke with the anesthesia, is that we are very cool, calm and collected. When everything is crashing in the ER or in the OR, or wherever we are, it’s very much, okay, here’s the problem, where do we go next? All right. And we start this checklist. It’s very much cool, calm, and collected in anesthesia.
And the joke is that we’re dead on the inside. And sometimes I would agree with that, in that we’re not going to be the people freaking out, oh my God, everything is crashing, go get this for me. Really? You know that actually with me, you know that things are real bad if I get very calm and monotone. And if I say, okay, what I need you to do next is turn off that vaporizer and can you hand me the epinephrine? Okay. Things are going down. Things are going down.
Dr. Andy Roark:
Yeah. Oh, man. Oh yeah. You are a bit dead on the inside though. That’s just [inaudible 00:03:55], different.
Tasha McNerney:
A little bit. And that’s fine. Yeah. And you know what? Listen, I got a therapist, we’re working on it. We’re good.
Dr. Andy Roark:
I think a lot of people could stand to be more dead on the inside. I think it would probably be… We all know of people who should be a little bit less alive inside. It would help them.
Tasha McNerney:
Just calm down.
Dr. Andy Roark:
Totally. All right. For those who don’t know you, you are a veterinary technician, specialist in anesthesia. You are the founder of the Veterinary Anesthesia Nerds Group. It’s a Facebook group, it’s a website, it’s conference. This thing has grown to… How many people are involved, engaged with the Anesthesia Nerds Group now?
Tasha McNerney:
We have about 65,000 members around the world right now.
Dr. Andy Roark:
Yeah, it’s awesome. It is super awesome. It’s super bonkers. And I could sit here and sing the praises of the anesthesia nerds. I’m all about practical education. I really like to learn stuff, that I’m, I’m actually going to use this. And that is what you guys are all about. So I really love it.
I’m super glad that you’re here. I thought of you recently when I was… I had a pet under anesthesia and I can’t remember why, it was an emergency of some sort. And I had this pet under anesthesia and it just dipped there for a second. So when you pause for a second and you’re, is this going to be an issue? And then it stabilized and then comes back out.
And I thought I could use a refresher on the crash cart. That’s exactly what I took away from that specific instance, was it was an emergency that came in. I can’t remember what it was. It went under anesthesia to get fixed. And I thought, eh, you know what? Let’s just freshen these skills back up.
And so I wanted to get you in and just say, run through the crash cart with me real quick. Let’s do a 100% refresher on what’s in my crash cart, what’s it do, what do I need to know about it? And just make me feel the dust has been blown off my crashing patient knowledge. Is that okay?
Tasha McNerney:
Oh, yeah. Let’s do it. Ooh, there’s probably a lot to cover, but we’ll maybe put it into categories when you’re looking at your crash cart. And again, I just want everybody to know that I’m talking about this in the context of an anesthetic crash cart, not necessarily your ER crash cart, which is probably going to be a little bit different.
But when we look at our anesthetic crash cart or what we want to have in that top drawer of our anesthesia machine or on hand during any anesthetic event, that’s what I’m going to talk about here. If that’s cool with you?
Dr. Andy Roark:
Yeah.
Tasha McNerney:
All right. So first of all, in an emergency, again, when I say to you, hey, things are not looking good, can you turn off that vaporizer? And then one of the first things that I want you to do is pull out, are real emergency drugs. And when I say emergency drugs, with anesthesia in mind, when I’m talking about are emergency things like atropine and epi and then our anesthetic reversals.
So these are really the two big things in our crash cart. We know that we want to have atropine or anticholinergic that we will use in emergencies because it has a very fast onset, shorter duration of action than glycopyrrolate. But again, in an emergency, we want that fast onset, all right?
Dr. Andy Roark:
Mm-hmm.
Tasha McNerney:
Now there’s some stuff, and I will let you guys listening at home do some research, because I think this is very, very interesting. Looking at the newer research that has come out in the past couple of years, especially starting in human medicine, asking, is there really any benefit to using atropine during a code or a CPR event? And the human medicine, human literature has actually found that there isn’t, and they actually don’t really use atropine anymore during emergencies.
