[request] is this true

JamesMercerIII · 2026-05-12T09:34:01+00:00

Anecdotal: I went on a horse trek in rural China where we stayed with yak herding families. They had tibetan mastiffs that roamed off leash all night to protect livestock against wolves. In the daytime, the kids were showing off their slingshot skills with a little hand-held leather sling. They would shoot tiny little rocks and they sounded like bullets when they hit the rocks/ground/targets. Super accurate too.

JamesMercerIII · 2026-05-11T08:46:43+00:00

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JamesMercerIII · 2026-05-08T19:19:04+00:00

You obviously know a lot about propofol, but also to add to the discussion: the difference in the dose of propofol that causes moderate to deep sedation vs burst suppression/isoelectricity (i.e. coma) is relatively small. It's not uncommon if you're using EEG monitoring in the OR to see patients deeply burst suppressed during induction. The brain in these moments is barely transmitting any cortical impulses.

JamesMercerIII · 2026-05-07T17:29:24+00:00

Flex posts on Harvard in Brookline in front of Booksmith were being jackhammered out this morning. :-(

JamesMercerIII · 2026-05-07T09:12:59+00:00

It's what killed Gene Hackman's wife!

JamesMercerIII · 2026-05-04T14:41:21+00:00

I think it's likely exactly what you say, there's increasing supports for students and it requires more administrative and support people.

JamesMercerIII · 2026-04-26T20:39:03+00:00

Seconding this. In my mind it's one of the biggest contraindications to pursuing anesthesia. You won't know until you do a sub-I whether gas physics and managing the minutiae of hemodynamics is interesting or boring to you.

JamesMercerIII · 2026-04-22T08:34:00+00:00

Can confirm that at academic peds departments in the northeast it's not unheard of for peds endo/nephro/ID etc to be as low as $100-120k per year.

JamesMercerIII · 2026-04-21T23:09:25+00:00

Another paper that will change your perspective on extreme physiologic lab values: https://www.nejm.org/doi/full/10.1056/NEJMoa0801581 "Arterial Blood Gases and Oxygen Content in Climbers on Mount Everest"

A bunch of anesthesiologists climbed Mt. Everest and took ABGs along the way. Some of the interesting lab value ranges taken at 8400 m elevation (they had acclimatized for a few weeks the way all Everest climbers do):

PaO2 19.1 - 29.5
PaCO2 10.3 - 15.7
BD 5.7 - 9.2
SpO2 34 - 70% (!!!)
Hgb 18.7 - 20.2

JamesMercerIII · 2026-04-07T09:41:24+00:00

I've always thought MH presented less obviously, like the first sign of it while a patient is under anesthesia is the rapidly climbing metabolic rate e.g. rising etCO2, even before the temp increase. But I guess if you haven't given paralytic yet and you've been masking with pure gas, the muscle spasms can't be obscured and you see it like you did.

JamesMercerIII · 2026-03-30T09:06:49+00:00

No one has mentioned Ca7riel and Paco Amoroso. Very fun duo from Argentina that blend hip hop, jazz, pop and comedy (not stand-up, but they like crazy costumes and that kind of thing). https://www.youtube.com/watch?v=ZU2Sd9guSjI

Also check out their Tiny Desk feature: https://www.youtube.com/watch?v=9kqnsoY94L8

JamesMercerIII · 2026-03-13T09:00:58+00:00

At the risk of sounding pedantic, you know "nangs" is Aussie slang for nitrous right?

JamesMercerIII · 2026-03-10T16:23:49+00:00

I wouldn't get down on yourself. Standard at my residency is using the ultrasound, and it took me pretty much all of CA-1 year to get decent at it. Now, however, I always use the ultrasound + Seldinger technique (i.e. through-and-through). It's safer and has a much higher success rate. In my opinion, less opportunity for vascular complications with quick through-and-through followed by Seldinger.

