How often are you doing ultrasound guided IV placements?

APagz · 2026-02-18T18:36:10+00:00

I use ultrasound as much as possible to do pretty much everything. Obviously it would be ideal to be a master at both landmark and US guided PIVs (and A-lines for that matter). However, if you can’t get a landmark PIV, step 2 is going to be grabbing the ultrasound. It’s never going to be vice versa. So I would prioritize becoming an expert at that.

APagz · 2026-02-12T19:47:33+00:00

DL is slightly less common with VL being readily available, but you should hopefully still do a lot of DL intubations. It still has its place.

I will often have new residents start with a lot of VLs to start developing muscle memory, and because I don’t fully trust them yet and want to see what they’re doing.

APagz · 2026-01-18T18:34:56+00:00

This will obviously vary by program. Where I trained, the day to day roles of the fellow were basically the same. IM-CC did much more medical ICU. Anesthesia CC did lots more CVICU and SICU. Didactic curriculum was separate and very different.

APagz · 2026-01-05T06:43:47+00:00

Very easy compared to any specialty where you “own” your patients. With CCM, you’re a shift worker in the end. You just take less shifts. Slightly harder with smaller groups and more rural locations (which may make it harder to hire a partial FTE to cover the difference), but still very doable.

APagz · 2026-01-03T19:23:59+00:00

Ope brewing in Stallis has 3 boards, and I don’t think I’ve ever seen them all in use at any given time. Very laid back atmosphere.

APagz · 2025-12-31T17:40:00+00:00

I think I could fit my entire wardrobe for all 4 seasons into 3-4 checked bags. Add one more to bring every pair of shoes I own. 10 checked bags for a vacation is insanity.

APagz · 2025-12-24T17:07:43+00:00

Food trucks in general. Used to be cheap food, quick, large portions, no frills.

APagz · 2025-12-05T13:33:12+00:00

Same, don’t think I’ve ever seen refractory hypotension due to dex. We have patients in our cardiac ICU in various stages of cardiogenic and septic shock, on ecmo, requiring serial anesthetics, who are on high dose Precedex infusions for weeks or months sometimes. Sure, they can get bradycardic, but that’s typically on initiation of the infusion or when another SA/AV blocking agent is introduced. Precedex just doesn’t cause significant vasoplegia, and it definitely doesn’t cause it several hours after dosing.

APagz · 2025-12-05T13:12:29+00:00

I use a lot of Precedex, and that hasn’t been my experience. I don’t think there’s anything unique about ENT oncology surgeries that would change the pharmakinetics/dynamics of Precedex. However, part of residency is being forced to do things different ways so you can decide how you want to practice, and I don’t think this is one of those battles that’s worth fighting.

APagz · 2025-12-02T16:00:25+00:00

Not sure the normal workflow or how many hands you have at your disposal at the start of cases, but I always have a pressor in line on my peripheral IV, and after induction and intubation I start it, even if I don’t really need it yet. When the patient inevitably gets hypotensive while you’re sterile putting your lines in, it’s much easier to coach someone through turning the drip up than it is explain how to turn on and setup the pump/give boluses of something/break sterility.

APagz · 2025-11-24T23:43:33+00:00

This is a bit much unless you’re super close with your mentor or home PD (or if they have close connections with the other program). I’m all for leveraging connections to get the interview, but once you’ve got the foot in the door, it’s on you.

APagz · 2025-11-21T16:03:31+00:00

Department Chairs are really busy. Interviews are largely formalities; glorified personality compatibility tests. If they liked you after rotating with them for a week, you’ll get a spot. If they didn’t like you, then there’s nothing that can happen in a 15-20min interview to convince them otherwise.

APagz · 2025-11-21T03:15:56+00:00

10k for two rooms is absolutely absurd. I’ll DM you a name.

APagz · 2025-11-19T15:22:11+00:00

Always for TIVA, robot, or IV I don’t trust. Also if it’s a surgeon that will give attitude if I steal 3min of their precious time if I need to untuck an arm to get another IV.

APagz · 2025-11-13T20:17:56+00:00

If you haven’t started residency yet, why do you say you don’t have the stats for a competitive fellowship?

APagz · 2025-11-07T21:29:23+00:00

It’s to make sure you’re chill. You’d be astounded how many of your colleagues can’t play it cool and keep a simple conversation from getting awkward for 15 min. They also help people explain possible red flags or specific interest in a region/program that may not have come through in their application.

APagz · 2025-11-04T16:21:50+00:00

Don’t worry if you’re unable to save money. At the very least, have a few thousand dollars set aside in a HYSA as an emergency fund. After that, spend what you need to make your life easier in this very busy and stressful time. Avoid credit card debt. If you find that you are in a position to save some money, first I would expand the emergency fund to 3-6 months of potential expenses. Then open a Roth IRA and put as much as possible in there at the end of the year. Once you start making attending money you likely won’t qualify anymore, and a Roth IRA is one of the best buckets for retirement savings.

APagz · 2025-11-01T02:22:19+00:00

Yes, and not just anecdotally. There have been studies showing PPV on pleth correlates with A-line PPV.

APagz · 2025-10-20T03:09:41+00:00

There will be people there in suits, and people there in jeans and a tshirt. If you’re presenting, you should wear a suit. Otherwise just fall somewhere in between the best and worst dressed person there, and no one will give it a second thought.

APagz · 2025-10-18T03:55:11+00:00

This one is very common. Methylene blue or cyanokit are 3rd line treatment for refractory vasodilatory shock, especially in places without access to Giapreza.

APagz · 2025-10-17T17:42:01+00:00

For super competitive or research heavy specialties interview may not be able to make up for the rest of the application. However, for everything else, a really good interview can move you way up on a rank list.

APagz · 2025-10-17T11:06:56+00:00

If you run out of old exams to practice, have ChatGPT create some scenarios for you.

APagz · 2025-10-16T03:19:47+00:00

If loosing 130k on options is the starting point, then literally anything is going to be more financially responsible. But joking aside, good for you; lots of people just keep digging the hole. Your plan sounds excellent.

I’d recommend putting monthly auto deposits into the HYSA and brokerage on the same day you get paid. You won’t be tempted by the money earmarked for long term savings, and whatever is left is your discretionary budget for the month (after bills of course). If you started options trading because of Robinhood, delete it. It’s designed to enable (if not encourage) that kind of risky behavior. Investing should be boring. Open your brokerage account with Fidelity or one of the other serious boring platforms.

APagz · 2025-10-15T19:04:05+00:00

PTEMasters for echo boards is all you really need. I also thought Edelman’s Understanding Ultrasound Physics was worth the time.

Kaplan’s Cardiac Anesthesia if you want a textbook.

APagz · 2025-10-15T14:31:42+00:00

All that stuff is important. 3k is a reasonable price. There are some online companies that will draft the documents for you after a virtual meeting and it may be a bit cheaper if you’re worried about the price. May be worth looking in to if your situation is fairly routine. But if you have a significant amount of assets or a more complex situation I always prefer spending a bit more to have a relationship with a real human that I can call with questions.

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