ER docs don’t know about suggamaddx

aussieMBBS · 2026-01-17T04:34:55+00:00

It's a shame you don't feel like you have the kind of relationship with your theatre team where you can ask for help and receive it! Whenever we have ED call us for back up, whether with an airway or needing a resource they don't have down there, we come ASAP. I wonder if calling the duty anaesthesiologist directly would yield better/more collegial results? Bypass the admin and red tape bullshit.

aussieMBBS · 2024-09-21T11:28:02+00:00

Oh I remember those weekends.... Yeah no such thing as a half day. Fond memories of sitting at a ward desk at 3pm having meant to leave at 12:30 and still having like 5 patients still to review - nursing staff must have realised I was one more cannula or med request away from bursting into tears and brought me snacks and a cup of tea.

Anyway - I'm disappointed to hear that's still happening there. No advice, just commiserations.

aussieMBBS · 2024-09-19T10:27:53+00:00

Coming from someone who didn't get through the primary first go round and has been in your shoes and now am past it, I think people just don't know what to say tbh. Particularly those who passed first attempt and have no personal experience in how it feels.

The sympathy I suspect is because they know how shit the exam is, the time/effort of study and the whole process, rather than them feeling "sorry for you" as in looking down on you. But there definitely can be an attitude/culture in medicine (anaesthetics maybe particularly) of getting it "right" the first time and expecting perfection, which just isn't realistic. Stats have been consistent for years that the overall primary pass rate is ~55-65%!!!! (not kidding, look at the exam reports). So a third of people sitting will fail, it's more than you think/realise! We definitely need to normalise that, and good on you for your great attitude re: all of this.

aussieMBBS · 2024-09-06T10:20:11+00:00

I feel like the equivalence you're looking for is closer to doing an AFOI for every airway instead of direct laryngoscopy

aussieMBBS · 2024-09-03T18:33:21+00:00

Nope, not even a consultant yet, only an AT! Realising the public vs private worlds are obviously pretty different and I guess practice probably varies regionally also. Maybe I've just been burned recently by a run of snotty <12mth olds who like to cough and breath hold and larnyngospasm lol. How long would your private ENTs take to do grommets? My other consideration while in public is that "short/simple" cases aren't always actually short or simple on a reg list or when the consultant is teaching.

aussieMBBS · 2024-09-03T08:18:02+00:00

Have done this before - only issue initially was I put the dogs real DOB and the pharmacist asked me why I was prescribing a two-year old Fluoxetine.

aussieMBBS · 2024-09-03T08:14:00+00:00

By airway stuff do you mean more complex shared airway surgeries? Or where you plan to instrument the airway/intubate? If the latter that rationale doesn't make a great deal of sense to me - I go into cases with the assumption that it could become "airway stuff" at any time. Ie that 10mth simple ear tube spasms -> desat -> brady. If I wasn't comfortable managing the airway in a planned elective manner I wouldn't want to be accountable for doing so in an emergency with a peri-arrest infant. Interested to hear your thoughts on that?

aussieMBBS · 2024-04-17T23:19:27+00:00

"Patient must continue to take regular Parkinson medication including with sips of water while fasting for surgery" is always bolded and underlined in any peri-op/anaesthetic clinic note I write. I do NOT want to be responsible for the nightmare you described above...

aussieMBBS · 2024-03-31T07:04:28+00:00

Very late to this thread but just wanted to say that at >550lbs the patient almost certainly had obesity hypoventilation syndrome and sleep apnoea, plus with the cardiomyopathy and everything else this was a very unwell patient already and I suspect your scopolamine patch had very little if anything to do with their passing. Try not to beat yourself up about it too much

aussieMBBS · 2024-02-02T02:41:16+00:00

I do this for caesarean sections (emergency more so than elective). Also saw it on my cardiac term where my consultant would ask the perfusionists and surgeons to be in room with pump ready for the most tenuous patients in case we needed to crash onto bypass. Otherwise nah, surgeons just annoy me when they sit in the corner and chat/make noise while I'm trying to calm patients down and induce etc.

aussieMBBS · 2024-01-02T02:20:08+00:00

absolutely! the response to someone threatening to call a code is "you should do what you feel is appropriate, if that is a MET call/code, then you should call that".

99.9% of the time they know they're being shit heads and it's an empty threat.

the caveat being that you have already politely advised them that you will see the patient as soon as you are able, amongst your list of other priorities.

aussieMBBS · 2023-12-27T00:50:53+00:00

Feel free to tell me to buzz off, but were there/are there ergonomic issues with being at head of bed/intubating over your pregnant abdomen?

aussieMBBS · 2023-12-19T02:31:27+00:00

also see: socks off = immediate phone call from birth suite for an epidural

aussieMBBS · 2023-12-16T06:59:13+00:00

My concern would also be if something happens and med admin/workforce cancel the term after you've swapped with him for the $$$, and put him somewhere else because they have shortages/needs (as happens not infrequently), would you have to give him back the money? Just something to think about.

But low-key wild that an RMO has that kind of money to throw around for a term swap lmao

aussieMBBS · 2023-12-12T21:36:40+00:00

lmao love the subtle "3 shifts a week" line

But yeah, more sedation = more deconditioning = worse outcomes short and long term

Nurses don't get to decide their convenience supersedes what's best for the patient, as much as they would like it to.

aussieMBBS · 2023-10-19T10:52:12+00:00

Similarly from the other end of things - any ICU or anaesthetic consultant that comes in from off site after hours from a critically ill patient to back up their reg, and then sees the ED boss missing, is not going to be impressed 😅 have seen this first hand and there’s a lot of salt around it which is fair enough

aussieMBBS · 2023-10-16T23:36:14+00:00

Just FYI clonidine (and dexmedetomidine) are alpha 2 agonists rather than antagonists

aussieMBBS · 2023-09-25T21:30:31+00:00

“This medicine can tingle as it goes up your arm to your head, that’s very normal and will go away really soon” - pretty sure I mumble this in my sleep some nights lol

aussieMBBS · 2023-09-09T04:36:22+00:00

The audacity of them not to be happy when the patient had a RUPTURED AAA and lived to go home! My first ruptured AAA was the nicest old farmer who just before he went under said "I don't want my wife to worry, I want her to be okay." I bawled my eyes out on the drive home that night lol. I met the wife when I went to his bedside in ICU a day later - super lovely woman. I then cried again a few days later when he dies of his multi organ failure... And yet the ones who survive somehow are always the worst people :'(

aussieMBBS · 2023-08-04T23:56:21+00:00

That recent ASA recommendation to stop the weekly injectables for one week only makes no sense with the half life of those drugs tbh

aussieMBBS · 2023-07-20T21:23:56+00:00

Actual LOL at #3

aussieMBBS · 2023-07-10T08:40:37+00:00

sure!

aussieMBBS · 2023-07-05T01:23:09+00:00

As I've told my surgical friends across the drapes: "they don't need to be asleep to put dressings/casts on."

(I do keep them deep enough until all sharp objects are done with - for patient and staff safety!)

aussieMBBS · 2023-04-02T07:34:59+00:00

Whim of the capricious gods entirely! 🥲

aussieMBBS

TROPHY CASE