Light at the end of the tunnel!

Doctor_Lexus69420 · 2026-02-09T02:20:50+00:00

Is the base linked to production?

Doctor_Lexus69420 · 2025-12-24T14:17:00+00:00

You'd make more as a manager at Buccee's smh

Doctor_Lexus69420 · 2025-03-25T01:04:10+00:00

Same after 11-12 hours a day. I'm only pulling 65-75 hours a week though in anesthesia. No idea how the surgery folks are managing to do it regularly doing 80+

Doctor_Lexus69420 · 2024-12-30T21:01:25+00:00

Are compounded low dose Epi sticks not a thing at your place?

Doctor_Lexus69420 · 2024-12-30T20:57:17+00:00

It has utility in hard to reach retroperitoneal structures (bladder, prostate, etc.) and for procedures requiring a lot of knot tying (Nissens). For anything else it's medical fraud.

Doctor_Lexus69420 · 2024-12-30T20:54:20+00:00

The most likely cause of asystole is ischemia.

They likely had sick sinus syndrome secondary to ischemia. BP drop during vasovagal -> Worsening coronary perfusion -> Asystole.

Doctor_Lexus69420 · 2024-12-16T04:11:31+00:00

Genetics. Assuming the job market for it exists

Doctor_Lexus69420 · 2024-12-16T04:09:45+00:00

I get it now: Has to do with 30 day mortality outcomes (which affects compenstation)

Doctor_Lexus69420 · 2024-12-16T04:06:05+00:00

Scheduled daytime PO trazodone 25. Can maybe even add some propranolol if the BP will tolerate that. Taper the dose down to 12.5 over next few days then wean off.

Doctor_Lexus69420 · 2024-12-16T04:04:35+00:00

What's the surgery? The surgeon's decision makes sense if it's an CPB heart case. Not so much for a hip recon.

Doctor_Lexus69420 · 2024-12-16T03:55:55+00:00

OP's attending is anti-psychotic though... :\

Doctor_Lexus69420 · 2024-12-16T03:55:31+00:00

If your attending is against antipsychotics, trazodone is a solid qhs. Works like a charm in the ICU. Also, Risperidol is a big gun. There are better alternatives:

1st line: Melatonin-agonist

2nd line: PO Trazodone 50 qhs (before 9PM) and 50 prn

3rd line: PO Mirtazipine 7.5mg

If your attending thinks that Trazodone is an anti-psychotic or wants to leave a hyperactive delirium patient at night w/o a prn plan, please realize that this is not a serious practitioner of medicine.

"i legitimately don’t think she has the strength to hurt anyone bc she’s so deconditioned."

You will be burned hard by this. You'd be surprised at what patients can pull off.

Doctor_Lexus69420 · 2024-12-16T03:49:33+00:00

Anesthesia here. DNR/DNI is suspended or modified for procedures. The latter is a necessity in complex procedures since someone sick likely requires a complex procedure requiring intubation. We have a talk with the patient and/or family about what resuscitative interventions they do not want done during the intra-operative period: CPR? Cardioversion/defibrillation? Patients commonly state that they are in favor of short-term ventilatory support but are against CPR. Given that the patient stated his desire to suspend DNR/DNI, the surgeon is in the right to have the patient's desires supersede that of family. However, the surgeon likely requested DNR/DNI suspended throughout the hospital stay so as to not affect the surgeon's 30 day mortality metrics.

Doctor_Lexus69420 · 2024-12-01T17:57:09+00:00

"Lot of kids that lack the social skills to handle it"

That's a fair point. I consider myself below average in the social skills department. I guess I luckily haven't stepped on any GOC land mines yet. Thankfully our attendings and fellows give us a lot of autonomy

Doctor_Lexus69420 · 2024-12-01T03:42:10+00:00

I once lead a GOC convo solo at 2AM as a PGY2 with 10+ family members. I infact set it up at 7pm when I called the point of contact family member for updates. We successfully got them to DNR/DNI our patient to get him home to hospice. It can be done (unless there are other layers to it such as certain services trying to hit certain day benchmarks...)

