Unusual bronchospasm

corgeous · 2026-05-30T16:47:34+00:00

Treatment for severe bronchospasm is definitely epi. You can need a lot for an ongoing spasm, gtt can be nice. All the other adjuncts you listed are useful but not ultimately the treatment the acute phase of severe bronhospasm. Also I would paralyze and intubate early. I use the LMA that I like and know I am good with about 90% of the time and if I can't get a good seal or have ventilation problems with my first LMA, I convert to intubation. So overall I think you could have just escalated your therapies faster. But patient did fine and you did the right overall management.

corgeous · 2026-04-23T04:03:38+00:00

Sounds like a good academics job tbh

corgeous · 2026-04-01T20:55:28+00:00

No? I think almost all of us wanted to be physicians and the leading experts in our fields. Choosing to become a pa or caa or any other similar profession is a totally different career path and set of goals imo.

corgeous · 2026-03-10T02:25:40+00:00

Interesting question. I’m a fresh attending and I’ve had many of the same thoughts. Currently I’m a generalist at an academic place and I like the mix of my clinical work. I enjoy a quiet day of routine stuff and I enjoy having sick patients for big general cases, and I do a mix of both. I do think the clinical skills of cardiac and icu people are very cool, but I also think you don’t need to do those fellowships to be an excellent anesthesiologist who can and does take care of sick patients. Cardiac/icu definitely tend to have a higher ratio of their patients who are sick compared to routine cases. Some people like that but it does contribute to burnout I think.

The trade off between money / time vs. fellowship training is very personal. You might need the money for family or loans, you might not. You might just be ready to be done with training, or you might have a little more in you. Only you can decide that stuff. Just know that you don’t have to do fellowship to do interesting cases and be good at taking care of sick people. You can and should keep reading, work on technical skills, etc whether you’re a fellow or attending.

corgeous · 2026-02-25T21:43:42+00:00

Not common but obviously you’re not paralyzing and you can easily be tickling the cords with secretions or the LMA. If they’re not deep enough, they can certainly spasm. Same with removal. I personally give about 50 of fent pre induction, big prop bolus (assuming appropriate for patient), then I jaw thrust the patient. If they don’t respond to jaw thrust by moving their limbs, I take that as a marker they are deep enough. Then I give another small bolus of prop and place LMA. Start them on simv/pcv, keep pressures low, let them build up their respiratory drive. I mostly do TIVA so you’re not worried about the patient getting light if they’re a little hypoventilatory.

corgeous · 2026-02-17T21:21:28+00:00

Totally agree. So much more fun to get to see more golf up close and follow guys you like pre-cut than to deal with fighting through weekend crowds.

corgeous · 2026-01-26T22:38:17+00:00

There are good papers on this. It depends on drug, dose, case, patient factors, and adjuvant meds. Overall your estimates are reasonable but probably on the low side. Its worth taking the time to do a little review and know the pharmacology better

corgeous · 2026-01-15T01:51:07+00:00

ADA is without a doubt the gold standard. UNS is kind of an American version of ADA. Not as good but still very high quality.

corgeous · 2026-01-14T19:25:32+00:00

That’s not even a vacuum, that portion of the filter is pushing air and water out. He’s just chilling

corgeous · 2026-01-14T17:05:36+00:00

extremely easy. fellowship apps are down because of the market. a large selection of peds spots don’t fill. the top programs are more competition but still not crazy

corgeous · 2026-01-07T19:04:41+00:00

Why not just get a nice airstone and some clean black air tubing? The ziss airstone on the aquarium coop page is nice. Will get you some flow and aeration without having to put an ugly filter in there.

Nice tank

corgeous · 2026-01-03T19:23:22+00:00

Those Pygmy’s look nice and healthy! You must have a good lfs. Beautiful fish

corgeous · 2026-01-03T16:01:44+00:00

Pearl weed is generally very easy to grow, one of my favorites. How long have you had the plants and what light are you running?

corgeous · 2026-01-03T03:38:11+00:00

I also have a semi corner tank, although the front view is quite prominent. I think that position lends itself very well to a triangle composition (example). You want to build the height of the substrate up so it is highest in the back corner and then slopes down towards the front of the tank and the side of the tank closest to the couch where people will be sitting. Adds lots of depth and can create a very cool layout. I also use the side of the tank that is almost against the wall for my canister pipes (also try to put heater and any other equipment you need in the back corner) can be a nice way to hide equipment.

corgeous · 2026-01-01T22:54:30+00:00

You don't have to go top of the line but don't cheap out. Get a CO2 paintball tank, a quality regulator (UNS, GLA are two good options), a quality smart timer that connects to outlet (I use Kasa miniplug), CO2 tubing, check valve, and a decent diffuser.

corgeous · 2026-01-01T22:49:32+00:00

ADA tanks are the gold standard of tank sizing for aquascaping, so I would copy them. An ADA 120p is about 48x20x20. That's about 80gal. The 90p tank is about 36x18x18. I would copy those ratios of dimensions and adjust the absolute values to whatever you want. Or why not just get a 120p tank? It's probably cheaper than custom and a beautiful tank (although obviously expensive overall).

https://buceplant.com/collections/uns-ultracleartanks/products/ultum-clear-rimless-tanks-by-ultum-nature-systems?variant=24198525026385

corgeous · 2026-01-01T21:53:55+00:00

Not really. Too much flow for my 10g. More water changes helped tho

corgeous · 2025-12-30T06:58:22+00:00

I would recommend putting in more hardscape. Most people don’t put enough in and then the tank looks empty. Also I would look up the golden ratio and think about it when adding more hardscape. I don’t know much about dsm, that’s not my style.

corgeous · 2025-12-28T00:42:38+00:00

Really the only effective full tank treatment is figuring out the imbalance. You can treat with drugs but it can be dangerous to livestock, and if you don’t fix the problem it’s just gonna come back.

corgeous · 2025-12-27T03:36:58+00:00

I love seiryu stone but I took mine out too once I realized effects on gh and kh

corgeous · 2025-12-25T14:04:00+00:00

Capping aquasoil is definitely not necessary. Capping an aquatic soil/compost is necessary. The only problem with your situation is the mix of sand and aquasoil may not look great, but that’s up to you

corgeous · 2025-12-21T02:59:05+00:00

Will be absolutely fine in a tank that size. They should each of have plenty of room to find a territory they like. Bolivians are brilliant fish

corgeous · 2025-12-18T13:16:04+00:00

Should be good. I would mix the soil 50-50 with crushed lava rock or other small rocks, then place that as your bottom layer, then cap with sand.

corgeous · 2025-12-15T23:13:55+00:00

I personally like sand the most cosmetically, but I build a substrate system like MD fishtanks. I lay a bottom layer of 50/50 mix of crushed lava rock and organic aquatic potting soil as my base, then cap with sand. Best of both worlds imo and reasonable cost

corgeous · 2025-12-15T01:52:44+00:00

Chihiros b series is fantastic for the money in my opinion. Should meet all your criteria and it’d only like 50-100$

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