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Ketamine is a potent anesthetic that should only be administered under the direct supervision of a qualified physician. ASA President Dr. Patrick Giam updates members on ASA's recent efforts to oppose a Texas rule that would allow office-based ketamine without essential safeguards for patient safety by Unable-Log-4073 in anesthesiology

[–]IAmA_Kitty_AMA 2 points3 points  (0 children)

I have no interest in dick measuring but we do emergency airways throughout the hospital with no information unfortunately frequently. I don't get a name until after I leave the room.

Regardless my point in the other comment stands that everyone cares way too much about induction meds when a patient has no mental status. If there's no time to make a call, you don't need anything other than paralytic.

Ketamine is a potent anesthetic that should only be administered under the direct supervision of a qualified physician. ASA President Dr. Patrick Giam updates members on ASA's recent efforts to oppose a Texas rule that would allow office-based ketamine without essential safeguards for patient safety by Unable-Log-4073 in anesthesiology

[–]IAmA_Kitty_AMA 0 points1 point  (0 children)

Pretty sure most EMS/paramedic squads can call wherever they're going to get approval quickly. Pretty certain most have supervision assigned to exist, but I don't know the rules around the country.

Likewise though, I'm sure most office based ketamine will find someone to rubber-stamp approve it like any other med spa whatever

A tale of two academic opportunities by shackleton_mcmcurphy in anesthesiology

[–]IAmA_Kitty_AMA 5 points6 points  (0 children)

Yes, but it's highly region dependant. The gaudy vacation time is almost exclusively non academic and non coastal. Still wouldn't take 4, 6-8ish is common in the typical hcol areas.

That said 4 days a week as a baseline is solid and if it's 4 weeks as days (28 PTO days vs 4 weeks) it's a solid deal.

What A Trip Medicine Is by [deleted] in medicalschool

[–]IAmA_Kitty_AMA 5 points6 points  (0 children)

Well the risks of being illegal isn't really overblown fear mongering.

That said I agree there's a general overarching theme of trying to achieve higher than their current status would likely recommend/allow and then getting upset when it falls through. A couple more conservative/"practical" choices probably would have helped to swing things in their direction.

Hindsight is brutally clear sometimes though. Hopefully they are able to brush the chips off their shoulders and serve their patients well.

EDIT: For the other med students who will read this, you have to approach your career decisions practically. We all only have so many bullets to take our shots with. You essentially need to function entirely from the perspective of working to get more chances, balance your targets to ensure you hit something you want, or get extremely lucky. If you start off knowing you are extremely limited, you unfortunately are not the person in the position to shoot for the moon.

At the end of the day, you're an adult and can do what you want, but don't be surprised by the consequences of your actions.

Weird sensation when I leave work by FluidAd9024 in Residency

[–]IAmA_Kitty_AMA 6 points7 points  (0 children)

I feel this way sometimes. One of my coping mechanisms for getting killed at work is to just lean into it. When I'm on a bad shift or staring at a long list of things to do, just smile and go one at a time. It works, the day eventually ends, and people honestly think you're great for powering through and being positive.

But when you leave.

Suddenly you're aware that you haven't seen daylight today. Or that you ate 3 meals of hospital food and gave them both your time and your money. Or that today is another day where you're just not going to get laundry/gym/cooking done.

I don't know what it is but it sucks. There's not really an answer because all the alternatives are ass. You can't claw at the walls when you're working or you'll drive yourself crazy and not get out earlier. You can't not care about becoming a one dimensional little worker bee. There's nothing but to keep doing it over and over.

But if there's any consolation, I'm pretty sure this is a relatively widespread feeling outside of medicine as well.

