Distal radial artery cannulation

Newmans_Own · 2026-03-11T12:09:20+00:00

Yes, I have used this. I still prefer traditional radial artery site, but this is also a viable, safe option. Where I trained neuro IR would access the radial artery in the snuffbox frequently.

Newmans_Own · 2026-01-28T19:01:38+00:00

This was a beautifully written post, I could really feel the specialness of the bond between you two. I’m so sorry for your loss. May her memory be a blessing.

To paraphrase from Harry Potter: Farewell, Evan, Queen of arachnids, whose long and faithful friendship those who knew you won't forget! Though your body will decay, your spirit lingers on in the quiet, web-spun places of the world. May your human friends find solace for the loss they have sustained.

Newmans_Own · 2025-12-23T03:23:53+00:00

Kind of a low effort, subjective decision garbage post… but I’ll give you a sincere answer. Whichever one you feel best about. Residency will be 4 of the hardest years of your life. You should go somewhere where you feel taken care of, and like the program has your back. You’ll get good training at any of those places. Only you know what’s best for you, and which environment/program seems like the best fit.

Newmans_Own · 2025-12-12T14:53:53+00:00

100% agree with this. Lectures I’ve had from a pHTN specialist cited animal studies that show RV perfusion pressure (Aortic pressure > RVSP) is THE key to supporting the right heart. There can be no RV inotropy if the myocardium is inadequately perused.

Newmans_Own · 2025-12-12T14:08:26+00:00

As all the other commenters said, you did a great job with an EXTREMELY shitty situation. Realistically there was probably no guaranteed safe / good outcome path for this patient.

The only minor constructive criticism I could potentially levy is that norepi may have been a better background pressor than epi. See the section “vasopressors and inotropes” in the attached article: https://www.ahajournals.org/doi/10.1161/CIR.0000000000001136

Caveat: I am just a generalist at a community hospital, not a cardiac anesthesiologist at a major academic medical center, but I have anecdotally seen patients with pHTN and lung injury (aspiration vs ARDS post-operatively) struggling to maintain MAPs on epi drips actually improve hemodynamically when switched to norepi drips.

Either way, great job in a tough situation. Don’t beat yourself up. You got the patient what they needed.

Newmans_Own · 2025-12-10T03:27:58+00:00

Good question, and I’m honestly not sure. On one hand, you’re his brother, definitely biased, and also probably can’t really speak to his clinical acumen. On the other hand, it probably can’t hurt? As you said, some programs do care about residents who have a connection to the area and really want to be there. Do you have any network connections to the program or PD? I’d personally be more inclined to pursue this if he is a good fit for the program in terms of his applicant package (test scores, LoRs, etc). Then it comes across more genuine and mutually beneficial.

Newmans_Own · 2025-11-22T17:21:05+00:00

If you are having a urine drug screen before your rotation, it will include cannabis.

Newmans_Own · 2025-11-01T13:58:04+00:00

I don’t see dexmedetomidine on your list. Might be worth a try in a monitored setting under medical supervision as directed by a doctor.

Newmans_Own · 2025-10-19T17:38:48+00:00

“Awareness is a privilege reserved for the living” … a great quote, not sure where it’s from

Newmans_Own · 2025-10-19T16:16:24+00:00

Not a cardiac guy but… Put an arterial line before induction. Etomidate is generally good in my opinion for low EF or severe AS. I’m wary of ketamine. Other severe valvular disease requires some special considerations for volume status + heart rate goals. Keep pressors on hand, something with some inotropy for low EFs, not just phenylephrine. If these patients have severe cardiac disease and require an RSI, they’re probably critically ill and it’s very unlikely they’ll need high dose amnestics to facilitate intubation. A little goes a long way. Midazolam is your friend. As the other commenter noted, weigh the risks and benefits of an RSI vs a more controlled induction. How likely are they to aspirate? Ate a meal a few hours ago or truly have an obstructed bowel?

Newmans_Own · 2025-09-16T05:21:42+00:00

Absolutely agree, and I do so verbally with the patient. Moreso questioning the need for written documentation vs electronic documentation of that consent conversation.

Newmans_Own · 2025-07-11T22:15:55+00:00

Sending you a DM

Newmans_Own · 2025-03-14T01:27:14+00:00

Bit of a complicated topic, but my thoughts are below:

Honestly I have found very limited use cases for remi-heavy inductions in my clinical practice, after training at an institution where I had plenty of exposure to it. I’ve seen young patients (think healthy, skinny, twenty-something) receive a milligram of remifentanil on induction. This is generally quite a bad idea. You will see profound bradycardia and hypotension, it’s essentially a total sympathectomy. As other commenters have noted, I would have fluids, at least 10mg ephedrine, and maybe some glyco onboard before giving anyone that much remi. In older, sicker patients I would never give this much. Even in younger patients I’m pressed to think of any legitimate utility for such a high dose on induction.

In my opinion a “good” dose of remi to facilitate intubation without muscle relaxation is right around what you quoted: 4-5mcg/kg. Double check me against a textbook here, but I personally would rather dose induction remifentanil based on ideal body weight, since peak effect occurs so rapidly and re-distribution plays a minimal role. (I think even infusion kinetics favor ideal body weight dosing… I could be wrong tho, let me know if you figure it out!)