And if you look at the newest recover guidelines, they actually state that atropine is not necessarily beneficial, but they don’t know if it’s really going to do any harm either. So if you feel you still want to keep that in your back pocket, you’re probably not doing any harm. But it’s a little different than we thought 10 years ago, that we don’t necessarily know that it’s really doing a lot during our CPR events or our code events. But I still will get it out. And I will say that my anesthesiologist will still have us give it during an emergency.
Our next is epinephrine, and that’s because we want that vasoconstriction. We want to make sure that our blood pressure stays tight. We want to make sure that we are delivering oxygen to the tissues to where it needs to go. So again, our emergency drugs.
Then we need to get rid of whatever anesthetic… Again, if this is a true anesthetic emergency, we want to make sure that we have reversals in our crash cart to reverse every single drug that can be reversed. Now, most of the time with anesthesia, we are administering opioids. So that means that we need naloxone first and foremost in our crash cart. So if we have an opioid on board, we want to make sure that we reverse that opioid with naloxone.
Second, most common drug class that’s used are benzodiazepines, things like Midazolam or things like Valium. And we have a reversal for those. And a lot of clinics don’t even carry the reversal. But I would say if you’re utilizing things like Midazolam or Valium in your clinic, you need to carry the reversal, just in case things get crazy. And the reversal for those, is a drug called flumazenil. It’s a little more expensive than naloxone.
And again, a lot of people don’t keep it regularly on their shelves. But I would say that if you have an emergency, you want to have at least one bottle of flumazenil or at least one in your OR if you have an anesthetic emergency. The next reversal agent that is very important would be Antisedan or atipamezole. So this is going to reverse your dexmedetomidine, or if you’re in a practice that is still using xylazine, you would want your reversal to be yohimbine, although you could use in atipamezole as well, working on those receptors.
So you want to have Antisedan for your dexmedetomidine, right? So if we came into an urgent situation, we want to make sure we have access to atropine and epi and the reversals for all of our drugs. Now, if you’re utilizing ketamine in your protocol, we don’t have a reversal agent for ketamine. So just realize that if you know things get crazy and you start reversing everything, that ketamine is still going to be on board. We don’t necessarily have a reversal for that.
Now, this is just for an emergency. I will say that there are a couple other drugs that I do think of as always having in my crash cart. One, maybe for some anti-arrhythmogenic effects. And then one for if we start to see maybe some irritation or something like that under anesthesia. And one of these is lidocaine, and the other one is diphenhydramine.
Dr. Andy Roark:
Okay.
Tasha McNerney:
I like to keep these on board, especially with our patients that are not hemodynamically stable, certain breeds. If we see a ventricular tachycardia under anesthesia, so again, this is a ventricular tachycardia. And when I say that, I mean a beat that is greater than 160 beats per minute.
So if we see something like this, again, that is going to be not great for forward movement of blood and cardiac output, which delivers oxygen. So we always want to make sure we have lidocaine available as well. Especially in these more critical patients, you might need to give a two mg per kg lidocaine bolus if you see that your patient is in V tach.
Now again, the reason I mentioned the rate is because sometimes I’ve gone into clinics where they’ll see what they describe as a slow V tach or a ventricular escape beat, where they’ll see it, but maybe the rate is still only around a 100 beats per minute or 110 beats per minute. We don’t treat those with lidocaine. That could actually make it worse. So lidocaine is for those ventricular tachycardic emergencies.
And then diphenhydramine, I usually like to have it on board because sometimes my surgeons will note, hey, I see that this patient has had a reaction to either… Maybe they have severe clipper burn or they’ve had a reaction to the chlorhexidine that’s been used to scrub their skin and now they have hives. So if we see something like that, we want to make sure that we can administer some diphenhydramine to them.
Dr. Andy Roark:
Okay, that makes sense.
Tasha McNerney:
Those are some emergency drugs. And so of what I like to have on my anesthesia crash cart. Now, these are adjunct drugs that I’ll talk about really quickly. And this is more blood pressure drugs.
Dr. Andy Roark:
Okay.
Tasha McNerney:
Because we know that inhaling anesthesia, along with a lot of the drugs that we are going to administer, like acepromazine, like propofol, like alfaxalone, these drugs are going to cause a decrease in cardiac output and vasodilation, which is going to lower our blood pressure. We know that hypertension’s going to happen, we want to be ready for it.
