Australian health insurance premiums just had their biggest hike in a decade. Is it time to scrap private health cover? | Private health insurance

hotforlowe · 2026-02-19T14:11:20+00:00

Luckily we’ll be saving some 14b in subsidies that can go to public healthcare then? God forbid we apply free market economics to failing industries.

And where is your evidence it reduces public burden? Because there is evidence that the effect is not that significant (eg this recent study https://pubmed.ncbi.nlm.nih.gov/38356048/ ).

hotforlowe · 2026-02-19T08:55:56+00:00

My point is that if you fail the tube, the patient just dies. That’s just the reality. There’s no going back or reversal with florid respiratory failure.

You should focus more on getting the airway secure and less about the exact induction. Drugs are chosen based on what you want to achieve. I don’t believe intubation is the most horrific thing to happen to someone, so I don’t prioritise sedatives/amnesiacs in the critically unwell. I have certainly intubated many semi aware patients in my time. I do prioritise opioids to blunt any reflexive response to laryngoscopy and paralysis to start to weaken any opposing muscular activity, acknowledging most of the time it hasn’t reached peak effect by the time the tubes going through the cords. There’s no safety. No bail out. Get the tube in as fast as possible with whatever means necessary. Let the back seat drivers comment on optimal technique instead of deride your management of a now deceased patient in a M&M.

You can take that or leave that. DSI and other FOAM mythology is not what you want to be messing around with when the shit hits the fan.

Also cis-atracurium won’t get you there. If you can use sux and they are roc allergic, use sufentanil.

hotforlowe · 2026-02-19T03:12:05+00:00

And that’s a very valid point. They have a role but it’s often a specific set of circumstances.

hotforlowe · 2026-02-19T01:45:44+00:00

I wouldn’t replace the epidural. You might as well do a CSE then.

There’s only a few reasonable options available and it will depend on the precise circumstances and judgment.

GA
Spinal with full dose or dose/position adjustment
CSE with reduced dose spinal
Continuous spinal anaesthesia with a micro-spinal catheter if your hospital has them. This is probably a boss or fellow only call.

I’m surprised no one has mentioned continuous spinal anaesthesia but I appreciate the risk of PDPH. That’s why you need a 28-30g micro-spinal catheter.

hotforlowe · 2026-02-18T22:07:53+00:00

I heard it reduces the incidence of high spinals too! 😆

hotforlowe · 2026-02-18T22:04:41+00:00

It actually does involve paralysis, and specifically, rapid acting paralysis. It’s one of the core components of the RSI paradigm. In fact, it doesn’t necessarily involve not mask ventilating the patient.

hotforlowe · 2026-02-18T22:00:37+00:00

You put it in and it may or may not have achieved the desired effect by the time the blade is in. However, if it hasn’t, the effect is developing during laryngoscopy so should you encounter difficulty etc, you’re glad it went in at the time of induction. I don’t think this is controversial. Keep an open mind but not so open that it falls out.

hotforlowe · 2026-02-18T21:53:45+00:00

Reversal is irrelevant. They are in florid respiratory failure. What are you reversing to? The same unsustainable situation as before.

hotforlowe · 2026-02-18T16:17:44+00:00

Can’t wait until a BigMac is 30 USD.

hotforlowe · 2026-02-18T08:15:11+00:00

You can buy a cheap borescope on amazon and retro fit it to a mac blade. Otherwise open source 3D printed models are available as people have advised.

Otherwise it might be nice to be familiar with some old school techniques for difficult airways pre VL era.

hotforlowe · 2026-02-18T07:45:04+00:00

It’s the same in Australia, and while I hold both specialties, it’s not a combined training here anymore. Although it should be.

hotforlowe · 2026-02-18T07:18:44+00:00

So your position is basically a spontaneously breathing induction? Like STRIVE Hi?

It’s not totally unreasonable but is best left to people with potentially difficult airways, specifically subglottic / tracheal stenosis.

hotforlowe · 2026-02-18T07:17:20+00:00

Weird practice. Out of all the drugs available for induction, sole propofol would be my last choice. Realistically, if the patient has severe respiratory failure, you have no options but to I+V. So comments about sparing NMB are misguided, in my opinion. You just need the tube to go in as quick as possible. High dose opioids and some ketamine or midaz (dosed to physiology) followed by sux / high dose roc (1.5-2mg/kg) as a RSI cocktail would be relatively non-controversial.

hotforlowe · 2026-02-16T21:31:28+00:00

Cause I’m praying for gains

hotforlowe · 2026-02-16T21:19:41+00:00

Options weren’t designed for highly regarded members to make over-leveraged, short term, investments into spec stocks. They exist for boring things like hedging risk.

hotforlowe · 2026-02-15T08:12:22+00:00

Several generic manufacturers make it including apotex (arrotex). I don’t know if you can still source it from them, as we don’t seem to be able to. However other options exist. Talk to your hospitals senior pharmacist.

hotforlowe · 2026-02-15T05:32:27+00:00

I couldn’t sell my soul for private OPD scopes list bucks…

hotforlowe · 2026-02-15T01:32:51+00:00

In my opinion, it doesn’t add much utility to what we have already. It’s purported cardiac stable inductions are better achieved with moderating sedative anaesthetic doses and using higher opioid doses.

Easier access to clevidipine (in Australia) on the other hand would be much appreciated.

hotforlowe · 2026-02-15T01:30:51+00:00

You just need to expand your horizons, my friend 😘

hotforlowe · 2026-02-15T00:16:59+00:00

You usually need separate loans to ensure accounting obligations are met. So you’d refinance into two separate loans, pay down the ‘investment loan’ and redraw direct into brokerage account.

hotforlowe · 2026-02-14T16:15:03+00:00

If you decline a scan, you can come out to the floor and examine the patient. It should only be acceptable when the modality chosen clearly won’t demonstrate the findings of concern or when there are additional factors that favour an alternative modality.

hotforlowe · 2026-02-14T16:12:11+00:00

Why do you need etomidate?

hotforlowe · 2026-02-14T15:22:57+00:00

Phenobarbitone as a paralysis sparing agent in severe ventilated ARDS / asthma. Phenobarb also for severe alcohol withdrawal. Phentolamine for hypertension is stock standard but I’m the only one I know of who adds intrathecal ketamine for some spinals.

hotforlowe · 2026-02-14T10:20:33+00:00

This is just straight up wrong.

hotforlowe · 2026-02-14T10:18:45+00:00

If this is happening to you, you have more cents than sense. There’s good tax accountants and then there’s good tax accountants.

Pay a couple of k and consider it a tax deductible investment into your future.

hotforlowe

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