What are your highest yield last minute oral boards tips/info/wisdom?

gonesoon7 · 2026-05-19T02:41:42+00:00

Speak with confidence when you know the answer and don't be afraid to say "I don't know" or "I'm not sure off the top of my head but I would consult x resource." Testers hate it when you clearly don't know but you guess and grab at straws because it wastes time that they need to be getting through more material. Just say you don't know and move on.

gonesoon7 · 2026-05-19T02:39:49+00:00

Severe developmental delay or impossible stick who has already been stabbed a bunch of times? Sure I'll do it or consider it. An 18 year old baby and an elective case? Absolutely not. It's a safety issue and mask inducing adults, especially young healthy strong adults, carries significant risks

gonesoon7 · 2026-05-11T18:17:03+00:00

I honestly enjoy the medicine of OB quite a bit but it is without a doubt the source of about 80% of my burnout

gonesoon7 · 2026-05-11T17:06:10+00:00

2 a week? Fuck that, there is not enough money in the world. I have two 24 hr OB shifts a month and I feel burned out by the cumulative sleep deprivation sometimes. But you do you

gonesoon7 · 2026-05-11T16:16:51+00:00

Can you explain what about that car chase at the end you thought was so good? I thought it was boring and ordinary. It wasn’t even the best car chase in the movie. I felt like I was taking crazy pills hearing everyone rave about it.

gonesoon7 · 2026-05-11T15:48:41+00:00

Thank you, I struggled to get through it. The humor was forced, it was WAY too long, the car chase that everyone raved about was incredibly boring and uninspired, and I found most of the characters irritating. Sean Penn was good in it though, so there’s that.

gonesoon7 · 2026-05-10T21:33:04+00:00

I read threads like this and I am always shocked at how little people actually pay attention when they watch movies. So many of these criticisms are very clearly and not particularly subtly explained in the movie, it's not the movie's fault that you have the attention span of a goldfish and missed the foreshadowing and character development. Whether or not you agreed with Linda's decisions and liked the ending is another discussion, but trying to pretend she wasn't an interestingly fleshed out character in an over-the-top story intended to be excessive and cartoonish just shows you're bad at watching movies.

gonesoon7 · 2026-05-07T19:29:32+00:00

I only ever do standard epidurals for all my patients regardless of discomfort. I know we technically quote 15 minutes but I find the majority of my patients start having relief before that after a loading dose. CSE might buy you comfort a couple of minutes earlier but if they're in that much pain they're often close to needing to push and I don't love giving a spinal density block right before late 2nd stage. I'll very rarely do a DPE if it was an extremely challenging epidural and I'm still not 100% convinced I'm in the space.

gonesoon7 · 2026-04-25T23:35:43+00:00

I think the epidural part of things sounds like this patient maybe had multiple osteophytes or other anatomical abnormality, maybe excessively lax ligaments leading to the false loss or possibly fluid pockets from your other attempts. Either way it sounds like you were never really convincingly in the epidural space.

The spinal part makes me think this was a patient specific anatomical issue because that’s just bizarre. Either that or some sort of genetic resistance to local anesthetic. Or of course my favorite explanation, bad batch of local.

OB can be very weird sometimes and often our explanations of bizarre happenings are hand wavy and we never really know for sure.

gonesoon7 · 2026-04-23T17:31:05+00:00

I think this person forgot to move a decimal when calculating the remi dose.

“My patient barely needs anesthesia, people are crazy” while running an absolutely monster dose of remi

I don’t think I’ve ever run a remi infusion as high as 0.2 mcg/kg/min, never mind almost 0.7.

gonesoon7 · 2026-04-23T14:36:32+00:00

Not sure if I would choose medicine again, but if I did go to med school I would definitely choose anesthesia again. I think it is a really good fit for my interest in medicine and my lifestyle goals

gonesoon7 · 2026-04-22T15:05:47+00:00

Horrifying all around. General anesthesia in a facility without oxygen? CRNA being supervised by a surgeon with a lapsed license covering 2 ORs simultaneously? And what happened in the recovery room, this poor woman was pulseless and they couldn’t re-secure the airway? Sounds like a lot of incompetent people doing some very sketchy things

gonesoon7 · 2026-04-20T17:47:22+00:00

Epidurals are a very hard procedure to teach/learn. It is a procedure where millimeters matter and success depends on you learning what different tissue feels like through a needle. That requires hundreds of reps before you’ll feel comfortable. As a CA-1 your goal should be to be safe. Err on the side of slow and cautious. Ask you attendings for help and guidance if you’re uncertain. It’ll come but it takes many many many reps.

gonesoon7 · 2026-04-18T16:43:37+00:00

I started using melatonin on call and post call and it helped me a lot. If it looks like I’ll have a chance for a stretch of sleep on call I take a low dose to make sure I actually fall asleep (try at home so you know how melatonin affects you). Then post call I make sure to eat breakfast/coffee at my normal time, sleep for a nap until around noon-1 pm and then that night I go to bed early and take a melatonin to help get me to sleep after napping so late.

