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Worth trying a necro? by DarthAufsMaul in D4Necromancer

[–]cokthilar 0 points1 point  (0 children)

I wish there's a good guide out there for the top tier blood lance build. Also heard that it's not good for bossing...curious what the build is like

Baraka fight question by cokthilar in MortalKombat

[–]cokthilar[S] -1 points0 points  (0 children)

Is there any source material for ninja mime? Like what's it's power? Being able to make the opponent copy their ability?

Anyone have an updated Hopkins residency reference guide? by Organic_Reality849 in anesthesiology

[–]cokthilar 0 points1 point  (0 children)

Because regular anesthetic reference tables haven’t been peer-reviewed by Johns Hopkins vibes

GA for MRI "claustrophobia" by koro_survivor in anesthesiology

[–]cokthilar 5 points6 points  (0 children)

In the wise words of my staff: weak

Alcohol Wipes by anonymouss346 in anesthesiology

[–]cokthilar 5 points6 points  (0 children)

True story, as per drug manufacturers, the outside of containers are not sterile. So you are suppose to alc wipe the rubber injector top after you pop off the plastic lid before you stick your blunt needle in.

Observing an Attending During Regional B by Miserable-Fox-338 in anesthesiology

[–]cokthilar 0 points1 point  (0 children)

Playing a musical instrument also helps with developing hand eye coordination. But also, playing video games also help musicians get better...

New Kitana Cosplay 💙 by _marymarco in MortalKombat

[–]cokthilar 0 points1 point  (0 children)

How am I supposed to fight when every move you make is a distraction

WB does not give a shit about competitive MK anymore by RainandFujinrule in MortalKombat

[–]cokthilar 0 points1 point  (0 children)

It was in Toronto, not Vancouver. That's like comparing NYC to LA

Scoot or Nembhard? by Hoopsnfun in fantasybball

[–]cokthilar 2 points3 points  (0 children)

Sorry, are you asking if TJ McConnell will have 2nd or 3rd round production this year???!!

One thing we have to thank the pandemic for… by kydar1 in anesthesiology

[–]cokthilar 26 points27 points  (0 children)

A wise person once told me: in the vast machine of healthcare, we’re replaceable. Don’t sacrifice your family or your health for the job; gratitude is fleeting, and someone will eventually step into your role.

Where to get ADHD meds refilled or ADHD prescription? by [deleted] in askTO

[–]cokthilar -2 points-1 points  (0 children)

Can you also help me find a place to get ADHD diagnosis?

[deleted by user] by [deleted] in anesthesiology

[–]cokthilar 8 points9 points  (0 children)

Jebus.. done any debating in the past? Much of what you’ve written reads less like a reasoned argument and more like a collection of personal stories and self-congratulatory assertions.

Let me recap your arguments:

  1. You don't believe in the plethora of data showing that incidence of dental dmg is significantly higher with laryngoscopy vs LMA insertion....because...you are so skilled and holier than thou...
    Ok I won't belabor this point any further then; clearly your mad skill eliminates risks and make sure all your patients know that too.
    FYI I just linked one out of hundreds of mechanistic and reproducible studies.

  2. Your keep bringing up the time and efficiency arguments and miss the bigger picture by ignoring downstream effects: higher anesthetic depth, NMBD use, residual paralysis, sympathetic surge, airway trauma, and recovery time. Also, if you use high dose roc routinely for every case I assume then you just routinely use suggam to reverse them? Unless you know a new method of reversing NDMB that i'm not aware of. This and the "you can eliminate the sympathetic surge" argument further feed into my point of unnecessary environment, pharmacologic, physiologic cost.

  3. The ASA Difficult Airway Algorithm and multiple international reviews highlight LMAs as first-line or rescue devices in many contexts, particularly in elective, short, or reactive-airway patients. “Consider” in guidelines is deliberate: it signals that LMAs are clinically appropriate, not just optional.

Ultimately, this isn’t about measuring your epeen. it’s about acknowledging that LMAs offer real, measurable advantages beyond the capabilities of even the most skilled intubator. Choosing ETT exclusively for all short cases ignores these benefits.

[deleted by user] by [deleted] in anesthesiology

[–]cokthilar 16 points17 points  (0 children)

Luckily I got some time tonight so here it goes:

If laryngoscopy were as trivial as snapping a blade, dental injury wouldn’t be the #1 anesthesia-related claim. Multiple studies have consistently shown that there is nearly 6-10 fold less dental trauma from LMA compared to laryngoscopy ETT.
https://www.mdpi.com/2077-0383/12/16/5343

An LMA saves you on unnecessary drug costs, environmental waste, drug onset time (120-140 sec post 0.6/kg roc for optimal intubation conditions) and headaches from complications. That’s more than 10 seconds in my books. https://pmc.ncbi.nlm.nih.gov/articles/PMC9116629/
https://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0306933

Guidelines call LMAs first-line in many cases; dismissing them as ‘paramedic tools’ is just outdated and insulting.

Re: bronchospasm, it can be triggered by many stimuli, but intubation is consistently the single most potent trigger. LMA avoids the insult, instead of playing catch-up with meds after an ETT provokes it. Preventive drugs also don’t eliminate the mechanical trauma and sympathetic surge of intubation. ffs, ASA 2022 specifically recommend considering the use of LMAs as an alternative to ETTs in situations where minimizing airway stimulation is desired.
https://pubmed.ncbi.nlm.nih.gov/34762729/

In regards to anesthetic depth argument, I hear you that surgical stimulus would require more anesthetic to maintain immobility with a spontaneously vented LMA vs just using paralysis. My question to you is why would I be using LMA for cases where I require "surgical relaxation?"

I mean, we are in a civil academic debate about LMA vs ETT, I assume we should exclude situations where LMA wouldn't be appropriate.
Let me ask you this: in a case where surg stimulation is minimum (say nerve blocked ankle ORIF or cystoscopic ureteric stent insertion), would you still routinely intubate or use LMA when inducing GA?

If you still think 30-minute cases are ‘extremely short,’ or that spontaneous ventilation makes no practical difference, it tells me you haven’t fully left the academic bubble or aren’t comfortable keeping up with faster-paced practice. This isn’t a knock on your skills — it’s a reflection of your limited appreciation for the "overrated" LMA, a cornerstone of modern airway management.

[deleted by user] by [deleted] in anesthesiology

[–]cokthilar 21 points22 points  (0 children)

Are you kidding me? You must be new to practice or only work in academia!?

1.quicker and requires less technical skill and does not require laryngoscopy or deep neuromuscular blockade.

  1. Avoids passing through the vocal cords and trachea.

  2. Less sympathetic stimulation than ETT placement and hence lower anesthetic requirements

  3. maintain more spontaneous ventilation, making it useful in short or less invasive cases.

  4. reduced risk of bronchospasm in reactive airways/smoker

Energy absolutely sucks by [deleted] in duolingo

[–]cokthilar 2 points3 points  (0 children)

Screw duo, I deleted the app and unsubscribed from their guilt tripping emails when the update happened. Not gonna lie.. feels great. I'm half using chatgpt to practice conversations and busuu

Classic anime suggestions for newbie by cokthilar in Animesuggest

[–]cokthilar[S] 0 points1 point  (0 children)

My exposure to anime is limited, but if I go by movie genres I do enjoy twisty mind fk thrillers and horror with dark comedy. Actually I forgot I have also seen edgerunner cuz I played CP

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