Now, most of the time you have a normal healthy hemodynamically stable animal. Something like lowering your vaporizer setting or administering a fluid bolus as a five mil per kg, is going to get you where you need to go for some animals. But for other animals, especially if you have a longer procedure in mind, we want to make sure that we’re not just letting that blood pressure and that mean arterial pressure dip consistently below 60, because then we know that oxygen delivery to really important tissues is going to be compromised.
And that’s why I always like to have some blood pressure drugs ready and available. Now, I’m not saying that every clinic has to have all of these blood pressure drugs, but the three that I keep on me at all times are going to be dopamine, dobutamine, and ephedrine. And dopamine is a mixed alpha and beta, and that’s why I really like it. If you have a patient, a cat that’s under anesthesia for dentistry, and we know that we’re going to do 12 extractions, it’s going to be a long procedure, but their blood pressure is already not doing so great, and they are also an elevated kidney value patient, and I want to make sure that they don’t get too hypotensive, then I’m going to start dopamine on this patient.
Again, we’re going to have alpha effects and we’re going to have beta effects, which means the beta is going to help to increase the heart rate in the contractility. And the alpha is going to give you a little bit of a squeeze on those vessels. Similar to another alpha active drug, dexmedetomidine.
Now dobutamine, and the reason I like to have dobutamine around is because for some animals, like your mitral valve disease patients, like your chronic heart failure patients, these little Shih Tzus that come in and they have heart disease. These guys, if we’re about to do a long procedure on them and they get hypotensive, they’re going to do better with dobutamine. And that’s because dobutamine primarily exit beta receptors. These little dogs sometimes can’t handle, with the heart disease can’t handle the vasoconstriction that comes along with alpha activation and dopamine. So we will go with dobutamine for these guys, because it’s having a party at the beta receptor. It’s all beta all the time. And that’s why I want to have dobutamine for those specific heart cases.
And then I also like to have ephedrine. And ephedrine is one of those because it is very cost-effective. It’s very versatile. You can give ephedrine as a one-off and it’ll last for about 30 minutes. So I find ephedrine very helpful. It’s an alpha and beta, very similar to dopamine. But unlike having to set up a concentrate infusion like you do with dopamine, you can give a one-off of ephedrine. Now you have to dilute it out. So make sure if you’re getting a vial of ephedrine, you are diluting this out. So you have maybe a one mg per mil concentration.
But then you could give a dose of it. And sometimes if I say to my clinician, well, I’m already tried the vaporizer, I’ve maybe tried giving… I don’t think the heart rate is an issue, and you’re telling me we still have 30 to 40 minutes left of this dentistry, but I need to do something about the blood pressure. If I don’t have access to dopamine, or I don’t want to take the time to set up a CRI. I can maybe just do a one-off of ephedrine.
And that’s really effective because again, ephedrine like dopamine effective at the alpha and beta receptors, and we get about 30 minutes of activity. So that’s what I keep in my back pocket, if I just need a quick something, and I don’t want to set up or I don’t have access to set up, a syringe pump and an infusion, et cetera.
And then some other things, just like equipment that I like to keep with me at all times is an extra endotracheal tube, an extra laryngoscope. And if you are at a practice that has access to it, certainly paddles for fibrillation. Now, again, remember if we are going to use paddles, this has to be a rhythm that’s a shockable rhythm. We’re not going to shock V tach.
Dr. Andy Roark:
Yeah.
Tasha McNerney:
But if you see it’s really critical, things go south and crazy and your patient is in V-fib, then we can shock that rhythm. But I will also tell you that I’ve worked in plenty of places that don’t have access to paddles and they’ve done okay with that.
Dr. Andy Roark:
Yeah.
Tasha McNerney:
Okay. But this is just equipment. And the reason I’ll go back to the laryngoscope and the tube really quick, is on the off chance your patient during movement from induction into the theater gets extubated, during the off chance that moving the patient around on the table, they get accidentally extubated. I want to make sure that I can quickly re-intubate that patient.
