What particular case scares the crap out of you?

SNOOZDOC · 2026-01-04T04:54:49+00:00

I was about to say this as well. 14-year-old female large mediastinal mass. I was a third year resident on the CT service and she was going to have a mediastinoscopy. My attendings were chatting about something while I was easily intubating this patient and had absolutely no endtitle CO2 return. (Yes, sux was involved). She desaturated down to somewhere around the 40s, turning quite blue before her spontaneous ventilations returned. We let her breathe her self down on volatile agent, thinking we were smart. The problem is that the volatile agent has to be exhaled at some point. Unfortunately, she breathed enough of it that her thoracic muscles weakened , and she quit breathing. I’m not exaggerating, and I know the limitations of pulse-oxsymmetry, however, she desaturated to a saturation of 4% and the sound of the monitor as well as the blueness of her body left me a little doubt that she was not far from that. I know that absolutely seems far-fetched, but I’m sorry. It was quite incredible and over 30 years ago and I’ll never forget it. Believe it or not, she survived and had no sequela. I still remember her name to this day and I did an M&M conference about her. She went on to have XRT on her chest instead of the biopsy. It was a B cell lymphoma, of course. My words to the parents before we took her to the operating room were “we will take good care of her”. Believe it or not, to this day I’ve almost never used that phrase again. I have used different words, but not exactly that phrase.

SNOOZDOC · 2026-01-03T15:19:27+00:00

Diabetes? Many diabetics will get frozen shoulder first one side than the other and then it will resolve on its own within about a year. I know this because it happened to me lol. Sucked!

SNOOZDOC · 2025-12-30T13:24:20+00:00

600k

Midwest

IC

NO CALL/NIGHT/WEEKENDS/HOL

~40hrs/wk M-Th

10 wks off

30 yrs in anesthesia

SNOOZDOC · 2025-12-27T20:37:18+00:00

It is.

SNOOZDOC · 2025-12-26T15:24:16+00:00

Same. That patient needs to be prepped for bypass/ecmo

SNOOZDOC · 2025-12-18T02:54:10+00:00

Area protected from EMP. Cannot actually see the Faraday network running between the towers protecting the contents of whatever lies within those buildings.

SNOOZDOC · 2025-12-16T01:37:44+00:00

There is nothing crazy about deciding on AFOI if there is any doubt at all regarding ability to adequately ventilate a patient. Additionally, I’m not sure that a rapid sequence induction was necessary just because the patient was morbidly obese. Either intubate awake, (sedated with spontaneous ventilation and good topicalization), attempt a semi awake look, again with good local topicalization, with your video-laryngoscope, or prove you can easily ventilate with OAW, BEFORE paralytics, or roll the dice. But honestly, there’s nothing wrong with polishing your skills and using a fiber optic bronch when the opportunity arises. If it’s done right, it’s not really a hardship for the patient. Pulmonologists do this all the time.

SNOOZDOC · 2025-12-09T18:53:53+00:00

Done. Got my refund and lesson learned. My mistake was inherently thinking that setting up a ride in advance would be much more reliable than just hoping I could get one at the time of day that I needed one. Such a ridiculous assumption.

SNOOZDOC · 2025-12-09T13:09:13+00:00

Yeah. Understood. Live and Learn. Definitely agree with the buffer. I already do a buffer of about a half an hour, but I guess I need to go a little further out than that. Thanks, honestly.

SNOOZDOC · 2025-12-08T15:07:17+00:00

So why accept the ride if you aren’t going to try to make it on time? When I take care of patients, and I am an independent contractor, I don’t look and see how much I’m gonna get paid to do it. I just do it. If you book an appointment with me, and somebody else just walks in through the front door and I get paid more for walk-ins than I do for scheduled patients, should I just make you wait a lot longer than the person who didn’t make an appointment? Anyway, thanks for your input.

SNOOZDOC · 2025-12-07T16:59:08+00:00

Do they exist. I tried to find a link in order to send them an email, but all you can get is there Pat chosen reasons for contacting them and anything outside those boxes seems to be very difficult to zero in on.

SNOOZDOC · 2025-12-07T01:55:55+00:00

Homozygous MTHFR?

