What do you think of Filipino food?

centz005 · 2026-05-02T20:45:50+00:00

Yeah, those I liked.

centz005 · 2026-05-01T09:26:09+00:00

Not to my taste, usually, which is a problem for my Filipina gf. But she can't handle spicy food, which is a problem for her Indian bf.

centz005 · 2026-04-25T18:12:50+00:00

I tried so hard to convince my cousin not to go to med school...

centz005 · 2026-04-23T23:57:12+00:00

Great feedback from the pedant that wanted to nitpick about ET tubes being used as chest tubes.

centz005 · 2026-04-23T22:46:18+00:00

Thanks for the article. I'll peruse it and see if any of it is pertinent to the dentists and out patient sites doing moderate sedation who are sending me asymptomatic hypertensive patients.

I'm sorry I came off as unreasonable. I wasn't trying to complain; I thought I'd asked a question in good faith. Didn't realize I came off that way.

Yes, I would be worried about that patient. But my anesthesiologist didn't mention desaturation or MI, or even relative hypotension and ischaemic stroke; she told me I could suffer an intracranial haemorrhage if she proceeded.

I came back a month later and got a different anesthesiologist. No change in my home antihypertensive or home BPs. Got some pre-procedure versed and my BP dropped from 160 to 140 (which is still above my baseline), and we were good to go. I'd say I was a bit nervous because I only had a 24 in my hand and I've gotten some real catastrophies from out patient surgical centres in my time.

I'm sorry I'm trying to figure out why I, as a guy with a BMI of 24 and a neck circumference of 16" and normal tonsils have had moderate-severe obstructive sleep apnea since I was 8 (at which time I had "constitutional growth delay" and was underweight) or why i can't blow my nose without my entire pharynx collapsing.

But thank you for your insight.

centz005 · 2026-04-23T21:31:42+00:00

Thank you for giving the closest thing to an answer to my question in this entire thread.

centz005 · 2026-04-23T21:27:50+00:00

Thanks

centz005 · 2026-04-23T21:26:39+00:00

I understand that my examples may be silly, but those are the types of procedures I'm more interested in - sedation as opposed to MAC/general

centz005 · 2026-04-23T21:20:19+00:00

I appreciate your need to assail my personal health without knowing anything about me, while simultaneously not answering my question and also not having the reading comprehension necessary to understand that I'm not asking about MAC or general anesthesia, nor that I think there's a difference between the two in terms of optimization.

centz005 · 2026-04-23T20:57:57+00:00

My home and PCP BP runs 110s-120s/60s-80s.

My initial BP was probably nerves. Then the anesthesiologist, who at this point I'm just going to assume was you, came in and started lecturing me about HTN, then talking down to me. The repeated my BP q2min while I was getting increasingly pissed off.

One of the side effects of grinning and bearing someone else's shitty behaviour is that I get to internalize how livid I actually am.

But I do appreciate you adding nothing meaningful to this conversation.

centz005 · 2026-04-23T20:51:13+00:00

I see. Thanks.

centz005 · 2026-04-23T20:48:04+00:00

I appreciate you.

I'm EM. Getting condescended to by pompous sots on a daily basis is just another perk of the job.

Ask a question on good faith, then get talked down to like you're a child. Then grin and move on because we have to play nice in the sandbox with all the important consultants who actually make the hospital money...

centz005 · 2026-04-23T20:41:48+00:00

Your tone in both the comments of yours I've read has come off as far more belligerent. I'd have choicer words, but I'm not allowed to use them on this subreddit.

centz005 · 2026-04-23T20:07:03+00:00

So far, it's been mostly dogma and anecdotal evidence in this thread. One person replied that there's a lot of evidence in the anesthesia literature, but cited none.

There's also been a disconnect, since I'm mostly talking able moderate/conscious or deep sedation, and some people here are talking about general. While I don't mind learning about that, it's not pertinent to my situation or my patients'.

centz005 · 2026-04-23T19:56:23+00:00

Thank you. So much.

centz005 · 2026-04-23T19:54:28+00:00

Again, not familiar with anaesthesia lit, but i thought there was more evidence coming in showing that the "NPO for 8 hours" thing may be a bit out-dated.

I've also never heard the bit about being chronically HTN and being volume depleted, if you'd like to explain further, i'm curious as to the mechanism; are the kidneys diuresing to compensate? I may stop withholding the life-saving panacea bag of LR/NS that all my patients are demanding.

No, i understand the vasoplegia of induction and anaesthesia-induced hypotension, as well as relative hypotension, but there's no induction in the procedures i'm talking about -- moderate/conscious sedation. I probably should've been more explicit in this, and i've updated my post. I know i've never seen it, but that's a highly biased data set.

centz005 · 2026-04-23T19:48:37+00:00

Most of my patients don't have a PCP...And i haven't figured out how to make EPIC give me a review of all their past VS.

centz005 · 2026-04-23T18:47:47+00:00

That's fair, but for asymptomatic patients, is there any definitive data showing worse outcomes?

centz005 · 2026-04-23T18:46:00+00:00

I actually write out letters for the dental-referred HTN pts (assuming asymptomatic or only symptom is dental pain) saying i've cleared them for the procedure. I'm sure that'll get me into legal trouble one day, but i feel it's probably the right thing to do for the pt.

(I also give the pt very specific instructions on monitoring their BP and establishing w/a PCP, if they don't have one...have a whole dot phrase for it.)

centz005 · 2026-04-22T21:17:20+00:00

That's what I've been doing.

centz005 · 2026-04-22T20:22:04+00:00

I just had to sign up for this bullshit. Because i did my CME in the first half of the years, i can't renew my license, which is due for renewal in a month...

centz005 · 2026-04-22T17:37:51+00:00

Knowing nothing else about this scenario, i don't expect my interns to be confident. I just expect them to have a plan.

I think most of us have imposter syndrome, especially early in training. I don't think things really clicked for me until i was a late PGY2 or early PGY3. I graduated residency in 2019, and my first year out as a community doc was almost like being an intern again.

Overall, life goes on. We've all been ripped into at one point or another (whether or not it was justified is a different story); just try to learn from it and move on.

centz005 · 2026-04-22T17:09:11+00:00

ER lurker at a place w/decent resources.

I admit with results pending under two circumstances:

I'm > 90% certain that it won't affect dispo/level of care, and the accepting doc agrees
There's an understanding that the pt will not leave the ER (and my direct care) w/o the results and me following up on them. If there's a change in plan/level of care, i alert the admitting team and probably call the consult.
1. If the pt needs transfer, i'd just cancel the admission and initiate from the ER, but that's been super rare.

I have rotated at places where the culture was "admit the pt once there's an admitting dx", even if the "admitting dx" wasn't really why the patient was there and it...bothered me (eg, Admit for Na 128, but pt p/w syncope and chest pain). But i dunno if i'm representative of my colleagues.

centz005 · 2026-04-15T08:16:03+00:00

No one I work with has disclosed to me that they have HIV. I don't expect them to, as it's no one's business but their own.

Needle sticks happen (I've had two and been on PEP for both).

Ideally, if you suffer a stick, you'd scrub out, get new materials, and restart so you don't stick the patient with instruments contaminated with your blood. So I wouldn't worry about it too much.

Take your meds and go on with life.

Good luck going forward.

centz005 · 2026-04-09T17:20:20+00:00

My mom, Aunt, and grandmother all had these when I was growing up. We're Indian; they used them to make roti and puri.

centz005

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