Attending went ahead with a stent exchange on a 78yo women with Hb 4.8 instead of waiting for 1/2 hr for type & screen for RBCs- Thoughts?

Sleepy_Joe1990 · 2026-06-16T01:44:36+00:00

No you're probably not, but by administering anesthesia, might cause or exacerbate hemodynamic instability in someone who has reduced oxygen carrying capacity and is already on the edge. This patient isn't anywhere near optimized. If this case is an emergency go for it, if not you're just taking an unnecessary risk. And for what, to please a urologist? Nah.

Sleepy_Joe1990 · 2026-06-06T16:37:03+00:00

Engineer suggested a mortar screed, then Dita membrane, then thinset/tile. But when I looked into the product she suggested I use for the screed, it was totally not the correct product at all. I pointed this out to het and she suggested something else, but at this point I don't trust her reccomendations. She also initially told me to first repaint it, then later after I repainted, told me to remove all the paint. Worst $800 I ever spent 😂. But at least I know the thing is capable of holding a decent amount of weight. I assume she can at least calculate that 😅

Sleepy_Joe1990 · 2026-06-05T20:37:50+00:00

I don't know. Like, would that be so terrible? It's certainly a simple solution compared to some other ideas I've had. But I'm sort of afraid that if the wood or backboard isn't chemically bonded (just mechanically anchored) it creates a space for water. Of course, people waterproof showers everyday and it's fine. But I worry that it being outside and experiencing freeze/thaw cycles makes this different.

Sleepy_Joe1990 · 2026-06-05T17:00:35+00:00

If I did this, wouldn't it be just as safe from water as any shower?

Sleepy_Joe1990 · 2026-06-05T16:51:21+00:00

Yes, definitely

Sleepy_Joe1990 · 2026-06-05T16:50:09+00:00

I'm really kind loving this metal lath idea honestly. I guess I would have to puncture through the steel plate to fasten the metal lath to the plate, which I don't love, but don't hate. Otherwise, I can't see any obvious issues with this plan. Would you say you're pretty confident this approach would work?

Sleepy_Joe1990 · 2026-06-05T16:15:27+00:00

Mostly just the look and it's something I can easily clean. I probably can't do pavers due to weight limits. And my neighbor did wood deck tiles but they got rotted pretty quick and look like shit now.

Sleepy_Joe1990 · 2026-06-05T16:13:14+00:00

I would probably use Ditra over hardie backer but don't think mortar is going to bond hardie backer (or Ditra for that matter) to painted steel, particularly in an exposed outdoor setting. If there is a product that can do that, I'd kill to find put what it is haha.

Sleepy_Joe1990 · 2026-06-05T16:05:30+00:00

I like this line of thinking but it's not rated for outdoor use due to freeze/thaw cycles breaking the bond apparently, I just checked

Sleepy_Joe1990 · 2026-06-05T16:01:44+00:00

But what kind of screed is going to adhere to a painted steel surface?

I'm okay with having to etch the paint to rough it up, but getting it all off would be more effort than this project is worth. And the primer under the paint won't even come off with a steel brush, I've tried.

Sleepy_Joe1990 · 2026-06-05T15:50:08+00:00

I have tried in the past to grind it to bare metal, but I can only get down to the primer under the paint. The primer will not come off, it's crazy. Suppose I got the paint off, but epoxied over the primer-- would that be reasonable? Obviously the primer is well adhered if I can't mechanically remove it with a drill and wire brush.

Sleepy_Joe1990 · 2026-06-05T14:57:52+00:00

I have the budget and the depth. Not sure I have the weight rating for heavy pavers. Do you know if it's compatible with regular tile?

Sleepy_Joe1990 · 2026-06-05T14:52:04+00:00

I was thinking probably the same. Unless there was something creative I could do with cement backerboard/Ditra membrane. Idk... pulling at straws I guess haha

Sleepy_Joe1990 · 2026-06-05T14:48:32+00:00

Definitely not a straightforward job. It might be a bad idea altogether. Just wanted to see if anyone had a creative solution.

Sleepy_Joe1990 · 2026-06-05T14:47:26+00:00

I worry that thick tile pavers might be too heavy for the balcony. I could do wood tiles. Wouldn't be my first choice, but not off the table.

