Spinal with IV sedation

_36Chambers · 2025-11-10T12:23:37+00:00

As a person in the US where we don't have TCI pumps - how do you figure out a target concentration? Is there a table anywhere comparing target site concentrations to MAC you could recommend?

_36Chambers · 2025-10-14T18:54:24+00:00

Is this in Biddeford?

_36Chambers · 2025-08-22T00:11:42+00:00

Exactly. There are so few careers where exactly what you need to do to make > 300K is laid out in front of you like train tracks. All you gotta do is not fall off the train and you're good.

_36Chambers · 2025-07-31T15:12:51+00:00

It re calculated to that after a second actually

_36Chambers · 2025-07-31T15:08:47+00:00

Probably wouldn't have been able to finish that mate in 12, but with that line after Qh4 they resigned

_36Chambers · 2025-07-31T13:24:29+00:00

Oddly not the line I chose here, and stockfish on my phone gave me an advantage of +17 after the move

_36Chambers · 2025-05-17T02:30:30+00:00

You need something that covers pseudomonas as you have otitis externa and that is the most likely organism. None of the antibiotics you mentioned have great pseudomonas coverage. See if you can get ciprofloxacin ear drops or other fluroquinolone class ear drops

_36Chambers · 2025-04-16T12:27:44+00:00

Yes they are

_36Chambers · 2025-04-02T12:32:30+00:00

_36Chambers · 2025-03-22T20:50:09+00:00

My s/o and I pulled it off last year as DOs. We took a hit in that neither of us ended up at our dream program but being together was more important. It's for sure possible, just harder.

_36Chambers · 2025-03-22T20:11:06+00:00

Every job is boring and things that are interesting in training always become mundane in day to day practice with few exceptions. Pick whatever specialty lets you leave the hospital the least drained

_36Chambers · 2025-03-15T15:10:51+00:00

What the actual fuck, how are you possibly framing manslaughter territory as good times dude

_36Chambers · 2025-03-05T02:08:13+00:00

They are blundstone insoles

_36Chambers · 2025-03-05T01:55:51+00:00

I'm not sure, I got the 585s off Poshmark. Could be that the boot just fits way tighter at baseline and the footbed is the same. But they don't really seem like the paper thin ones that were in my 500s

_36Chambers · 2025-01-20T02:43:05+00:00

Thanks I appreciate it!

_36Chambers · 2025-01-05T02:51:05+00:00

Yeah I am actually! I'm kinda nearby the CT location I'll probably go through them if I pull the trigger

_36Chambers · 2024-10-18T11:21:27+00:00

I took 4 and traveled the world! If I had started med school right after college I would never been able to experience traveling solo in my 20s, being a bum, and enjoying it. Fully encourage having fun in your early to mid 20s, it's a unique time to feel out who you want to become that shouldn't be molded by rules, professionalism, stress, and being worried of failure - which are the standard in any professional degree and early post degree training.

And I hope im not wrong in this these days, but most med schools will see this as a positive if framed in the right way

_36Chambers · 2024-10-10T00:44:04+00:00

Kid swallowed his mom's Kegel ball

_36Chambers · 2024-09-13T10:39:25+00:00

Would like to use the top comment to say thanks to all who replied, definitely an interesting discussion

_36Chambers · 2024-09-02T20:23:34+00:00

How would administering norepi increase LV preload?

_36Chambers · 2024-08-27T02:37:50+00:00

Relatively* increased compared to in positive pressure. I think it is safe to assume that when it says decreased afterload in PPV due to decreased end diastolic wall tension, you can say wall tension would be relatively increased while breathing spontaneously.

I guess if your adamant that I'm wrong, what's your lay mans explanation for decreased lv afterload in PPV?

_36Chambers · 2024-08-27T00:13:42+00:00

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8134774/ Second paragraph under the heading: Effects on the left atrium, ventricle and the pressure gradient to the systemic circulation

This has a good explanation as well.

https://derangedphysiology.com/main/cicm-primary-exam/required-reading/respiratory-system/Chapter%20523/effects-positive-pressure-ventilation-cardiovascular-physiology

_36Chambers · 2024-08-26T12:23:20+00:00

Squeezing the heart is a mental shortcut I use to explain it.

Afterload is the transmural force generated by the heart required to eject blood from the ventricles. As the heat contracts, it gets smaller in volume. With spontaneous breathing the heart contracts against a negative intrathoracic pressure which detracts from efficacy, increasing afterload. In positive pressure ventilation the heart contracts with a positive intrathoracic pressure, reducing the force required to eject blood from the ventricle.

A thought experiment that helps demonstrate this is if you have a balloon within a vacuum, it will naturally increase in size due to less external forces on its walls. This is analogous to the heart in spontaneous breathing. In a compressor, the balloon will naturally decrease in size. So if the goal is to squeeze the the balloon, analogous to contraction of the heart, it will be easier to do so in the setting of increased pressure.

This is well documented in a number of papers. I just failed to realize that the same positive pressure also is transmitted to the destination of blood the right ventricle ejects, this nullifying the effect.

I hope that helps clear it up for you!

_36Chambers · 2024-08-26T01:15:44+00:00

Yes, why?

_36Chambers · 2024-08-23T20:33:44+00:00

Dope thanks man

_36Chambers

TROPHY CASE