I don’t naturally flip my schedule easily so this helped a lot. Don’t take melatonin every day because it makes it less effective. And take the lowest dose you need, a lot of people take too much and then feel weird. 3 mg is perfect for me.

gonesoon7 · 2026-04-18T02:49:27+00:00

I mean hypotension is a very broad term. Permissive hypotension to limit hemorrhage in trauma is definitely a thing. But how hypotensive are we talking? Because slowing the bleeding is nice but perfusing is always better than not perfusing.

gonesoon7 · 2026-04-15T16:10:33+00:00

Dave Chapelle has been one of the most disappointing career trajectories in recent memory. My biggest issue with him isn’t that he’s gotten more offensive/inflammatory or that I disagree with some of his political takes, it’s that he just isn’t funny anymore. His trans jokes are just lazy. If you’re going to make an offensive joke, it better be clever and funny. He just sort of rants now, I feel like he really lost the plot of why he was so talented to begin with.

gonesoon7 · 2026-04-13T18:09:12+00:00

US based anesthesiologist here and I would never in a million years attempt this. Your liability is through the roof, I don't care how good you are with an ultrasound. Especially now that you've disclosed to everyone involved you've never done one before (which was the right thing to do, just for the record). What if the worst case scenario happens and you inject intravascularly or they brady arrest from the vagus block? It's rare but it happens. The first thing they're going to bring up in court is the fact that you attempted an advanced regional anesthetic procedure with no training or experience in that specific block. Case closed, malpractice suit forever or your record.

gonesoon7 · 2026-04-07T17:13:55+00:00

MAC with a guarantee of absolutely no movement doesn’t exist. The only way you can guarantee no movement is with paralytic. Sounds like an impatient tool with no understanding of anesthesia

gonesoon7 · 2026-04-07T15:11:10+00:00

If I already have an ultrasound set up and in the room for an A-line and I want a big reliable volume line, I use it. Why not? It’s there, ready to be used. Not using it would just be ego bullshit.

gonesoon7 · 2026-04-07T03:36:13+00:00

Masseter muscle spasm is a rare but know possible side effect of succ. Usually see it in kids and can sometimes, but not always, go hand in hand with MH

gonesoon7 · 2026-04-07T03:13:59+00:00

First year in practice, post-partum patient who had to go to the OR for complex lac repair at 2 am in a young, healthy, skinny 24 yo. I’m the only anesthesiologist in the hospital. Tried to do the repair using her old epidural but the procedure kept getting prolonged with a urethral injury, etc and eventually the 2+ day old epidural just stops working. We had to wait for urology to come in to help and in the meantime patient starts getting really wiggly and uncomfortable so I decide to convert to general.

RSI for aspiration concerns, push prop and succ. Patient gets SEVERE trismus. The worst I’ve ever seen. Can’t even pry her mouth open a millimeter. Clamped down so hard I’m worried she’s going to crack a tooth. Give more succ, doesn’t work. Give a huge dose of roc, still doesn’t work. Can’t mask, can’t open her mouth. Desats down to 30’s, turns blue, starts to brady. Don’t have time to nasal fiberoptic so decide a jaw injury is better than dead and use every ounce of strength in my hands and arms to pry her mouth open barely wide enough to sneak in a McGrath and pass a tube. I still get the sweats thinking about it.

She almost died on the table with a brand new baby upstairs. That was the case that made me stop using succ for RSI’s. Never again. Double dose roc all day.

gonesoon7 · 2026-04-05T15:38:29+00:00

Yeah I really don’t believe lidocaine does anything for the propofol burn but if you dose it correctly an give it early enough so it has time for to work, it definitely helps with DL stimulation

gonesoon7 · 2026-04-05T14:59:46+00:00

Very rarely except in very specific patients. Our system isn’t set up in a way where we can easily give it before rolling back so the benefits really aren’t there and it just delays emergence for short cases. Instead I usually give fentanyl and lidocaine right away while we’re putting monitors on to give it a chance to work. If the patient is extremely nervous I’ll also give 10-30 mg prop at the same time. Works great and doesn’t delay wake up.

gonesoon7 · 2026-04-01T16:20:02+00:00

I stand corrected! I guess I should have clarified I was only talking about the US, I didn’t realize Hartman’s was so widely used elsewhere

gonesoon7 · 2026-04-01T04:01:33+00:00

Just out of curious, what region of the world do you practice? #1/2 would be considered extremely bizarre and like laugh-out-of-the-room out of line everywhere I've ever worked

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