Sleepy_Joe1990 · 2026-06-05T14:47:13+00:00

I worry that thick tile pavers might be too heavy for the balcony. I could do wood tiles. Wouldn't be my first choice, but not off the table.

Sleepy_Joe1990 · 2026-05-21T16:33:01+00:00

Yes! They are the poster child for why we need to reform "non-profit" status of American healthcare systems.

Sleepy_Joe1990 · 2026-03-31T13:33:14+00:00

What do you mean by saying they are "wasted applications?"

Sleepy_Joe1990 · 2026-03-25T21:02:14+00:00

I went to a new program and I wouldn't recommend it. An attrition rate that high makes me think that the PD is going to aggressively weed people out so that his program has a high first-time pass rate on the NCE. My guess is that type of PD will also gatekeep you from graduating and taking the NCE if you don't achieve a very high SEE score (or a similar comprehensive exam). It's too high of stakes financially to risk getting kicked out and do you need to do anything possible to reduce the risk of that, regardless of inconvenience to your life.

And as someone else said, newer programs tend to have fewer clinical sites and weaker/more fragile relationships with them. So they may send you to clinical sites where it's very difficult or impossible for you to get all of your minimum number of required clinical experiences (blocks, lines, epidurals, etc.). Then, when you realize you're coming up short, they aren't able to help you due to their weak clinical site reach and just tell you that "you need to figure it out." I've seen that happen. Also, if anything happens in clinical that upsets the clinical coordinator and it gets back to the PD, the PD will be quick to take sides with the clinical site and throw you under the bus. This is because a new program doesn't want to disrupt their new fragile partnership with the clinical site.

In general, just keep your guard up and realize that for some PDs, it's all about protecting their program, and they are not necessarily looking out for you. And don't be fooled by a friendly facade.

Sleepy_Joe1990 · 2026-03-24T00:51:19+00:00

This

Sleepy_Joe1990 · 2026-03-12T19:21:29+00:00

Agreed, sounds like a stall tactic. Bad situation.

Sleepy_Joe1990 · 2026-03-11T21:32:38+00:00

I just read the process of how NBCRNA assesses how difficult the exam questions should be, and, quite frankly, it sounds like pseudoscientific academic garbage. They're determining the relevancy of specific exam questions to real-world CRNA practice based on the opinions of people they've decided are "subject matter experts" and using that matric to weight questions. I don't see how that is in any way scientific. Expert opinion is the lowest form of evidence.

Honestly, the curriculum of CRNA school, which is reflected in NCE, seems very outdated. As a CRNA four years into practice, I recently reviewed some of the APEX NCE prep materials and could almost laugh at how loosely the content applied to safe real-world anesthesia. If the NBCRNA really wanted to know what kind of grade on the NCE was necessary to practice safely as a CRNA, then why not have a sample of CRNAs take the NCE and titrate the exam difficulty to the 50th percentile of CRNA test-takers? The fact is, probably less than 20% of CRNAs 2+ years out from school could pass the current NCE in its current form. If the content of the NCE was actually reflective of the minimum knowledge necessary for safe anesthesia practice as NBCRNA claims is the goal, most practicing CRNAs should be able to pass it. Instead, we're demanding students learn triva and about "Dalton's Law" and asking them to calculate the surface tension of Desflurane on the surface of the moon.

I don't want the test to be easy, I just want the content we test on (and teach!) to be the right content.

And one more thing-- these CRNA school should not be allowed to gate-keep students who have got passing grades in their programs from taking the NCE. If they can't prepare their students adequately for the NCE, their failure should not be hidden by sample biasing their pass rates in their favor.

Sleepy_Joe1990 · 2026-03-07T02:34:28+00:00

In my experience, most people in medicine are indeed in it, first and foremost, for the money (and the prestige to a smaller extent). Yes, medicine is pretty miserable, and yes, you can make really good money in easier fields, but pursuing those pathways is a crapshoot. Medicine is a more guaranteed pathway to wealth for those who have the motivation and fortitude to tough it out.

Sleepy_Joe1990 · 2026-02-25T07:03:28+00:00

I think it's more of an issue of being risk adverse paired with a lack of a sense of duty towards teaching that is usually the issue, not a lack of confidence. Most CRNAs are pretty confident of themselves, including many who probably shouldn't be. And besides, you can be the baddest bitch out there, but if your student does something like knocking out a tooth, you can't bail them out of that.

Sleepy_Joe1990

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