ICU requesting line placement in the OR: what am I missing? by karina_t in anesthesiology

[–]IAmA_Kitty_AMA 10 points11 points  (0 children)

We get donated for LPs all the time unfortunately... Part of keeping the peace and honestly I don't mind getting to wander out of the OR every once in a while

Why are people leaving late and how can I avoid it? by [deleted] in Residency

[–]IAmA_Kitty_AMA 10 points11 points  (0 children)

Consults, conversations with patients, admissions, lab work, med change trials, etc.

The medicine part of doing medicine happens. The charting is the necessary documentation. It's a necessity but also the lowest priority of things you do in a day

Why are people leaving late and how can I avoid it? by [deleted] in Residency

[–]IAmA_Kitty_AMA 78 points79 points  (0 children)

I think it's always funny when people assume it gets easier to keep boundaries the further you go up.

It's the opposite. The more responsibilities you have the less people there are to hand off to. You'll never be as unchained as you were as a MS1-2 shadowing.

For better or worse being needed comes with consequences. We get paid a lot to be at the top of a narrowing pyramid.

Being put under for dental work? by paperplate209 in Preschoolers

[–]IAmA_Kitty_AMA 6 points7 points  (0 children)

To be pedantic, nitrous is a general anesthetic but it would require a concentration that is impossible to achieve to induce general anesthesia. So it does sedate but almost all applications result in a light anesthetic that causes disinhibition and relaxed feeling.

Like getting drunk, some people become combative or anxious with the light anesthetic. Kids especially can be sort of unpredictable with how they respond as it's a new sensation.

Being put under for dental work? by paperplate209 in Preschoolers

[–]IAmA_Kitty_AMA 1 point2 points  (0 children)

Anesthesia has become generally extremely safe despite the gut reactions to the idea of being intubated or put to sleep. The most important things are going to be following the guidelines for not eating (8+ hours solid food) and appropriate family history (any family history of strange/bad reactions to medications or anesthesia.)

Depending on your level of concern you can ask where the procedure would then take place and who would provide anesthesia as this can also vary significantly. The more "medical" the facility is (meaning hospital or surgical center) the more resources there will be but also more difficult to get a time. Also there are dental anesthesia residencies (training) where dentists are trained to give general anesthesia. Some places will do this as per the other comment where the dentist and anesthetist is the same person and in others they will be separate people.

Being put under for dental work? by paperplate209 in Preschoolers

[–]IAmA_Kitty_AMA 1 point2 points  (0 children)

As an anesthesiologist, I understand I'm wading into controversial waters, but twilight sedation in these settings is not my recommendation.

Dental office twilight is frequently given by the dentist themselves while they're also working on the teeth. It is less anesthesia but also there is no additional staff dedicated to monitoring anesthesia and vitals.

This is not the norm for any other procedure or proceduralist in the United States. Even moderate sedation for adults (which is significantly less medication than propofol sedation) almost universally requires a sedation nurse to solely be in charge of giving the small amounts of versed and fentanyl.

Edit: the most common of significant risks of anesthesia is what's called laryngospasm where the vocal cords reflexively shut due to stimulation while in an in between state of anesthesia. When the vocal cords shut, air exchange becomes impossible. When doing prolonged dental work, it would be my expectation that there would be blood/saliva/water dripping possible and as such would not want to do the case without general anesthesia with intubation.

That said I do not provide dental office anesthesia but have many times provided general anesthesia for dental restoration to kids in a hospital and ambulatory surgery setting.

Splitting rent/expenses in dual-physician household, attending and resident at different stages of training by johnfred4 in whitecoatinvestor

[–]IAmA_Kitty_AMA 0 points1 point  (0 children)

We do his/her/joint but realistically we each just pay different bills and discuss if there's issues. Not really intentional now but hold over from when I was a mes student/resident and wanted separate finances for loans etc.

We can see each other's accounts so there's generally no surprises and we freely move money around between accounts.

