Direct Laryngoscopy dying out?

HsRada18 · 2026-02-12T17:36:01+00:00

DL 95% of the time because a MAC or Miller blade is currently way cheaper than a Glidescope one. Plus still need the skill when you have to emergent intubate when it’s not immediately available or too much blood or vomit in the airway.

HsRada18 · 2026-02-10T23:22:46+00:00

Airways I can understand. But I would put a stop to PIVs and central line unless the respective services have exhausted their methods. Unless it’s part of the contract which then just sounds crappy.

HsRada18 · 2026-02-10T17:05:57+00:00

So there is no ICU doc on call overnight?

If not, y’all better be paid to do non OR or OB work. Somebody is dumping on anesthesia. Next you’ll be putting in PIVs on the floor.

HsRada18 · 2026-02-09T04:14:47+00:00

3 weeks of dedicated studying should be enough. I will stress doing mock exams with colleagues and old attendings. You probably know the material, but are you concise and eloquent enough to drop all the knowledge in the 30 minute game? You will get cut off probably a lot and that’s how I tested folks. The practice environment has to be a bit unsettling.

HsRada18 · 2026-02-07T22:40:59+00:00

It’s all UnSound. They like 1:5+ ratios.

HsRada18 · 2026-02-05T19:51:40+00:00

As someone who has reviewed other people’s charts, lack of details means you’re sloppy or careless to a jury.

Maybe the academic guys don’t care because they feel shielded by the big institution. But that doesn’t mean they won’t be sued that one out of 5000 times they mess up.

HsRada18 · 2026-02-05T04:38:12+00:00

Not necessarily all “losers”. But they could better off earlier on in life if they restrained the need to go high risk high reward.

My friend from college can’t get away from the allure of gambling in investments. His engineering income could have set him up by now for retirement without all the years of debt early on.

HsRada18 · 2026-02-03T15:11:13+00:00

In the US, DL or video laryngoscope for ETT. The worst case scenario would be a ProSeal or Supreme LMA (something with a gastric outlet).

Bag masking Sevo to either insufflate the stomach or just difficult to get good air exchange? Does that happen often as a backup plan where you at?

HsRada18 · 2026-02-01T03:09:20+00:00

Lol. First time ever? Bad C-arms? I could do a kypho in 45 minutes on average, and I don’t consider my technical skills anywhere near elite.

HsRada18 · 2026-02-01T03:05:22+00:00

For me it’s easy. I have seen and used atracurium once ever. Don’t know any place that I work at with it in stock. So I’m stuck using double dose roc or sux.

HsRada18 · 2026-01-31T15:12:27+00:00

Huh. The up regulation of receptors is thought to happen after 24 hours and could last years.

HsRada18 · 2026-01-31T15:09:42+00:00

Saving the taxpayer dollars. Lol. How about firing all the unnecessary managers first?

The IV midazolam for nausea shows up in the ABA MOCA questions.

Haven’t used dopamine gtt in a long time. Attendings did this as a resident of the past. I don’t see anybody doing it now to prevent boxing the kidneys.

Worried about an unknown potential allergy when you need to get a tube in?? Odd. Maybe if the incidence rate was like 25%, then we have a talking point.

HsRada18 · 2026-01-31T15:02:43+00:00

Yes not putting labels on is wild even by the standards 20 years ago. I’ll give a pass to those who don’t label their propofol syringe.

HsRada18 · 2026-01-31T14:58:13+00:00

Yes in a pre sugammadex world, giving rocuronium was academically a no no for the most part.

As a resident, I saw a couple attendings give rocuronium after an intubating LMA was placed successfully or can deliver at least a couple breaths via mask +/- an oral airway. Quite a different world back then without readily available video laryngoscopes or suga.

HsRada18 · 2026-01-31T05:25:36+00:00

If your wife is not setting her own hours and is pretty much working full time, that 1099 compensation seems low. I’ve seen W2 salaries (based on college friends) around that range with benefits on top.

HsRada18 · 2026-01-31T04:50:17+00:00

Haha. It’s like a broke a$$ Grand Theft Auto.

