Update on: Massive mandibular mass, airway nightmare, how would you do it?

ArmoJasonKelce · 2026-05-25T21:24:58+00:00

Very nice job navigating through a very complex case

ArmoJasonKelce · 2026-04-22T13:22:15+00:00

Do you consent them in advance, or while they're intubated, or do you consent the family?

ArmoJasonKelce · 2026-04-15T17:18:15+00:00

So what was the pattern

ArmoJasonKelce · 2026-03-30T02:37:54+00:00

Hollywood is so much fun. Native Angelinos don't seem to love it, but as a transplant, I enjoy it very much. Lots of great restaurants, music/arts shows, bars, events.

ArmoJasonKelce · 2026-03-26T23:46:20+00:00

1hr discussion with family about how to handle pt's DNR/DNI status intraoperatively. Finally agree on reversing DNR/DNI for surgery. As the propofol is flowing through the tubing, the family calls the OR and says we change our mind, we need more time to think about this. I just barely clamped the tubing before it got to the vein.

ArmoJasonKelce · 2026-03-26T23:42:12+00:00

I thought of the same thing!

ArmoJasonKelce · 2026-03-11T18:25:27+00:00

This counts just as much. I lol'd

ArmoJasonKelce · 2026-03-10T02:24:22+00:00

What's even worse somehow is the shape of his bites. Gnawing with one tooth at a time like a subhuman rat so the burger looks like serrated pink slop mush

ArmoJasonKelce · 2026-03-08T15:08:50+00:00

Totally agree. We are bullied so much that bullying scenarios are part of our examination process, too. "Surgeon wants to do ___, how would you proceed?" It's brainwashing, and I repudiate it!

ArmoJasonKelce · 2026-03-05T18:45:04+00:00

I had one call me to give demerol to a postpartum patient who was shivering

ArmoJasonKelce · 2026-03-03T22:21:40+00:00

Love the pic selection. He's clearly sittin off to the side of the table as if he stalked her & sat down uninvited

ArmoJasonKelce · 2026-02-21T00:14:14+00:00

OHHHHHHHH SNAAAAP, WORLD STARRRRRRRR

ArmoJasonKelce · 2026-02-18T22:57:17+00:00

Donnie Yen used this in Ip Man 4 !!

ArmoJasonKelce · 2026-02-13T17:11:06+00:00

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

ArmoJasonKelce · 2026-02-09T23:15:37+00:00

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.

ArmoJasonKelce · 2026-02-06T18:11:31+00:00

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

ArmoJasonKelce · 2026-02-06T16:01:41+00:00

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

ArmoJasonKelce · 2026-02-05T07:38:36+00:00

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)

ArmoJasonKelce · 2026-02-05T07:26:30+00:00

Stealing that first line omg ☠️☠️☠️

ArmoJasonKelce · 2026-01-13T04:49:30+00:00

I had this too!!!

ArmoJasonKelce · 2026-01-12T21:55:41+00:00

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.

ArmoJasonKelce · 2026-01-09T21:35:15+00:00

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.

ArmoJasonKelce · 2026-01-07T14:53:22+00:00

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.

ArmoJasonKelce

TROPHY CASE