And again, a laryngoscope is going to be the best way to do that because it’s going to give me visualization of where I’m going with the tube, if there are any problems, et cetera. I want to be ready for those problems. And that becomes, especially, especially important, if you’re dealing with brachycephalic patients. Always have an extra tube and laryngoscope ready to go.
Dr. Andy Roark:
Yeah, that totally makes sense. This is amazing. I did not have this as clearly broken down for me in vet school as you just did. This would’ve been so helpful, 15, 20 years ago. This is amazing.
Dr. Andy Roark:
Hey guys, I just want to hop in really quick and give a quick plug. The Uncharted Veterinary Conference is coming in April. Guys, I founded the Uncharted Veterinary Conference in 2017. It is one of a kind conference. It is all about business. It is about internal communications, working effectively inside your practice.
If you’re a leader, that means you can be a medical director. It means you can be an associate vet, who really wants to work well with your technicians. It means you can be a head technician, a head CSR, you could be practice owner, practice manager, multi-site manager, multi-site medical director. We work with a lot of those people.
This is all about building systems, setting expectations to work effectively with your people. Guys, Uncharted is a pure mentorship conference. That means that we come together and there is a lot of discussion. We create a significant percentage of the schedule, the agenda, at the event, which means we are going to talk about the things that you are interested in. It is, as I said, business communication-focused, but lots of freedom inside that to make sure that you get to talk about what you want to talk about.
We really prioritize people being able to have one-on-one conversations to pick people’s brains, to get advice from people who have wrestled with the problems that they currently wrestled with. We make all that stuff happen. If you want to come to a conference where you do not sit and get lectured at, but you work on your own practice, your own challenges, your own growth and development, that’s what Uncharted is.
Take a chance, give us a look. Come and check it out. It is in April. I’ll put a link in the show notes for registration, ask anybody who’s been, it’s something special. All right, let’s get back into this episode.
Dr. Andy Roark:
All right, wonderful. Talk to me about some dosages. So are there dosage calculators that you really like? Because there you are and you’re doing the procedure and this is a stressful time and things start to go off the rails. What do you do to keep those things top of mind for you in a useful way where you say, okay, this is what we need? It’s not just epinephrine to effect, although that works.
But how do you track that information? How do you keep that in a very handy format? Because you just know it, you’re just… I know you know it, but is that the best way to approach this?
Tasha McNerney:
It’s probably not the best way to approach it, because again, unless you’re really dead on the inside and you can block everything out and just go to your Rolodex of drug dosages, nevermind that thing’s beeping and people yelling. Again, I can do it, but I think that’s just because, I don’t know, my brain functions a little bit differently.
Dr. Andy Roark:
I’ve had people say, how much? And I show them with my fingers like this much, and they’re, that’s not scientific.
Tasha McNerney:
That’s not a… Nope. Don’t do that, you guys at home.
Dr. Andy Roark:
Yeah, don’t.
Tasha McNerney:
But certainly I would say for anybody who is interested, look at the VECCS website. They have a lot of really great things. Look at the RECOVER Initiative, that’s going to give you a really nice dosing chart. And I do know that if you go to RECOVER and look at the RECOVER Initiative and their website, they also have posters that a lot of clinics will use, that give you the dosages of, based on weight. They have a quick weight chart.
So a lot of ERs and emergencies will have this just hanging in their practice where they have a really nice weight chart that’s busted down between atropine, epinephrine, reversal drugs, things like… Again, if you’re in an ER setting and things get really crazy, you want to bust out the vasopressin, things like that.
So I really would recommend RECOVER because that’s probably the most up-to-date guidelines as far as what the research is saying, new updated dosages and having it easy and accessible. Another thing that I do recommend that every practice does is take those dosages and make an Excel spreadsheet or an emergency drug calculator, print that out based on the patient’s current weight and have that ready to go.
The time to print it out and put it into the Excel spreadsheet is not when everybody’s screaming and the dog’s losing a lot of blood. We want to make sure that we do that beforehand. And again, because it’s a really stressful time, it’s nice to have this printed out and checked beforehand. Because again, when things are really crazy and you’re really stressed out and your clinician says to you, okay, I need you to give a certain mg per kg dose, and then your brain is, wait, how much does this patient weigh? What’s the concentration? And you’re trying to do this quick math, doesn’t usually work out well. And those precious seconds that you’re taking to calculate out this drug can make a huge difference.
