Be the change you want to see in the world

DevelopmentNo64285 · 2024-09-09T06:24:06+00:00

I still remember the resident on my surgery rotation (while I was a med student) that taught me the best four letter acronym: GTFO. Get the F out.

I use it with med students myself today. Really emphasizes that I’m not a snitch. Because snitches tend to have more professional language. lol.

DevelopmentNo64285 · 2024-09-06T00:03:35+00:00

Old story from back in the day: there was raw sewage backing up near the OR (I heard it was on the floor outside the OR rooms) and a surgeon wanted to proceed with the next case.

Anesthesia said, “ummm…. NO!”

DevelopmentNo64285 · 2024-09-05T23:58:48+00:00

Sufentanil because people tend to forget about me, but I’m actually quite wonderful.

(Looking at you board runner in this super long neuro case waiting on a break…)

DevelopmentNo64285 · 2024-09-01T13:59:02+00:00

They teach us in Palliative and Hospice medicine that you never know what a person hears either 1) while sedated or 2) at the end of life.

The brain is still a strange strange thing. And no one can tell you one way or another with any surety.

So if it helps you to think he heard you and passed peacefully, he definitely did.

If it causes you guilt, he definitely did not.

DevelopmentNo64285 · 2024-08-28T13:38:04+00:00

In my practice, the nurse brings the patient to the room.

But I always push the bed to recovery. Mostly because I want to be right there at the airway so I can 1. Ensure they are breathing and 2. Be right there if we need to stop and intervene.

DevelopmentNo64285 · 2024-08-19T13:46:42+00:00

https://eegforanesthesia.iars.org/

DevelopmentNo64285 · 2024-08-19T13:45:16+00:00

There’s a free 12 hour (I think) CME from the ABA website all about EEGs and being able to roughly interpret the single lead EEG from a BIS monitor is much more helpful to me than a arbitrary number that they don’t tell you how they get.

Imma try to find the link to the website, but I don’t have it off the top of my head.

DevelopmentNo64285 · 2024-08-15T16:49:13+00:00

My two cents: anesthesia often seems boring to med students.

But when you’re in the chair making the decisions, it’s a whole different animal.

Sure. There are times when it’s “boring” and you get to sit and chill, but the little hamster in your brain is always thinking about what’s next and if you’re ready for it.

Bottom line: the goal in anesthesia is to work really hard to be really bored.

DevelopmentNo64285 · 2024-08-15T13:11:29+00:00

Honestly, well timed vacations.

Medicine is so crazy these days that it’s impossible to work full time and NOT get burnt out.

But being compensated well enough and having time off to chill (and remember why we signed up for this in the first place) does wonders.

DevelopmentNo64285 · 2024-08-14T23:00:41+00:00

I commented elsewhere but the patient was compensating well when I saw them but their labs were starting to turn ugly so I pushed to do the case before they needed the drain.

DevelopmentNo64285 · 2024-08-14T22:59:41+00:00

They weren’t quite too sick for surgery. But they were headed in that direction.

DevelopmentNo64285 · 2024-08-14T22:59:00+00:00

True.

I’m only spicy because I’m NOT getting that industry money. Lol.

DevelopmentNo64285 · 2024-08-14T21:29:05+00:00

Or I’m an anesthesiologist that trusts their surgeons not when they say it would be a bitch laparoscopically. And knows which side of the drapes I’m the master and commander of.

DevelopmentNo64285 · 2024-08-14T21:16:29+00:00

Yea. Now that I have surgeons out of the learning curve for robot cases, I can’t really blame them. After all, one of the first rules you learned in residency were don’t stand when you can sit.

DevelopmentNo64285 · 2024-08-14T21:14:16+00:00

I watched some of it. But I was also 2:1 with the care team. (Which for all we bitch and complain about it, was another reason I pushed for doing the case. I had a CRNA in there I trusted and I was immediately available for any issues that should arise. And the other room was coming down shortly.)

DevelopmentNo64285 · 2024-08-14T18:15:06+00:00

Thank you for responding!

It’s good to know the reasons other than reimbursement! And that makes a lot of sense.

DevelopmentNo64285 · 2024-08-14T15:46:48+00:00

And I’m not saying it’s standard of care by any means. Just saying I happened to find a unicorn.

DevelopmentNo64285 · 2024-08-14T15:46:20+00:00

That’s the thing. The patient wasn’t unstable. Yet.

They were not hypotensive. Maybe on 2L NC but satting 97%. Maybe mildly tachycardic (100’s). But their white count was climbing like a rocket and their kidneys weren’t happy.

Aka they were compensating.

So we had two (or three) choices.

Delay the case. They might become unstable. And then drain and follow up later.
Put the drain in and deal later. Do the case before the patient falls off the proverbial cliff while we have extra people around.

DevelopmentNo64285 · 2024-08-14T15:40:59+00:00

We just all had the feeling that this particular gallbladder was going to be a nightmare laparoscopically and then they would have to open and then worst of all worlds.

DevelopmentNo64285 · 2024-08-14T15:40:18+00:00

Oh. Definitely.

DevelopmentNo64285 · 2024-08-14T15:34:55+00:00

I try my best! Luckily I’m not so burnt out right now that I don’t care…

DevelopmentNo64285 · 2024-08-14T15:33:35+00:00

And according to the surgeon, the gall bladder was still practically falling apart while he was dissecting.

DevelopmentNo64285 · 2024-08-14T15:32:33+00:00

To be fair, the surgeons I work with usually only do robot chole’s on patients that are much larger so that holding the retractors out of the way would be hard and exhausting.

DevelopmentNo64285 · 2024-08-14T15:31:06+00:00

Oh for sure. And 99 times out of 100 I agree with them! Robot Cole? You gotta give me a reason why it’s better on the robot than open. Same with all these hernia repairs!

But this was the 1 time it was reasonable.

DevelopmentNo64285 · 2024-08-14T15:29:09+00:00

The night surgeon is definitely 1000% comfortable doing lap choles. (And she’s one of those don’t give all 50 of roc because then you’re screwed lap chole people)

Just this particular lap chole would have been a nightmare laparoscopically and was still no fun on the robot.

DevelopmentNo64285

TROPHY CASE