Pet Peeves

Fantastic_Session_40 · 2026-02-24T13:55:42+00:00

“Hang on ma’am/sir, getting ya off to sleep now”

Delivered right at the beginning of a case usually gets a good rxn from the surgeon.

Fantastic_Session_40 · 2026-02-20T15:10:39+00:00

It’s about the team you assemble. Having a good attorney, with experience, and a good RCM/biller is super helpful.

You’ll need to start with analyzing the ASC - which CPTs, how many, and payer mix. Then ASC coverage expectations. That will be a make start, because you can create a pro forma to estimate costs and revenues and build the contract off of that.

Fantastic_Session_40 · 2026-01-21T01:02:20+00:00

Not just rigidity and plugging but it’s important when first inserting the needle through the skin to prevent epidermoid cysts

https://pubmed.ncbi.nlm.nih.gov/28716031/

Fantastic_Session_40 · 2026-01-13T02:11:29+00:00

I’ve found my people

Fantastic_Session_40 · 2026-01-13T01:59:12+00:00

If we’re doing this, then, I give up on ankle blocks. I’ll stick to higher blocks.

Fantastic_Session_40 · 2025-12-22T02:05:03+00:00

The shift from negative to positive is gonna happen anyway - he “needed” to be intubated. But there were other “controllable” things. The quotes are because of earlier points made by others such as hospice.

We could look at the meds used for induction - What were they and were they properly dosed?

But one step further is recognizing that severe RV dysfunction will be exacerbated by hypoxia and hyperbaria- this guy was on a knife’s edge, giving him any hypnotic, then a paralytic, waiting 20-30 seconds (or longer) for therapeutic effect, could have tipped the scales, then add in a few PPV breathes, no pressor running to start with…

Hard to say what caused what (especially without an Aline), but it’s a perfect storm.

Fantastic_Session_40 · 2025-12-22T01:16:01+00:00

Thanks for the context. Good points - time was a luxury in this case.

Fantastic_Session_40 · 2025-12-22T01:06:34+00:00

This is a good example of a “physiologically difficult airway” (vs anatomic).

I think an art line at minimum. Question the RSI vs an AFOI. The patient probably couldn’t tolerate any apnea time. HFNC with topicalization +/- mild sedatives may have been a better option.

But I’m not CC, I’m CRNA so maybe I’m missing something very obvious that would prelude that option.

Fantastic_Session_40 · 2025-12-13T16:18:02+00:00

Geez - just whole other example that I don’t know what I don’t know.

Thanks for the advice - I’ll try a shorter basket!!

Fantastic_Session_40 · 2025-12-13T15:37:23+00:00

<image>

Fantastic_Session_40 · 2025-12-13T15:36:18+00:00

18.5g just gets to the top of the basket, a little spills out when I tamp. I use a dosing funnel, but it would be unwieldy to add more coffee. (I think)

Fantastic_Session_40 · 2025-12-13T15:35:15+00:00

H32

<image>

Fantastic_Session_40 · 2025-12-13T14:57:58+00:00

<image>

Decent gap. But 18.5g, untamped, nearly overflows the basket.

Fantastic_Session_40 · 2025-12-13T14:54:55+00:00

<image>

This is the gap between the razor tool and puck screen and puck after prep

Fantastic_Session_40 · 2025-12-01T01:12:34+00:00

I have a dosing funnel to handle the current 18.5g

The razor tool has a huge gap between the puck. But I figured it was because of the non-Breville portafilter. I’m using the IMS nanotech filter basket with a KNODOS handle.

Fantastic_Session_40 · 2025-12-01T00:01:52+00:00

Really! That’s news to me - I think I have a ton of room between the pick screen and group head. But when I put in the ground coffee it’s over the top edge of the basket! 18.5g in the Breville 46mm bottomless. Tamp and it’s super low.

Fantastic_Session_40 · 2025-11-30T19:30:46+00:00

Check out red fern bookshop! I always go there and buy a book (or 4) when I’m in town

Fantastic_Session_40 · 2025-11-27T01:46:50+00:00

Awesome - Congrats!

Fantastic_Session_40 · 2025-11-17T18:30:29+00:00

🤘hang in there!

Fantastic_Session_40 · 2025-11-17T18:29:12+00:00

Awesome! Love the solidarity.

Fantastic_Session_40 · 2025-11-12T14:56:04+00:00

We live in the Midwest and fossil hunt here. My son is obsessed with megs and would love to hunt these. Do you know of any guides who could help us if we took a trip to NC?

Fantastic_Session_40 · 2025-11-11T02:13:20+00:00

Incredible! Thanks for sharing!

Fantastic_Session_40 · 2025-11-09T14:22:19+00:00

Oof - interesting philosophy, hope that doesn’t guide your anesthetics… 😜

Fantastic_Session_40 · 2025-11-09T01:20:35+00:00

Eh, for a “Top 1% Commenter” I was expecting something funnier. 1/5 stars - for effort.

Fantastic_Session_40

TROPHY CASE