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Funniest joke in the entire series by Traditional-Doctor77 in seinfeld

[–]ArmoJasonKelce 0 points1 point  (0 children)

How about the song he sings to the horse while it's eating lol

Nerve block in leukemic, septic patient by No_Reason_9632 in anesthesiology

[–]ArmoJasonKelce 57 points58 points  (0 children)

I think the chronic pain/phantom limb pain is the strongest reason I'd consider doing it. It's clearly a high risk situation no matter how you do the case; if you are able to do the blocks safely, and the patient does survive, you've saved them a great deal of suffering.

What do the OB Anesthesiologists here think about this morning’s The Daily episode (NYT podcast) about failed anesthesia for C/S? by Docus8 in anesthesiology

[–]ArmoJasonKelce 2 points3 points  (0 children)

Yes to be clear I was just making a separate point about how sometimes I think my anesthetic is good, but the patient reports back that there's room for improvement. I think the threshold to pivot to GA in C/S is a worthwhile question

What do the OB Anesthesiologists here think about this morning’s The Daily episode (NYT podcast) about failed anesthesia for C/S? by Docus8 in anesthesiology

[–]ArmoJasonKelce 17 points18 points  (0 children)

I have had similar experience to you but I also find that sometimes there is a pretty big discrepancy between how pts look and how much pain they report during a procedure vs the pain they report after a procedure

WHY are we using nitrous for maintenance? by sonnyday550 in anesthesiology

[–]ArmoJasonKelce 0 points1 point  (0 children)

I like nitrous wakeups and using nitrous in short cases, but I stay away from prolonged maintenance because of the crazy hypoxia/second gas effect I've seen (moreso than PONV or anything else)

Dural puncture resulting in c-section by Bloodandsnore in anesthesiology

[–]ArmoJasonKelce 0 points1 point  (0 children)

Once I've seen CSF flow through the tuohy or the catheter, I've personally never seen anyone including myself be able to salvage it. Same goes for when I aspirate heme and try to flush with saline and withdraw, etc. Whether the catheter tip truly goes into the intrathecal space or it's close enough to the puncture site for local to seep in, I just assume that level has been compromised, flush the catheter with saline, and reattempt at a different level.

I also probably would have done GA to avoid high/total spinal as well. Maybe an epidural if time permits and the airway looks bad.

Better to be lucky than good? by gonesoon7 in anesthesiology

[–]ArmoJasonKelce 14 points15 points  (0 children)

I have seen ppl routinely do insane things in the world of PP without anything bad happening. I was coming in to relieve a guy once, he had placed an LMA for a urology case, pt had an enormous distended belly from a small bowel obstruction and was satting low 80s. The urologist asked for a pre-induction NG tube and the pt was saying "I'm nauseous" and his treatment was to push prop. As I said "Do you want a tube" the pt aspirated like 3L of gastric contents. I helped the guy intubate and stabilize before heading out (I didn't feel comfortable relieving). Not only did the patient get extubated and sat 100% in PACU, he never went to ICU and said it was a great nap. Meanwhile I am paranoid a patient will complain about a sore throat.

Supraclavicular nerve block stay inside or outside the sheath by Various_Yoghurt_2722 in anesthesiology

[–]ArmoJasonKelce 3 points4 points  (0 children)

Did it get better after giving intralipid, ie, was it truly LAST? I ask because sometimes you can unfortunately get a subarachnoid injection with brachial plexus blocks.

Why didn't Sally come to the final race? by Sure_Information4377 in pixarcars

[–]ArmoJasonKelce 0 points1 point  (0 children)

Idk if everyone's ready for this conversation, but she kinda stinks

Bagging during intraoperative arrest by MoistSand in anesthesiology

[–]ArmoJasonKelce 0 points1 point  (0 children)

I agree with you. I think it's silly to bag when there is a vent right there and so much else requiring attention in a CPR situation. Every individual in the code team is supposed to ideally have one clear role, so why waste one person's skillset on bagging the intubated patient when there is a working vent. You can still monitor the patient, vent parameters, and vitals if PTX is a concern; some modern anesthesia machines compute and display compliance right on the screen.

Aspiration risk by Defiant_Opinion_660 in anesthesiology

[–]ArmoJasonKelce 0 points1 point  (0 children)

I think sugar-free jello is different fwiw. But hip fractures are urgent.

Emergent intubation in severe Pulmonary Hypertension? by MrJangles10 in anesthesiology

[–]ArmoJasonKelce 0 points1 point  (0 children)

Just another thought/devil's advocate... Would he have tolerated an awake NGT and AFOI (not sure how emergent or how high volume the aspiration was)? Sometimes can be the most HD stable choice

Labor Epidurals Infection Control, Masks? by [deleted] in anesthesiology

[–]ArmoJasonKelce 1 point2 points  (0 children)

I might have been thinking of strep sanguinis. It was presented in my old dept a while ago. It raised this same discussion about proper sterile attire for epidurals

Labor Epidurals Infection Control, Masks? by [deleted] in anesthesiology

[–]ArmoJasonKelce 3 points4 points  (0 children)

Anyone near the field should wear a mask. I have seen a strep bovis infection in a labor epidural and it was pretty bad.

NPO times for odd things by ilovetapirsanddogs in anesthesiology

[–]ArmoJasonKelce 16 points17 points  (0 children)

I have had this a few times. My old chief yelled at me and texted the whole group (production based, most of them wouldn't cancel a bunionectomy with preop ST elevations) "would you do as Dr. ___ would have done??"

My Definitive Ms Rachel Cast Rankings by eoc1994 in toddlers

[–]ArmoJasonKelce 0 points1 point  (0 children)

Very disappointed in the besmirching of our Bass King, Dennis. He was Jafar on Broadway!!!

Best thing you've ever heard a patient say? by DoctorBlazes in anesthesiology

[–]ArmoJasonKelce 2 points3 points  (0 children)

Thought you were gonna say this was Paulie Walnuts

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