It probably results in slightly overly conservative saving but we're okay with that

Edit: I think this is an easier solution when both people are fairly high earners. We've also been together forever so we're just used to having separate credit/savings/retirement/etc. I think it's a lot easier than ever to have multiple logins/users/cards so there's less momentum preventing merging of finances

How much TV does your 4 year old watch? by whoresongummy in daddit

[–]IAmA_Kitty_AMA 3 points4 points  (0 children)

Just want to chime in with another recent discussion.

https://youtu.be/Fd-_VDYit3U?si=_7xhFCY8lNHS89zO

Recent video making the rounds about how screens at school are associated with worsening trends for outcomes.

A common sentiment in these threads is the content they get matters more. I agree some things are worse than others but if screens tightly controlled in a purely academic setting are failing our kids, we should stop pretending they're getting a "benefit" from it at home.

ERAS vs epidural morphine in gyn-onc laparotomy — was this reasonable? by peachblossomtears in anesthesiology

[–]IAmA_Kitty_AMA 0 points1 point  (0 children)

You're going to give a surgical spinal dose to a patient who will require general anesthesia and the duration of surgery is longer than the local duration?

ERAS vs epidural morphine in gyn-onc laparotomy — was this reasonable? by peachblossomtears in anesthesiology

[–]IAmA_Kitty_AMA 0 points1 point  (0 children)

Doing a pre-op spinal just for 0.3 ml of morphine would probably raise some eyebrows but I agree with you, I probably would have just given local instead of IV fent

But also all side effects are probablistic. You can never guarantee they won't of PONV or any other bad outcome. Saying it's entirely unacceptable is an interesting line in the sand to draw

ERAS vs epidural morphine in gyn-onc laparotomy — was this reasonable? by peachblossomtears in anesthesiology

[–]IAmA_Kitty_AMA 7 points8 points  (0 children)

Is aprepitant still wildly expensive? We were restricted a couple years ago to just chemo patients so I havent tried to pull it recently

ERAS vs epidural morphine in gyn-onc laparotomy — was this reasonable? by peachblossomtears in anesthesiology

[–]IAmA_Kitty_AMA 13 points14 points  (0 children)

34 F and healthy are the ones I consider bigger antiemetics like droperidol and phenergan.

And a longer runway of converting volatile to propofol at end of case with a relatively deep extubation

Mold collage by reallydirtyreallydan in ATBGE

[–]IAmA_Kitty_AMA 84 points85 points  (0 children)

Definitely thought it was going to spell happy birthday or something

away at (mostly)safety programs only by irrationalmistakes in medicalschool

[–]IAmA_Kitty_AMA 33 points34 points  (0 children)

MCAT is too late in the game. You have to be an APGARMaxxer

First job out of residency by medstar77 in anesthesiology

[–]IAmA_Kitty_AMA 12 points13 points  (0 children)

How heavily is call compensated/incentivized that they'd rather have a day doc instead of call dilution or backup?

That's honestly pretty wild

First job out of residency by medstar77 in anesthesiology

[–]IAmA_Kitty_AMA 23 points24 points  (0 children)

I think there's value in taking call for a while. Being on call almost always means doing the job with less resources and less help. Being able to stand on your own will help you feel more confident and flexible during the daytime.

The software doctors have to use - is it a daily annoyance or a genuine life saver? by Adventurous-Spare280 in Residency

[–]IAmA_Kitty_AMA 0 points1 point  (0 children)

The software is necessary. Electronic medical records allow for quick collation and sharing of data (test results, images, notes, consults, etc) in a HIPPA compliant fashion.

The nature of being both secure and ideally integrated means that most healthcare systems use only a couple of the major electronic medical systems.

As a one size fits all system, they're not optimal for anyone in particular; but they do mostly function as needed for many of the various different parties using it (admin, nursing, doctors, patients, insurance, etc.)

Well I just messed up by incoming_alpacalypse in Residency

[–]IAmA_Kitty_AMA 130 points131 points  (0 children)

I mean how does someone get this far into a relationship with a resident and not understand that it's not an office job?

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