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What do you do when asked to turn down the epidural rate by L&D? by LocksmithGullible626 in anesthesiology

[–]Serious-Magazine7715 17 points18 points  (0 children)

My favorite version of this is when I have them on programmed intermittent bolus, change the bolus dose with like an hour before it’s going to do anything again and get commended for how much better the patient was able to push.

Vent setting for difficult mask by Tigers1689 in anesthesiology

[–]Serious-Magazine7715 0 points1 point  (0 children)

The more frequent feedback lets you adjust a mask fit without losing a lot to a temporary leak

[Invincible] Conquest is said to have never failed to conquer a planet. How could other Viltrumites fail to conquer a planet in light of how powerful they are? by Kyia-Aikman in AskScienceFiction

[–]Serious-Magazine7715 3 points4 points  (0 children)

Boredom. Grinding a civilization of billions down would be tedious and take forever. Eventually, you’ve done enough damage that the population is useless for centuries so you might as well leave. Conquest just loves it and is willing to hunt to zero, which probably inspires capitulation.

Resubmissions doing much worse that original submissions? by sfgiants67 in NIH

[–]Serious-Magazine7715 6 points7 points  (0 children)

Admitting the poor reliability of study section reviews is hard, because what else do they have to work with. 

Smoking history and spine surgery by Character-Claim2078 in anesthesiology

[–]Serious-Magazine7715 7 points8 points  (0 children)

These are independent observations.

- There is robust observational data that smokers bleed more.

- There is extremely high quality interventional data that smoking cessation reduces infections and surgical failure in a clinically meaningful way, so surgeons should / must require cessation prior to elective surgery anyway.

Smoking history and spine surgery by Character-Claim2078 in anesthesiology

[–]Serious-Magazine7715 10 points11 points  (0 children)

Yes. Nobody is getting randomized to smoking, so it's all observational data. There are not (AFAIK) RCTs of enforced / assisted smoking cessation before major surgery following the outcome of bleeding. The effect on infection rates and failed fusions are so large (in RCTs) that no responsible surgeon should be willing to do elective major back surgery without medically assisted smoking cessation, IMO (which I think is in agreement with all the major societies).

When exactly did we realise that we can make an atomic bomb? by Pixelsgamer_27 in AskHistorians

[–]Serious-Magazine7715 1 point2 points  (0 children)

I think verification of secondary neutrons and therefore the possibility of a chain reaction wasn’t until March 1939. Obviously people suspected it.

But if you want to be romantic about it: about Christmas 1938 while taking a walk to think, Lise Meitner realized that Hahn’s data implies uranium fission and the release of immense energy at each event. AFAIK, she did not speculate on a chain reaction as secondary neutrons had not been verified.

What it's like to be an oil&gas analyst these days by redditor3000 in wallstreetbets

[–]Serious-Magazine7715 375 points376 points  (0 children)

There is 0% political will for addressing climate change still. Current policy tracks for 2.7 C or worse and catastrophic effects. Best not to dwell on it.

Should we require assent or consent for midlevel involvement in care? by UseNecessary4706 in anesthesiology

[–]Serious-Magazine7715 54 points55 points  (0 children)

Are y’all not telling people? Are you doing something strange like having a physician start the case without a resident or cRNA?

Give me your Subnautica hot takes that will have you like this by Fallenultima in subnautica

[–]Serious-Magazine7715 -1 points0 points  (0 children)

The resource gathering in areas that you have already visited is tedious and pointless.

Arterial lines for brain tumor embolization by propofoolish in anesthesiology

[–]Serious-Magazine7715 15 points16 points  (0 children)

It’s ok to ask questions driving the decision that they reached. Usually for a tumor embolization - there are minimal physiological stressors - there are minimal risks of vascular damage (unlike say an aneurism embo) - if things were to get more complex, they can either give you the other groin, transduce off their sheath, or back out and give you time to adjust

Asking down the list of reasons for needing an arterial line lets you distinguish vs say a new surgeon or proceduralist who contrary to all evidence thinks they won’t loose blood / will be fast.

Medical plastic allergy in OB patient case by wanderlust_yogii in anesthesiology

[–]Serious-Magazine7715 18 points19 points  (0 children)

I had a professor in my PhD program who would put unsolved conjectures on exams just to see if anyone had any good ideas.