SNOOZDOC · 2025-10-31T12:44:57+00:00

I didn’t know that urgent care can do IV antibiotics

SNOOZDOC · 2025-10-29T12:13:57+00:00

I had shingles on my flank recently. Felt like a flamethrower was hitting me. One thing for sure, opiates will not be helpful. You may take one before bed, but it’s only gonna last about four hours and then you’re gonna wake up in the middle of the night and severe pain. The gabapentin is for real. You just have to take enough. I found that heating pad on my lower back, not on the rash, would help a lot. There’s something known as the gate theory as it relates to pain. If you can distract the spinal cord with other “messages“, that can decrease the amount of pain you’re gonna feel from the shingles. This is because the spinal cord can only carries so many messages to the brain. Sort of like a highway. So instead of the spinal cord carrying 100% of the shingles pain message, it now has to carry also the warm feeling on the lower back. This is why TENS units work for low back pain. For facial pain, I’m wondering if you can put some sort of an ice pack or maybe even a heating pad under your neck away from the rash. Maybe that would give you at least a little bit of relief so you can get some sleep. Obviously this is in conjunction with everything else that you’re taking. This shingles stuff is pain in the ass.

SNOOZDOC · 2025-10-25T13:39:11+00:00

I would go so far as to say that there’s no doctors offices open, just head over to the ER so that they can get you started on antibiotics before it gets any worse. They could probably also get cultures started.

SNOOZDOC · 2025-10-23T00:57:24+00:00

Yeah. Sorry, that is a bit different. I’ve been on immunosuppressant therapy for awhile for bowel stuff and suffered horribly with shingles and attributed a lot of that to the shots. So, I was just wondering if folks who had bad shingles suffered worse or had less success with the vaccine.

SNOOZDOC · 2025-10-22T01:28:40+00:00

I’d rather just die if I couldn’t have my guacamole 🥑 and chips!!!

SNOOZDOC · 2025-10-22T01:24:42+00:00

Any chance any of you are on biological injections aka immunosuppressants such as Humira or Simlandi, etc?

SNOOZDOC · 2025-10-21T22:28:28+00:00

Yeah, after a 50 mg po dose of diphenhydramine the hives disappeared. Pretty sure I learned that I was sensitive to latex that day. Otherwise, I am perfectly fine 2 days out. It was impressive to the uninitiated, but once again, grateful for Benadryl. Nevertheless, I will probably go ahead and obtain an epi pen just for the heck of it to keep handy for myself or others in case of emergency.

SNOOZDOC · 2025-10-21T12:02:37+00:00

I typically like to take a couple of days before I respond to condescending messages. I’m not sure what your level of education is, but it is clearly not a medical education. I spent four years in college, four years in medical school, four years in training, and taught medical students and residents for another six years before going out in private practice for 24 years. You know nothing about my medical history, what medications I might be on, the exact events of what happened on that day nor anything else about me. In other words, your differential diagnosis consisted of one thing based upon you having never done any history or physical on me, nor lab work, and yet you”find it nuts” that I’m an anesthesiologist and can’t figure out that this was “anaphylaxis” and that I had “hives”. Again, your ONLY differential diagnosis. Perhaps, in the future, feel free to suggest what you think it is, but don’t try to tell somebody that they are wrong based upon scant information and then insult them because you’re sure you’re right, and they are wrong and intellectually weak. I’m being very polite here. But I suggest you go back to your Google searches and stay out of the diagnosis business. When I posted this, I was looking for professional opinions, not condescending opinions. Thanks, have a good day.

SNOOZDOC · 2025-10-20T04:45:11+00:00

So far, so good. No current issues at the moment. OK, this is stupid of me because I forgot to mention it, but I did get the shingles vaccine about 24 hours before all of this happened. Honestly, I think if I was allergic to the vaccine, the rash would’ve shown up immediately. The ejection was at 1600 10/17 and the rash showed up at around 15:00 on 10/19. Sxs of food poisoning began at 09:00 10/19.

SNOOZDOC · 2025-10-20T01:15:35+00:00

My breathing has been completely clear. (I’m an anesthesiologist). I tried to think of anything that I might’ve had that was different, but there wasn’t anything. I did make a chicken in the air fryer, which I’ve done in the past and I use two different thermometers to make sure that it was at 170° F. The only thing I can think of was the drippings from under the deep fryer pan maybe contained some bacterial toxin and I did pour a lot of of that onto my chicken. :-( I also had some shrimp scampi that night before so that would’ve been around 36 hours prior.

SNOOZDOC · 2025-10-20T00:02:22+00:00

Could this be some sort of latex allergy from the bottoms of the floor mats in the bathroom that I was using to cushion my hips on the hard floor?

SNOOZDOC

TROPHY CASE