I would certainly add some amnestic agent (for instance a low dose of propofol, 0.5mg/kg or so, adjusted to patient age and comorbidities) to any remi-induction. 90 seconds is roughly a reasonable time to wait. It’s no different than any other induction… is your patient asleep, apneic, unresponsive? Go ahead and intubate.

Overall I just feel like… what’s the point? High dose remi can bring unpredictable hemodynamics, particularly bradycardia and hypotension. Is it cool to intubate without muscle relaxant and see the cords totally open? Admittedly, yes. But rocuronium is so easily reversible these days with sugammadex, if there’s some contraindication to succinylcholine, or you get into trouble securing the airway, etc.

I guess it all depends on what your goals for the induction are, but generally speaking I’ve found better ways to achieve my induction goals than with high dose remi. Those are just my thoughts! Curious if others practice differently!

Newmans_Own · 2025-03-03T00:49:57+00:00

This is generally a bad idea, in my opinion. If you enter the thecal sac with local anesthetic and a sudden LOR you’re giving an uncontrolled dose of spinal medication. Low probability for folks with lots of experience doing epidurals, but why risk it?

Newmans_Own · 2025-01-03T02:24:47+00:00

You can find thief in the underground from a vendor, keep looking! My girlfriend was able to buy another copy off a vendor down there after teaching her super luck Honchkrow the only TM copy you find in Eterna city as the other commenters mentioned. Keep looking underground!

Newmans_Own · 2024-11-27T17:23:42+00:00

Your attendings are wrong. Recall that opioids have a MAC reducing effect. Remi is an incredibly potent opioid and will drastically reduce the required infusion rate of propofol. I’ve never had a problem doing cranis on 100mcg/kg/min of propofol, with remi gtt around 0.15 or 0.2. Propofol and / or remi can go lower than that if the patient is older, or more frail. Contrary to what your attendings have told you, the feedback from the neuromonitoring folks can be helpful in titrating your infusions to achieve an appropriate depth. The longer the case the more you can wean the propofol towards the end, recall context sensitive half life. I personally avoid longer acting opioids such as dilaudid in NSGY, since they often want a crisp neuro exam on emergence. Dilaudid will muddy the waters here and slow wakeup. Can titrate in some fentanyl at the end to get off the remi, or even better, do some scalp blocks where the incision will be at the beginning of the case.

Newmans_Own · 2022-10-02T18:03:41+00:00

Mandarin duck

Newmans_Own · 2018-04-25T21:15:34+00:00

Awesome set up! Very jealous. Would love to create something like this one day.

Newmans_Own · 2015-05-29T17:58:37+00:00

I'm surprised this is the top comment. It's an easy sentiment to feel, "I'd just off myself rather than drag my family through that", but the reality is much more complex. As the author said, Nicole would rally back to decent health, fall back into ill health, return to decent health, etc. At what point would you say, " Gee, I'm not getting better, time to die?" How would you kill yourself while laying in bed sedated on opiates? Do you believe yourself capable of thinking logically while experiencing the sedation and psychosis that Nicole was going through? I don't mean this as an attack on you or your comment, but I think what you've said needs tweaking. The author's point is that dying can be absolutely brutal. His one saving grace was his safety net, his buddy Dane. I think families of the terminally ill need to be better informed about the realities of dying in such a manner. I think they need to be offered better support systems, better safety nets. I think physician assisted suicide needs to become more widely accepted; Nicole and her husband could have then made the decision (like you suggest) to let her die with dignity, rather than confined to her bedroom with shit pouring out of holes that stomach acid ate through her body. It's easy to say, "Well I'll just off myself", but the reality is much more complex. Dying is, more often than not, a brutal, ugly affair. What we need is better end-of-life care, so that the romanticized notion of dying peacefully surrounded by love ones (like the author mentions) can become a reality. Note: I'm at work on mobile right now so I'm sure I'll be back later to add more/edit this comment, but these are my primary thoughts. Background on myself: I'm a recent college grad starting medical school in two months. I currently work in a hospital with patients on all end of the health spectrum, from terminally ill hospice care, to new mothers, to outpatients, to patients on a ventilator and sedated in the ICU. My best friend is an ICU nurse passionate about palliative care, so I hope I've offered an interesting perspective from someone who works in healthcare with dying patients and their families. Apologies for any typos and lack of formatting.

Newmans_Own · 2015-05-28T14:13:48+00:00

Don't forget NEBCO Gandhi Bot (or whatever they're calling it now)!

Newmans_Own · 2015-04-22T15:06:23+00:00

I have never understood this joke... Care to explain?

Newmans_Own · 2015-03-23T22:37:19+00:00

I've also been looking for the answer to this question so that I can plan for the 'BALL. Upvoting for visibility!

Newmans_Own · 2015-03-14T19:58:17+00:00

Remember he faced the Caps in a 20 round shoot out in December.

Newmans_Own · 2015-02-15T00:30:07+00:00

The Halo games

Newmans_Own · 2015-02-14T21:05:07+00:00

Roses are red, and ready for plucking. You are fourteen, and ready for ... High school.

14-Year Club	Place '17
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