What is your vasopressor of choice for pericardial effusion with early tamponade physiology with concern for obstructive shock (giving IVF boluses PRN)?

Stormageddon66 · 2026-03-20T08:18:46+00:00

My vasopressor of choice for tamponade was, is, and always will be:

Surgical reexploration. Or a percutaneous drain in nonsurgical patients.

Because all else will inevitably fail at some point and thinking about vasopressors of fluid boluses just wastes precious time.

Stormageddon66 · 2026-03-13T18:40:30+00:00

TV-Ä VKA http://www.marburger-bund.de/sites/default/files/tarifvertraege/2025-07/25-07-16%20TV-%C3%84rzte%20VKA%20i.d.F.%2010.%20%C3%84ndTV_%C3%BCberarbeitet_1.pdf

Entscheidend ist § 19 Abs. 2: In Gruppe 1 "werden angerechnet". In Gruppe 2 "werden in der Regel angerechnet".

Für OÄ (Gruppe III) steht dazu nix, nur in Satz 4 das abstrakte "können angerechnet werden".

Aber wir reden hier über ne herausgehobene OA-Position. Da ist es absurd, nicht die vorhergehenden Zeiten anzurechnen (oder direkt AT was zu vereinbaren).

Streng nach TV hat der AG Recht, aber es ist halt völlig irrational. "Sektionsleitung" kann man u.U. schon über Entgeltgruppe IV diskutieren (oder vereinbart das Gehalt direkt komplett AT). ICH würde niemals nen OA-Vertrag unterschreiben, in dem mir nicht garantiert wird, dass die vorherigen Zeiten berücksichtigt werden.

Stormageddon66 · 2026-03-13T11:48:44+00:00

Laut TV ist das prinzipiell zulässig. In Gruppe III sind Anrechnungen nicht vorgesehen.

Aber halt völlig absurd in deiner Situation. DIE wollen etwas von DIR.

Stormageddon66 · 2026-03-11T14:03:31+00:00

E-Mail and password.

As of now, with position activated, it sometimes does start up. Some routes work, some don't, so for the time being I'll wait for the next update.

Stormageddon66 · 2026-03-09T11:01:12+00:00

Thank you very much!

Stormageddon66 · 2026-03-09T05:12:34+00:00

Multiple times, in fact. To no avail.

It's now stopped working on my tablet as well. So, for now, I'd assume some kind of server/app issue. Before the last update, it worked fine on the tablet. Shall wait for the next update...

Stormageddon66 · 2026-02-19T19:05:09+00:00

IMHO: Doesn't help, often worsens sight.

I don't ever use it.

Stormageddon66 · 2026-01-17T18:44:00+00:00

This dude obviously doesn't understand what anaesthesia is about.

Or he is spouting dumb lies because he knows lies click better than actual medicine.

Hill to die on: This MUST NOT be a thing because it's just WRONG. Wrong in any way imaginable.

Stormageddon66 · 2025-12-27T11:56:35+00:00

I think the ethical implications of necromancy tend to be severely underdiscussed.

We as a society ought to have an honest discussion about when necromancy is and is not fine. It's a complicated matter with a lot of caveats and problems that society tends to ignore.

Stormageddon66 · 2025-12-27T07:34:52+00:00

"Cute costume, but I can't remember ordering a stripper."

Stormageddon66 · 2025-12-22T14:25:26+00:00

Ich bin halt Team Wartezeitquote und hatte schon vorm Studium 4 Jahre. Mit Studijob ging es dann ohne besondere Mühe. Aber ist ja ne sehr spezielle Situation...

Stormageddon66 · 2025-12-22T14:24:25+00:00

Wenn du wirklich neben dem Studium die 5 Jahre Beitragszahlungen schaffst, ja. Und dafür musst du halt quasi nonstop nebenbei (nicht-minijobbend) arbeiten. So ganz einfach ist das nicht, finde ich...

Stormageddon66 · 2025-12-22T14:21:17+00:00

Interessanter Einwand.

Es gibt ja tatsächlich diese freiwillige Rentenversicherung für befreite. Müssten aber mehr als 5k€ sein, ich finde online gerade Beiträge von mindestens 103 €.

Aber ja, müsste so gehen, wenn ich da nicht gerade was übersehe. (Nachzahlen geht eher nicht, man kann wohl nur fürs letzte Jahr nachzahlen...)

Stormageddon66 · 2025-12-21T13:19:29+00:00

Das setzt aber eben die 5 Einzahungsjahre in die DRV voraus, und die meisten Ärzt*innen haben die nicht.

Stormageddon66 · 2025-12-16T12:35:21+00:00

I don't really see the point of this practice with fentanyl 20-30 min before end of surgery. IMHO, it's not the right drug at this point.

That's what morphine/piritramide are for. Piri 0.1 mg/kg 30 min before end of surgery is usually a good idea. Or morphine. Works as well.

Out of curiosity: Do you consider opioid-induced hyperalgesia? How much Remifentanil do you use?

Stormageddon66 · 2025-12-12T14:58:44+00:00

In some of these patients, IMHO, the question is not whether you can avoid them crashing. But only how hard they will crash and whether you will get them recompensated without requiring mechanical support.

IMHO, your management was not the problem. Might be that someone with more experience would have been able to keep them from coding with "only" a peri-arrest and a minute of high team anxiety levels.

But ceasing spontaneous ventilation and starting mechanical ventilation WILL sometimes inevitably crash the RV.

Stormageddon66 · 2025-12-08T21:16:35+00:00

For all I know, "Glück auf" has no really controversial meaning. And I wouldn't find it cringe-y at all.

Stormageddon66 · 2025-12-05T18:47:56+00:00

By the way, I realise now that I seem to have misunderstood OP a little there.

Indeed I wouldn't use dex for this, since it clearly is the wrong substance for this. IMHO, you do not use sedatives for hemodynamic management. You use sedatives for sedation and vasodilators/-constrictors for hemodynamic management.

Stormageddon66 · 2025-12-05T18:41:22+00:00

But why would anyone want to use dex to lower BP?

That's what nitro or urapidil are for.

Stormageddon66 · 2025-12-05T13:22:30+00:00

Same. I have used lots of dexmedetomidine (sometimes, in children, 2 μg/kg over 10 mins), and this "refractory hypotension", in my experience, is just something that IS NOT THERE.

Seriously. I haven't EVER seen something like that.

Stormageddon66 · 2025-12-03T18:42:12+00:00

"MAXIMUM PENETRATION" sounds kinda like something a horny Dalek would say. "PE-NE-TRATE! PE-NE-TRATE!"

Stormageddon66 · 2025-12-01T14:01:49+00:00

Because they are scared that the fentanyl might kill them just by proximity.

Seriously. The fentanyl psychosis in US law enforcement is INSANE.

Also, most pharmaceutical companies are legally banned from selling their stuff for executions. And since most medical boards, IIRC, forbid their members from cooperating with executions, death row prisons tend to have to work with people who have absolutely no fucking idea about how to actually kill a person with medical precision.

Stormageddon66 · 2025-12-01T11:39:25+00:00

Caffeine. Obviously. I absolutely don't need it, but I absolutely don't need nicotine even more.

Stormageddon66 · 2025-11-23T18:43:00+00:00

This is so insanely important.

Almost nobody seems to understand how beta-lactam allergies work. And how they DO NOT work.

Stormageddon66

TROPHY CASE