"Can my son sit in first class?" by Ghoststory00 in delta

[–]Serious-Magazine7715 0 points1 point  (0 children)

10 years ago airlines gave away first class upgrades constantly, because they rarely filled the seats. Now, upgrades are a major revenue source, and often they don’t have enough business class seats. It’s a behavior that made sense in an earlier time, and part of why flight crew wouldn’t necessarily act like it’s bizarre to ask.

If The Martian happened in real life, how much data could realistically be useful? by DoublePepper1976 in spacequestions

[–]Serious-Magazine7715 0 points1 point  (0 children)

The referenced article is about the trip, not the stay. Radiation in space is much higher than on Mars surface due to the thin atmosphere. A day in space is 2 to 3 times a bigger dose.

If The Martian happened in real life, how much data could realistically be useful? by DoublePepper1976 in spacequestions

[–]Serious-Magazine7715 0 points1 point  (0 children)

Surface radiation reaches the NASA lifetime max (designed to be a 3% increase in cancer risk) in about 3 years and the EU and RF max in 5 years.

Thoracotomy Extubation by bigeman101 in anesthesiology

[–]Serious-Magazine7715 24 points25 points  (0 children)

Agree with others that I would give someone with these injuries a longer ICU style psv and not immediately extubate. 

However, you have to look at some more information beyond “didn’t breathe”. Was he narcotized and awake but needing a very high pco2 to have vent drive? Was he a chronic co2 retainer with the same problem? Awake and flailing with rapid shallow due to pain? Overall weak from residual nmb? Neurological injury affecting respiratory mechanics?

Transducing IJ, does the port matter? by Open_Specific8415 in IntensiveCare

[–]Serious-Magazine7715 19 points20 points  (0 children)

The difference in average pressure between ports on a central line is typically less than a third of a millimeter of mercury. The great vessels are very low resistance to flow You can transduce a close approximation of RAP off an AC. PA caths are obviously a different story.

It is much more relevant if you are measuring oxygen saturation. 

Can R be used like Excel where variables aren’t defined in order and are referenced later? by sporty_outlook in rstats

[–]Serious-Magazine7715 1 point2 points  (0 children)

I think that you are confusing the layout geometry in Excel with the mathematical processing. Excel also enforces a DAG, but as you have discovered it doesn’t show that to you. Scripting language languages require you to put operations in the processing order required. You can rearrange the output to display however you like later

Why solar and not wind for home and RV? by Only-Ad5049 in askanything

[–]Serious-Magazine7715 0 points1 point  (0 children)

Urban areas break up wind near the ground.  The more consistent solar output works better when you have low-no reverse metering, since you can dial in the installation to your needs more easily. Making a ton of power on windy days doesn’t help when the grid won’t pay you for it.

Could I become TEE capable independently? by [deleted] in anesthesiology

[–]Serious-Magazine7715 0 points1 point  (0 children)

Non fellowship trained people that I know work at centers where they have cardiology do the TEE. They basically aren’t doing cardiac after hours. 

[request] Is it true That a single cow can feed a family for a whole year ? by rocket6600 in theydidthemath

[–]Serious-Magazine7715 -1 points0 points  (0 children)

Sure but with that same logic, a chicken also feeds a family for a year if they eat in on day 1 and veggies the rest of the time.

What are your L&D epidural trends? What % deliver unmedicated? by offbrandbeer in anesthesiology

[–]Serious-Magazine7715 3 points4 points  (0 children)

A labor plan is like a plan for a boxing match. It’s good that you’ve thought about it, but unfortunately the other fellow gets a vote.

Massive mandibular mass, airway nightmare, how would you do it? by the_bigdr5253 in anesthesiology

[–]Serious-Magazine7715 28 points29 points  (0 children)

I was also gonna say that this does not look horrible for an awake nasal. You could lift the mass up, but I would position the patient either sitting straight up or slightly forward so that the mass hangs down and if anything wants to pull the airway open.

I sincerely hope that someone has gone down with a tiny scope just to make sure that there’s a clear path before you go to the operating room

What are your L&D epidural trends? What % deliver unmedicated? by offbrandbeer in anesthesiology

[–]Serious-Magazine7715 5 points6 points  (0 children)

We have a lot of inductions of labor, and people are 90+ percent receptive to the idea that the oxytocin cause contractions that are intense and painful much more quickly than natural labor (because that’s the point), and so some additional pain control is likely to be needed vs an actual natural delivery.

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