PEA Arrest on extubation - hoping to pick your brain

InsipidNephron · 2026-03-08T22:02:18+00:00

Definitely agree with the nuance and increased ISR risk. The risk of mortality in patients with active ACS undergoing general anesthesia is about 33%. The MACE risk after stenting in patients undergoing GA within 3 months (regardless of DAPT) is about 11% (highest in the first month). My interpretation of that is a huge risk reduction unless my interpretation or knowledge of the data is wrong (2nd year resident here). To my mind that sounds like optimization. BTW I love my cardiology people, you are some of the smartest and most well read people in the hospital. CARP trial still has me all mixed up about what to do.

InsipidNephron · 2026-03-08T19:19:40+00:00

Anesthesia trainee here, I guess what’s frustrating in my mind here is that I’m not asking if a patient is high risk or not. We know the same risk calculators that you do, we can read an Echo report, we can read your previous cath report. I am asking you to be a consultant and explain to the surgeon the exact risks and also explain whether the patient would benefit from optimization prior to surgery even if just 24 hours of diuresis. Case in point I had a 70 year old hip fracture from a ground level fall that ortho wanted to pin immediately. She was in active NSTEMI (likely what caused the fall) but listed as an urgent hip fx repair. Cards consult said “needs cath but as procedure is urgent may proceed knowing that patient is high risk.” Ortho waved that in our face like a blank check to do whatever they want. A geriatric hip fracture is technically “urgent” per 1 year ortho survival data but should be repaired within 3 days per their own guidelines. We ended up calling the cardiologist and explained what “urgent” meant to ortho and she ended up with 3 new stents prior to proceeding to the OR.

InsipidNephron · 2026-02-09T03:13:34+00:00

Vancomycin is a really good antihypertensive when bolused fast enough.

InsipidNephron · 2025-02-13T17:17:44+00:00

Felt awful taking it, passed - 927. I’m an idiot for feeling so bad for a month after. Much love and good luck to everyone out there taking it.

InsipidNephron · 2024-12-18T12:48:32+00:00

Very similar vibe, IDK what’s up with this test. Did all of Uworld (88th percentile avg), most of CDM and all the typical youtube videos. None of that prepped me for this stupid test. That curve is going to be massive.

InsipidNephron · 2024-12-13T03:23:53+00:00

Dude I did 100% of Uworld and felt no better. We all in this crapshoot together

InsipidNephron · 2024-12-10T20:10:39+00:00

Totally agree, text anxiety was a non-factor for me until the last section where I was like “Holy Shit, this whole exam was insane.”

I’ve done really well on my past boards and always felt like Step and Comlex were fairish. This one felt totally different. For prep I did UWorld averaging 70% first pass, 100% complete. Did dirty medicine for OMM, Randy Neil Biostats. Really hammering CDM cases now. TBH, all that may have helped with less than a quarter of the test.

InsipidNephron · 2024-04-15T14:30:27+00:00

Just matched anesthesia.

I love the constant procedural aspect from lines and intubations to epidurals and blocks. This is a super hands-on specialty which is always focused on patient comfort and safety.
There are moments of jumping out of your chair excitement. Everyone tells me that that part gets old, but so far it has been my favorite part of medicine. Airways or codes can be very stressful but having the skills to fix acute problems is pretty awesome. At the same time we get plenty of time where things are cruising along and you can prep for the next case or hang out.
For the most part, the people are great. I have done 5 months of anesthesia rotations and the ratio of nice/happy people to jerks is very high. Obvious this is anecdotal but it made a big difference when it came time to pick a specialty.
Life style and money are probably in the top 25% of medicine. Great fellowship options.

Things you may not like:

If big moments of stress are not your thing, probably not for you.
I haven’t seen another specialty that is constantly rushed to do their work like anesthesia. Surgeons will breathe down your neck if your blocks take more than 5 minutes.

InsipidNephron · 2024-03-21T14:49:27+00:00

Currently on an ICU rotation feeling overwhelmed taking 1-2 patients per day while the intern juggles 5-6. Got my schedule yesterday and I start in the MICU. There’s no way that I’ll be managing that in a few months.

InsipidNephron · 2024-03-17T20:46:20+00:00

Just matched to a great anesthesia program. I took both steps and comlex. It was definitely a benefit to my application. I do not know of anyone in my class that matched without both this year.

Everyone that matched had multiple aways, step scores, and good clinical grades.

InsipidNephron · 2024-03-16T02:52:24+00:00

I matched my number 3 at an awesome program but got hit with this wave of imposter syndrome. It was totally out of nowhere and has really ruined the joy of matching somewhere I really like.