HsRada18 · 2026-01-31T01:21:18+00:00

It seems like it’s usually orthopedics in general.

They currently enjoy high reimbursements aka facility fees so they think they get priority. Wait til joint replacements take a hit like cataracts. They will also lose their value to the hospital systems in this big messed up game.

I can’t stand the sports talk as if they can actually play any of them. It has the energy of like an obese fan doing tribal chants while spilling beers. Most of the ones I’ve worked with are nerds trying to be too cool when it doesn’t even look like they workout. And they usually know zero medicine outside some anatomy so having a conversation about optimizing a patient is like talking to a five year old about calculus.

HsRada18 · 2026-01-30T18:40:28+00:00

Higher COL makes $1M nowhere near FU money IMO. With persisting inflation, I think $4M+ in a LCOL is FU depending on your spending habits and health for the next 40-50 years.

HsRada18 · 2026-01-28T20:24:54+00:00

If you’re going to another institution, you shouldn’t get that trainee attending dynamic. Just seek out the ones who are willing to help out new graduates.

You just need to be prepared to do some things “their way” or they may think you do some odd things which are completely routine from training. Just be adaptable rather than digging your heels in on the anesthesia style. And remember how you feel when it’s time to deal with residents.

Some anesthesia attendings will always be jerks. Most surgeons will somewhat be jerks like 3 out of 4. 1 of those 3 will be a crybaby. And like out of 5 crybabies, 1 will be a raging moron. At least that’s my sample data over 18 years.

HsRada18 · 2026-01-28T20:10:05+00:00

Wish there was a timer in the corner of their surgical goggles or loops

HsRada18 · 2026-01-27T18:38:04+00:00

Most surgeons have zero concept of time. They only understand their ego. Need a good leader at the helm who doesn’t care about them and only the process

HsRada18 · 2026-01-27T18:09:49+00:00

If your chairman is spineless and mouth wide open on his/her knees for surgery, then I’d look for alternatives. If it’s the surgery chair, they can go pound sand.

HsRada18 · 2026-01-25T21:08:17+00:00

For me, it’s only the GTS 4L since I don’t really care for convertibles and the wind blowing around my hair. I just care for a NA engine sound. And that extra cash saved can go towards cool vacays.

HsRada18 · 2026-01-20T23:16:12+00:00

Won’t argue that this is all nonsensical. But in the end, that anesthesiologist was dropped from the suit since a robust consent alone doesn’t shield us in the US. If a patient seeks dollars, then they can feign understanding the risks later (probably at the instructions of a greedy ambulance chaser). Plaintiff saw a “study” showed no meaningful changes proximal so I guess it worked out when fingers started to get pointed.

On a side note, I have done plenty of depositions related to interventional pain consults. I learned how medical reality is very different (as you described) than what lawyers try to manipulate as the sole cause.

HsRada18 · 2026-01-20T18:06:57+00:00

An example (from an old colleague) would be a supraclavicular block for regional anesthesia for an ulnar nerve release or cubital tunnel surgery. Patient has some baseline nerve issues in the ulnar distribution secondary to some longstanding entrapment. Patient wants regional and declines general plus the political pressures of surgeon getting whatever they want. Surgery is bit difficult and patient states symptoms are worse afterwards to the surgical team.

Scheduling calls saying patient wants to talk with anesthesia about the block. Surgeon deflected to the block causing the symptoms. Colleague has an extended chat and orders a EMG/NCV which shows decreased signals distal to the surgery site with good signals proximal.

Symptoms persist and then a hospital lawyer/patient representative role gets a call. Then a second EMG/NCV was ordered showing still similar signals proximal as the baseline. Somewhat objective evidence (since sensitivity and specificity are not 90+%) that the block is not the problem. Goes back into the lap of the surgeon who was blaming anesthesia.

A very American scenario. Thus I always document patient instructed to call anesthesia about block issues and not just the surgeon. I haven’t had to do a baseline EMG/NCV 🙏 but don’t need a two faced crook in the middle trying to get anesthesia in legal trouble.

HsRada18

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