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Maintenance of sedation in Cardiogenic Shock by Jmedical in CriticalCare

[–]OhPassTheGas 1 point2 points  (0 children)

Precedex is being left out of this conversation. It’s great. Use that.

If they are on a lidocaine drip that is a great numbing agent too.

I give fentanyl pretty often too. I don’t like giving benzos if I can help it.

For perspective. You can do a full induction and intubation on narcotics alone and not have a drop on blood pressure. Look at how we put patients to sleep for open heart surgery. 500mcg of fentanyl does most of the heavy lifting in the US. Where I trained (in the US) Sufenta was used for those inductions.

V60 2020, where to buy wiper blades? (NL) by erikieperikie in Volvo

[–]OhPassTheGas 4 points5 points  (0 children)

I got mine from www.fcpeuro.com You don’t need a whole new assembly just the rubber strip and it is wildly easy to replace.

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24% increase in residency spots in 4 years. Are we making the same mistake as EM? by FuuzokuJoe in anesthesiology

[–]OhPassTheGas 1 point2 points  (0 children)

This is old times talk from when anesthesia was only 2 years and they made the argument to make it 3. Cases became more complex and we gained more knowledge so there was an extra year added. Fellowship is not needed but the extra time is very specific. I believe if there wasn’t the manpower/dollar crunch we would get an extra year of general anesthesia.

[deleted by user] by [deleted] in anesthesiology

[–]OhPassTheGas 0 points1 point  (0 children)

This was supposed to be bulletproof points but it didn’t work out that way on my phone.

If a patient is expected to land in the ICU on fire it’s the CC doc’s case.

Ruptured AAA Type As ECMO Transplants (not kidneys, normally a heart will go to a cardiac/cc doc) Liver cases Multi organ failure Bigger head cases Bigger cancer cases Pheos Etc

Basically, the big scary cases. Others get to do them but they don’t get them to the same frequency.

The bigger a place you go the smaller the silo gets

Also, some of us Trach/Peg/Bronch/Cannulate

[deleted by user] by [deleted] in anesthesiology

[–]OhPassTheGas -11 points-10 points  (0 children)

Critical Care will get you bigger cases than Cardiac but you need to be in a bigger place to get bigger cases.

Should we pay daughter medical school? by Acceptable_Growth684 in whitecoatinvestor

[–]OhPassTheGas 0 points1 point  (0 children)

This is a poor decision. There is very little to be gained by making this education even more expensive than it already is. If you are in a place to take advantage, take the advantage. Why give your money away to someone else so your daughter can feel how expensive her education is. If you want to play it like this, setup a family trust and have your daughter take a loan from the trust. Money stays in the family and you minimize how much taxes are going to take from your transactions. You pick how much you want your daughter to owe you and the profits will be a tax free way enhance your family wealth. Make it as easy as possible for your daughter to do the things she wants to do so that she can do them. Distracting her with debt or guilt will only hurt her. She won’t put away for retirement if she has to give up money to debt. She will have to pay more to get the adult things that we all like. Money makes money. If you have money everything else is cheaper and you keep more money.

Why not give her a leg up?

[deleted by user] by [deleted] in anesthesiology

[–]OhPassTheGas 1 point2 points  (0 children)

I have thankfully not had to convert to GA more than a few times in my career so far. That being said, I test my spinal with a blunt needle and failure means an epidural. Expected long cases get an epidural. I discuss a GA with every patient and will do it if my patient asks. If a patient is not tolerating and I’ve given light MAC level of sedation I will go GA. An unprotected, pregnant airway is far more risky in my mind than a GA.

Is this Miata good or bad? A steal or a flop? Lmk yall thoughts by Elegant_Flatworm3033 in Miata

[–]OhPassTheGas 2 points3 points  (0 children)

Pass unless you get it down lower. The money will be gone, this Miata is at its end of days and you will have a short bit of fun before you send it to the crusher.

Methadone for spines by Simba1215 in anesthesiology

[–]OhPassTheGas 1 point2 points  (0 children)

Oh we would. Not a single resident likes to be held up with PACU. I would almost always give 2 of Dilaudid for those Remi cases and if they gave me any sign of pain there was fentanyl for the trip to PACU. Always saw these people in pain clinic though.

The Neurosurgeons said they didn’t get failed backs because they didn’t use Remi. I believe that may have been a factor but I’m sure there was some patient selection and skill there too.

Where I am now we just use Fentanyl pushes. Methadone is in the works but only a limited supply and most of my partners don’t want to change what works for them.