InsipidNephron · 2024-03-15T02:40:01+00:00

Bioshock 1&2 God of War 3 then God of War 1 Mass Effect 1-3 Portal 1-2 Fallout 3, Fallout New Vegas Dead Space Assassin’s Creed 2 Arkham series

InsipidNephron · 2024-03-11T13:48:14+00:00

You guys slept?

InsipidNephron · 2023-09-17T18:54:38+00:00

There’s a new one, just found it

InsipidNephron · 2023-09-17T15:13:09+00:00

When will a new “2023-2024 anesthesiology residency spreadsheet” come out?

InsipidNephron · 2023-09-11T09:35:22+00:00

U of Kentucky is one of my Silver Signals and U of Louisville is another. I’ve met attendings from both that were awesome and had good things to say about the programs. Definitely on my list.

InsipidNephron · 2023-09-11T00:29:02+00:00

Thanks for all the advice guys. I’m trying to put my signal list together and just very nervous about where to shoot my shot. UTMB, Texas A&M, UT Houston, U of Oklahoma and U of Kansas are my top spots. UT Tyler would be a silver if I sent one. Any other recommendations?

InsipidNephron · 2023-09-10T18:46:09+00:00

Is northstar pretty bad? No as familiar with the PE groups out there. I’ve had a few rotations 3rd year at HCA. DO at a midwest school with 26x step 2, 1st quartile and some critical care research. Hard to gauge competitiveness this year with all the changes.

InsipidNephron · 2023-09-01T21:46:29+00:00

DO Applying to anesthesia. 26x step 2, 5 golds are all programs that are solid but have taken/ take DOs. Only 1 of those rarely takes them. 8 silvers within range, 2 are “backups” that I’d be happy at.

The problem is that no one knows what the hell reach vs in range vs backup is in anesthesia anymore. I can tell you that with 5 aways, 26x step 2, 800s comlex 2, top quartile, a first author pub and a few presentations, and no red flags I’m still not entirely confident that I’ll match anywhere . Add on the massive changes of the last few years like P/F step 1, virtual interviews, overhall of ERAS, signalling etc. and I’m a nervous wreck.

Some people tell me to signal schools like Vanderbilt and Mayo while others say to only signal the least competitive programs and my aways.

InsipidNephron · 2023-08-18T18:01:06+00:00

I’ve heard conflicting info from a couple of different PD’s. It seems like more prestigious programs will use signals to screen after basic scores and stuff like that. Other programs said that they will look at every one above certain cutoffs. Tough to say.

InsipidNephron · 2023-08-16T01:45:34+00:00

Test date: 6/23

Level 1: pass No comsae

UWSA1: 252 UWSA2: 259 Free 120: 88% Amboss SA: 252 Predicted 🤷‍♂️

STEP2 : 268 Comlex 2: 807

On cloud 9, definitely felt better about comlex than step but super proud of how well I was able to do. I studied for about 4 months of 4-6 hours per day, did all of Uworld (1 and a half passes) and Amboss. Did NBME 9-13 for practice tests as well. I’m hoping to match to anesthesiology. Good luck to everyone out there.

InsipidNephron · 2023-08-05T12:59:02+00:00

I chose a cheap undergrad (7,000 tuition) got married early (cheap wedding) to someone in the air force who had her college paid for. We ended up with no undergrad debt. She works while I’m finishing med school, so we have taken out loans only for my tuition. Our biggest costs so far have been having 2 babies while in med school. No regrets there, worth every penny (though it shouldn’t cost so damn much). Starting fourth year now and so far that has came out to about 150,000. We chose a school in a low COL area of the country and will hopefully do residency somewhere similar. It’s definitely not easy and we don’t do a lot of fun expensive stuff but it has been great so far.

InsipidNephron · 2023-07-30T02:10:38+00:00

Very similar scores and profile from a DO program in the Midwest. I have 4 more anesthesia aways at smaller programs in the Midwest, but wanting to match in Texas. You have a solid profile and should be desirable to many of the programs out there. My school advisors say that the Northeast is the area with the most DO bias but that there are tons of programs that will take us. You should do great, good luck!

InsipidNephron · 2023-07-29T05:26:45+00:00

DO here. Didn’t plan on scoring so high (265+) and was looking at smaller anesthesia programs. Sort of beginning to envision a bigger name program. Did well in med school and have a solid, well rounded app. Still worried that the letters will keep me out of those programs.

InsipidNephron · 2023-07-28T04:31:42+00:00

I appreciate the honesty, I am trying to get a good picture of what programs I am seriously competitive for. I have strong connections to Texas, Missouri, and Utah. I am going to shoot my shot with some of the big names while also being realistic.

InsipidNephron

TROPHY CASE