Dr. Andy Roark:
Yeah, that’s fantastic. I’ll put a link to the RECOVER Initiative drug doses in the show notes, so people can check that out. I don’t think I need a link to Microsoft Excel, but…
Tasha McNerney:
No. I usually say… Because people can make their own Excel, again based on what they have in their clinic. Because I don’t think that every clinic maybe has vasopressin ready to go for their solutions.
Dr. Andy Roark:
Yeah. No. I love that. I think that makes a ton of sense. What are the most common pitfalls that you see? And what are the things that people are either putting together on a crash cart or using what’s on their crash?
Tasha McNerney:
I think that most common pitfalls, at least from an anesthetic perspective that I see, is that there’s not a regular checking of the crash cart and whether or not the drugs are expired or whether or not we have enough volume of the drug ready to go.
Dr. Andy Roark:
Yeah.
Tasha McNerney:
So for instance, [inaudible 00:22:36] I would give you… Yeah, to actually do what we need to do. Yes, I may have a bottle of atropine in there, but if there’s only 0.4 mls, that might not get me where I need to go.
So having somebody check that before the procedure. And I’m a huge fan of checklists. You guys know me, I love checklists. I love anesthesia checklists. If you haven’t read the checklist manifesto, please do yourself a favor and read this. It’ll change the way you practice.
But certainly having checklist in anesthesia and having somebody to go in before the anesthetic event even happens, check that anesthesia machine, check that cart, make sure the lidocaine is in date. Make sure that you have a bottle of glycopyrrolate ready and available. Make sure that if you’re going to use dopamine, again, you have enough volume to make up your CRI. I’ll just give you an example. I was doing, I was helping out anesthesia on a 62 kg-
Dr. Andy Roark:
Wow.
Tasha McNerney:
Great Dane.
Dr. Andy Roark:
Yeah, it’s 140 pound Great Dane.
Tasha McNerney:
Great Dane.
Dr. Andy Roark:
Holy crap.
Tasha McNerney:
In for a CT procedure. And I went to look at the crash cart in our anesthesia machine in CT, and I’m looking at it and I was, we only have one ML of atropine in this bottle. So, I have atropine and it’s in date, but again…
Dr. Andy Roark:
That’s not going to make one side of his mouth [inaudible 00:23:53].
Tasha McNerney:
If something goes crazy with this patient, now I have to run to a whole other side of the hospital to get more atropine because that one ML is not going to be enough for that Dane.
Dr. Andy Roark:
Yeah. Yeah, that totally makes sense. Awesome. Tasha McNerney, thank you so much for being here. Where can people find you online? Where can they learn more about Anesthesia Nerds?
Tasha McNerney:
Yeah, so the Veterinarian Anesthesia Nerds is currently a Facebook group, and that’s where we do a lot of our discussion and case-based stuff. But you can also find us on the website, veterinaryanesthesianerds.com. And on the website we have links to the Veterinary Anesthesia Nerds podcast, as well as a calendar of events.
So you can see where all of us are speaking. And when I say all of us, I don’t just run Anesthesia Nerds by myself. I am joined by Darci Palmer, who’s a VTS in anesthesia, and she works out in Alabama. And then I’m also joined by Steven Satal, who is a VTS, not only a VTS in lab animal, but also a surgical research anesthetist and just a wealth of information there.
So we have a calendar, so you can see if you wanted to come hear us talk or lecture. We have a calendar on there as well. And then we have a contact form as well. So if you have something that you wanted to ask the Anesthesia Nerds or you wanted to request some help for something, you can get us there.
Dr. Andy Roark:
That sounds fantastic. Awesome. Thank you so much for being here. Guys, thanks for tuning in. Take care of yourselves. Have a wonderful rest of your week.
Tasha McNerney:
Thanks for having me.
Dr. Andy Roark:
And guys, that’s what I got for you. I hope you enjoyed it. Hope you got something out of you it. Thanks again, Tasha, for being here. Guys, if you liked it, if you enjoyed this episode, tell your friends, share this thing, because really, this is great information.
Always, always feel free to write us an honest review, wherever you get your podcast. That means a lot. Gang, I will talk to you later on. Be well.