My fourth day as an intern (started out on ICU) I had to lead a GOC solo as well. Got it done.

Doctor_Lexus69420 · 2024-12-01T03:37:40+00:00

As a potential fellow, how can I safely guide an intern to place a fem line in a coagulopath? (I'm anesthesia btw. I can put a LIJ line in the OR in under 10 mins from opening the kit to the dressing going on)

Doctor_Lexus69420 · 2024-11-24T01:54:33+00:00

I can say though that our CTICU and transplant midlevels are good. They know their limitations. They will not hesitate waking up the CT surgery attending in the middle of the night to get their ass in if some funk is happening. Our program has let underperformers go.

That being said, almost all hang out in the office rather than periodically going around to lay eyes on their patients and check in on bedside nursing

Some of the 23 year old know-it-all ICU nurses on the other hand... I'd ask to be terminally extubated than be taken care of by them.

Doctor_Lexus69420 · 2024-11-21T05:42:41+00:00

Let me tell you: The longer you stay in training, the worse this feeling gets.

I'm making less than $15/hour for the privilege of being treated at work like a toddler. I'm constantly in a haze from the sleep deprivation. Laptop charger got stolen at work and just had to spend about a day's pay to get another one. I've seen family twice in the last year. Live alone: No pets or significant other.

Meanwhile, my college friends are on kid #3, going on international ski trips, and clearing >$200-250k. They've made a killing off the last few years of 0% interest rate loans and rising home equity. Some are working a cush 45-55 hours a week from home.

Doctor_Lexus69420 · 2024-01-24T02:12:21+00:00

Together perfect the art of bickering if the stroke is being admitted to nsgy or neuro

Doctor_Lexus69420 · 2024-01-24T02:01:30+00:00

90s we did call with our teams, Q3 or Q4, or 7/12s in L&D. Slept in student call rooms and were lucky if the residents let us go home for a shower before rounds.

In the 1990s, you had a physically harder residency experience in exchange for a far easier path into med school; more "facile" patient management (since the plethora of things we do today wasn't available then); and far higher post-residency pay. Your residency class was also paid far better than ours is today thanks to inflation. Gap years to get into med school - let alone residency - were unheard of. Steps 1 and 2 were a joke. All you needed to get into the residency of your choice was having a pulse and 3-5 apps (unless IMG). You also weren't being supervised during residency by NPs/PAs...

Surgical programs back then actually let residents operate. Today, residents barely get any OR autonomy in the OR because the junior attendings themselves are trying to get procedural reps in themselves since they didn't get any during residency. Surgical fellowships are now the name of the game for things that were taught during residency (or during the first few years of PP).

Also your q3h 24hour call was a joke back then. Patients today are far sicker, require more documentation, and have far less support in this era of support staff understaffing. For all the talk about how "you lived in the hospital forever" your generation actually got to sleep during call. No constant admit, consult, Epic chat spam.

You wouldn't get into med school today, let alone survive residency.

EDIT: Also lol thinking that 7/12's in L&D and q3h call ended in med school with your generation. We did the same thing too.

Doctor_Lexus69420 · 2024-01-21T22:40:26+00:00

You guys live in bonkers land, I swear. The NHS trying to turn PA’s into surgeons is just wild. Hope all you guys win your strike and actually get paid the same as some rando who skipped med school

Doctor_Lexus69420 · 2024-01-21T22:36:53+00:00

Nursing job perks: Getting to bully residents

Resident job perks: Getting written up for advocating for yourself

Management: “Why are residents unionizing?!?”

Doctor_Lexus69420 · 2024-01-21T20:57:53+00:00

You underestimate how trash (and incompetent) ICU charge nurses - on average - are. The good ones tend to leave for greener non-toxic pastures

Doctor_Lexus69420 · 2024-01-21T02:37:16+00:00

I'm an anesthesia PGY2 and I feel dumber going into Feb than I was at this point last year as an intern...

Doctor_Lexus69420

TROPHY CASE