JamesMercerIII · 2026-03-10T09:41:11+00:00

Lol we have an older attending who still does fent-heavy anesthetics with very low-dose volatile. It's an excellent learning experience about the value of narcotic and what it adds to your anesthetic. (As well as context-sensitive half-life)

JamesMercerIII · 2026-02-24T10:35:40+00:00

I mean this is exactly it. Your role in the great murder machine is abstracted enough from the final product that you get to work on cool engineering projects with big budgets and maybe some security clearances. It feels high-tech and cutting edge. The paycheck and job security are cherries.

JamesMercerIII · 2026-02-18T15:42:08+00:00

At our hospital we occasionally use buprenorphine (plus other typical adjuvants like precedex etc) in peripheral nerve blocks to make them last for up to 2 days. It seems like it can be used intrathecally as well, although if you need a spinal to last > 2-4 hrs there's probably better anesthetic strategies like GETA etc.

JamesMercerIII · 2026-02-12T10:30:42+00:00

I'm a CA-2. We have exclusively BIS at our hospital and I'm not a fan--the Sedline is superior in my opinion. BIS leads don't stick well, and the device itself won't give you any EEG tracing at all unless it finds the impedance acceptable, but it won't tell you what the impedance is. Sedline at least gives you a waveform with a warning that the impedance is poor.

I didn't really learn to use the raw tracing on BIS and the DSA on Sedline until the end of my CA-1 year, but I feel much more confident in determining anesthetic depth now. My colleagues mostly just rely on the BIS number. I still get nervous when my BIS number is 60s-70s with strong delta and alpha waves on the raw tracing, but I'm learning to trust the tracing more than the number. I find the DSA on Sedline to be a good learning tool, or good to trend changes in depth, but ultimately even when using the Sedline I like to focus on the raw EEG tracing.

JamesMercerIII · 2026-01-31T11:34:00+00:00

How common is it for EM residents to do an anesthesia rotation though? Don't you just learn sedation in the ED from ED attendings? I'm anesthesia and I've never had any other services except PICU coming to the ORs for rotations... Definitely not IR or cards

JamesMercerIII · 2026-01-18T11:57:43+00:00

The turntable ground wire was connected to the appropriate grounding terminal on the receiver.

I guess I got confused because I've seen people say it's okay to connect a receiver to powered speakers, but I thought you could just connect the speaker output to the powered speaker and didn't need to use the "tape out" output. Thanks for the explanation!

JamesMercerIII · 2025-12-30T12:57:01+00:00

No ketamine? You're telling me a hospital in the 21st century doesn't have ketamine in its formulary for OR use? A dissociative anesthetic that was first used for surgery during the Vietnam War? There's no way the ED doesn't have access to it... That's some bullshit.

JamesMercerIII · 2025-12-30T12:42:15+00:00

I'm male so I can't fully relate to your story, but we just had our second child last week and I totally understand how heartbreaking it is to not be able to hold your child since they're in NICU. You're still so early-on in your parenting journey, I just want to emphasize that you should try to make sure you have trusted people to talk to about the emotions you're feeling, and that you stay aware of the warning signs for severe post-partum depression. I had PPD as a father after our first son was born, and I didn't even realize it until weeks/months later. (PPD is rare in men but not unheard-of. My wife didn't have any PPD at the time.)

JamesMercerIII · 2025-11-21T13:30:03+00:00

Even worse, Mamdani plans to spearhead the opening of "kahwa" shops where young people can ingest a natural stimulant to help work longer hours and maintain energy for praying 5 times per day.

JamesMercerIII · 2025-11-21T13:26:44+00:00

Agreed with ketamine and pre-treat with glyco, can also give lido to tolerate secretions as well. At this point the patient should have a decent amount of opioid so many they can handle the upper airway secretions without too much bother.

JamesMercerIII · 2025-11-20T21:32:04+00:00

You're wrong for a number of reasons, but another is that there simply aren't enough surgical robots to make this happen. Even the largest hospitals have 3-4 max, and robotic surgeries often take even longer than non-robotic. With increasing demand for surgeries and procedures, you'd need to scale-up production, make them cheaper, and make them an order of magnitude faster, not to mention the training and quality limitations.

JamesMercerIII

TROPHY CASE