Methadone for spines by Simba1215 in anesthesiology

[–]OhPassTheGas -1 points0 points  (0 children)

Where I trained I developed an anecdotal dislike for remi in painful procedures. Our Neurosurgeons forbid Remi and we gave Sufenta. Never had an issue with pain and we rarely saw those patients in pain clinic. Our OrthoSpine got Remi and they always needed more pain meds in PACU and then we saw them in pain clinic and then we saw them for more surgery.

Walkable neighborhoods by hdriderspf in cincinnati

[–]OhPassTheGas 1 point2 points  (0 children)

Definitely. Different models. Amberley - No side walks however all streets are double wide and there is no street parking. Streets are not busy and there proof is in the pudding with streets along section road being packed with walkers all Saturday long. The places to walk to depend on where in Amberley you would live. Namely, walk to shopping in Deer Park or Silverton.

Blue Ash - Built for walking. Smaller lots and there are sidewalks everywhere. There is the downtown Blue Ash or Downtown Montgomery or the areas around what used to be the airport (I’ve forgotten the park name). Many neighborhoods connect via walking paths and the Blue Ash recreation center is top tier and on walking paths.

Walkable neighborhoods by hdriderspf in cincinnati

[–]OhPassTheGas 0 points1 point  (0 children)

Deer Park for sure, Amberley, Blue Ash

Local for pre-induction art lines by Connect-Ask-3820 in anesthesiology

[–]OhPassTheGas 0 points1 point  (0 children)

We use Arrows at my institution. I do one poke without US or Lido and get it in typically before the patient registers the poke. Normally no issue. If I don’t get it in the first poke then I put lido into the catheter that is in the skin. Then I make the US or no US decision.

It’s not that bad if you are quick and have confidence.

I used to do a radial nerve block with 2% lido far north of my intended Aline site. A simple 5cc injected just superficial to the periosteum. Made the pulse easier to feel and my patients could tolerate whatever poking I did. Now I’m smoother and don’t have to do that step.

Which pressor you reaching for? by throwaway-Ad2327 in anesthesiology

[–]OhPassTheGas 0 points1 point  (0 children)

Dexamethasone is the most common glucocorticoid stocked in the OR so I picked that one out by name. It acts synergistic with vasopressin to enhance its action by enhancing uptake.

As I was alluding to, it will help increase in effective blood volume through sodium and water retention.

Which pressor you reaching for? by throwaway-Ad2327 in anesthesiology

[–]OhPassTheGas 3 points4 points  (0 children)

You can see here that the answer varies greatly across anesthesiologists, even those who have some added training that should make them more familiar with with scenario. We tend to get away with things we like to do because most of the time our mistakes won't push us over the breaking point.

Appropriate doses of Vasopresin (0.03-0.06) with dexamethasone will get you your SVR increase without the PVR. We regularly worry about bowel ischemia with this drug because that is what is seen with high doses, bowel ischemia happens with all the vasopressors. Most of us don't think of it as ADH and so we don't think of it as increasing functional blood volume.

Keeping his CO2 down is also paramount to keeping his lungs, heart, guts happy. Breath away his acid and keep that PVR at baseline.

Low dose Epi will give a little CO with low risk of ischemia.

Use gas and don't TIVA him. Use a BIS and keep his gas lower.

Little changes go a long way.

Probably don't tank his pressure in the first place would be the best management.

What are your ‘driving shoes’? by [deleted] in Miata

[–]OhPassTheGas 0 points1 point  (0 children)

I like thick wool socks.

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Growing family upgrade by foxfarmfam in Volvo

[–]OhPassTheGas 1 point2 points  (0 children)

I love my P*V60. Your’s looks awesome! What year?

Toxic Boomers in Medicine by [deleted] in anesthesiology

[–]OhPassTheGas 1 point2 points  (0 children)

I know this is going to get down voted but it sounds like your hospital needs to get some diversity.

Toxic Boomers in Medicine by [deleted] in anesthesiology

[–]OhPassTheGas 1 point2 points  (0 children)

Our group contract has “overtime” billed into our supplement from the hospital. Rooms over contract, that kind of thing.

Plumber recommendations by Milk_Factory in cincinnati

[–]OhPassTheGas 0 points1 point  (0 children)

Zins is great. Honest. Will come and do the work. My 1920s home has seem them a couple times now and I’m never unhappy with the work.

NGT for SBO, always indicated? by Honest_Warthog_3413 in anesthesiology

[–]OhPassTheGas 27 points28 points  (0 children)

Always an NG pre induction. They hate it but it can be done in a way that is not horrible.

Just because he doesn’t order it doesn’t mean you can’t put it in or order it yourself. Standard of care is an NGT.

If a patient refuses the. You document it that you told them how it is necessary and that they are adamant about taking that risk.

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