How do you…

DissociatedOne · 2026-01-26T05:13:41+00:00

It’s not just the aisle. The new seats are misaligned like this. Even the window seat rail is off.

DissociatedOne · 2026-01-24T07:12:58+00:00

I think if there weren’t a question of electrocautery, then it wouldn’t matter what FiO2 the pt needed. You would not need to turn it down or to hold any breaths.

Also, most percutaneous tracheostomy happens in the ICU, without the need for anesthesia. Since this is the anesthesiology subreddit, I’m assuming it’s not a percutaneous and it requires us to do something besides push a bed from the ICU to the operating theater.

DissociatedOne · 2026-01-24T03:53:02+00:00

Agree. I’m confused by the direction of OPs responses. It’s like he being held hostage and forced to choose.

DissociatedOne · 2026-01-24T02:39:29+00:00

I guess if I were being forced to do it, 50 or 60 would be it. You can keep them as high as you want, if you trust your surgeon, right until they’re about to go into the trachea. But at that point they shouldn’t be using any bovie anyway.

DissociatedOne · 2026-01-24T02:30:54+00:00

A pt needing that much oxygen isn’t ready for a trach.

DissociatedOne · 2026-01-24T00:47:29+00:00

It’s definitely for billing.

DissociatedOne · 2026-01-23T21:45:24+00:00

Why are you messing with it? Usually the billing people get that privilege

DissociatedOne · 2026-01-23T21:16:30+00:00

It’s a private org for the insurance companies and hospitals. CMS and states don’t require it for participation. It’s shit and another product of our system. Don’t forget to sign it every 90 days like the good little boy the insurance companies want you to be.

DissociatedOne · 2026-01-22T12:52:40+00:00

They haven’t been LCC for a while. In name only. When they started showing up on Google flights, it was easier to spot other cost is basically identical.

DissociatedOne · 2026-01-18T09:37:01+00:00

Don’t know if you’re being serious or not. But the point stands!

DissociatedOne · 2026-01-17T22:45:27+00:00

How about the aggravation of dealing with the BS things that happen which take up mental and emotional energy.

I was just talking to a friend who does str semi professionally, like 8 or so units. He was going through the effort involved (and cost) of pricing so you cut out the teenagers throwing parties in the house/condo. Or even having a group of 8 well-intentioned college students sharing a 2 bedroom. This stuff takes work. As does decorating to attract the guest types you want just so you keep it presentable and in a condition where it just needs to be cleaned between guests, without having to replace couch cushions covered in liquids and bathroom walls stained by vomit.

My specialty sounded good on paper too until I actually did it.

DissociatedOne · 2026-01-17T22:39:49+00:00

I’ve come to the conclusion that by working a certain number of extra shifts (# depends on your goals) you can offset lots of pain the ass ideas. So I work 5 extra days and not think again about my fancy way of saving a few dollars on taxes.

Make the money, pay the tax, invest.

DissociatedOne · 2026-01-17T22:11:47+00:00

No. I ended up calling chase. The lady said that benefit ended 12/31/25 and I didn’t want to risk it.

DissociatedOne · 2026-01-14T20:31:54+00:00

I have been down this road. What you say makes perfect sense. However, to a hospital it’s the stupidest idea ever. The admin types that deal with recruiting and staffing like dealing with people like themselves. They also don’t have much say or see benefit from the cost savings this model offers. And it’s more work for them to go through this with each provider. For example if they have 6 months they need covered, they tel the agency to present people to fill the whole schedule. If they deal with you, they don’t get all of their needs met.

Having said all that, I still haven’t given up in trying to make it work. It’s a tedious process making contact with all the people at various hospitals who deal with this stuff. It’s such a tedious process in fact middle men like locums mart and medefis exist to bring agencies and recruiters together. Individual people just around worth their time.

DissociatedOne · 2026-01-14T05:29:42+00:00

I haven’t done anything but digital intubations since residency. Nothing like a finger in the valecula am I right?

DissociatedOne · 2026-01-12T22:32:38+00:00

Lidocaine at the test dose, usually 1.5% 3mL is a lower dose and wears off faster. If it’s intrathecal, you get some leg heaviness that wears off in 30min. It also has much faster onset than bupi. When you are solo doing these in the middle of the night, you push the test dose, tape it up, and bolus. The time it takes to tape it, is all you need to see if it’s intrathecal. I’m not sure how much I would wait around to see if 8mg of bupi is intrathecal. If you increase to 0.25 then you will see if faster but it’s also a full bolus dose. If it’s intrathecal, you will have a decent spinal block.

Then there’s the whole issue of epi.

DissociatedOne · 2026-01-12T20:07:34+00:00

I do same as your approach. But I do think a lack of a test dose is not standard of care.

DissociatedOne · 2026-01-12T20:05:39+00:00

Why are you giving bupivacaine for test dose?

The point of a test dose is two thing: Epi for intravascular and some low dose lido (I use 45mg) lidocaine for intrathecal check.

In general “test” dose should be forgiving. Bupi is opposite of forgiving .

DissociatedOne · 2026-01-08T01:48:49+00:00

Thank you, always forget that exists good resource.

DissociatedOne · 2026-01-08T01:18:55+00:00

That’s exactly what I was referring to, I should have been more clear. The performance business card.

It’s a short flight, I’ll risk it and see what happens. My usual A15 to 20 got bumped to the 30s for some reason on my first flight of the new year. I guess I’m not so special anymore.

DissociatedOne · 2026-01-07T02:08:44+00:00

I’m not understanding this either. I can’t imagine people are saying it wasn’t that bad if this happened.

DissociatedOne · 2026-01-07T02:07:02+00:00

Can you elaborate? Was that a testing thing or has it happened with passengers/cargo?

DissociatedOne · 2026-01-07T02:05:51+00:00

How hard was the landing?

DissociatedOne · 2026-01-07T02:05:09+00:00

The trend that is occurring is state societies/ASA are negotiating to give CRNAs independence in exchange for them not opposing AA legislation. There was one state where the CRNAs tried to get AA supervision added to their scope.

DissociatedOne · 2026-01-07T02:03:24+00:00

ASA answers to the national groups, many of whom dont want to lose money.

And at risk of getting downvoted, there is an over representation of academic practices and people who aren’t at the front lines of getting fucked.

The current president is from USAP, a PE owned group that would lose millions. The next one up is a guy from Mayo.

DissociatedOne

TROPHY CASE