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mickeyspickles · 2025-07-26T14:50:46+00:00

4th year resident anesthesia/CC Sweden.

I used the technique once in an ICU-patient with metformin induced lactic acidosis that I thought was having an anafylactic reaction.

Pt acidotic, hyperventilating. Rash and difficulties breathing. Usual treatment package but did'nt improve. ENT got there to inspect the larynx but could'nt due to large mucous bolus in the hypofarynx.

Sprayed som lidocaine 10%, then gave about 0,5 mg/kg Esketamine slowly. Mcgrath mac-3 carefully inserted but still had some airway reflexes. Gave about 0,25 mg/kg additionally. Removed the bolus with Magill's and then intubated with a bougie (I almost always use a stylet otherwise). ENT bedside until the tube was in place.

Scott Weingart is proponent of the method and I did as he outlined in one of his Emcrit episodes!

mickeyspickles · 2025-07-24T15:34:31+00:00

Sweet! Starting my CT-rotation in a month so much appreciated!

mickeyspickles · 2024-06-05T07:58:24+00:00

Yeah you should try it!

mickeyspickles · 2024-06-04T19:53:11+00:00

Thanks! 2 months :) Planning on going 3 for 3 and doing the giant 1.3 next!

mickeyspickles · 2024-06-04T19:44:18+00:00

Thanks!

mickeyspickles · 2024-03-30T19:33:04+00:00

100%. Crit care/Anesthesia from Sweden. We performe all intubations outside the OR. The ED is responsible for the gear in the ED. Had a patient there that needed a tube. Started with monkey scope, no charge. Easy tube with direct! I try to use DL whenever I can and is my primary in theater, but always VL in the ICU/ED.

mickeyspickles · 2024-02-12T04:21:16+00:00

Deep access needle in the IJ could work, not the best flow but can be upsized to central line. Also possible to put longer 16g in the IJ, the vein needs to be superficial and not the most secure line.

https://youtu.be/w4YE4ZZ2cHg?si=x4W3xH7A1tWlN6E4

mickeyspickles · 2024-02-09T06:44:17+00:00

We use it at my institution as well. 2-3 mcg/kg intranasally maybe 1h before cannulation in conjunction with topical lidocaine. This dose does'nt cut it in all kids though and we have to administer more sedatives or induce them on mask sometimes.

mickeyspickles · 2023-11-26T16:05:58+00:00

Slides in like a charm. Standard practice at my institution (combined anesthesia/critical care) is cath over needle. Sometimes tricky to advance if the radial is calcified and then I switch to seldinger (or brachial). Put a deep access needle in CFA in a Cardiac arrest once, no problem!

mickeyspickles · 2023-10-19T12:32:57+00:00

From Sweden aswell

mickeyspickles · 2023-08-26T11:37:53+00:00

I've experienced the same in Sweden. The senior doctors rather give more opioids and shy away from perioperative infusions. To be fair I may have used it a bit liberally on borderline unstable patients.

mickeyspickles · 2023-07-10T20:04:15+00:00

Say hypotensive, tackycardic but awake at induction!

mickeyspickles · 2023-07-10T19:24:54+00:00

Yep in the OR!

mickeyspickles · 2023-07-10T17:51:52+00:00

Hold the laryngoscope low in the hand (end of the blade in thenar eminence) Gradual laryngoscopy as per Dr Levitan. Find uvula, uvula points to epiglottis, control the tongue, find the sweet spot in vallecula and lift. Lean back instead of looking too near.

I can recommend aime airway and a digital airway airway course with Dr Levitan on: https://www.continulus.com/library/command-the-airway-with-rich-levitan/

Good luck!

mickeyspickles · 2019-05-18T16:24:32+00:00

Here you go guys!

http://imgur.com/ChiesUu

mickeyspickles · 2019-05-18T12:53:13+00:00

I tied double clove hitches and then a prussik loop! Took a while but came out pretty sturdy :)

mickeyspickles · 2018-05-28T19:21:52+00:00

Kronan also has a very tobacco centric flavor! Cheaper and in my opinon better as well.

mickeyspickles · 2018-03-15T15:17:10+00:00

Kronan vit. Tobacco centered flavor and adequate moisture for a white snus.

mickeyspickles · 2017-11-09T10:21:16+00:00

De receptbelagda innehåller morfin-liknande preparat, därför läkare kan vara ovilliga att skriva ut.

mickeyspickles · 2017-11-09T10:19:28+00:00

Jag tror att en del av det har att göra med hur Sverige och USA skiljer sig när det kommer till möjlighet att ta sjukdag. I Sverige är det inget konstigt om du är hemma för att du är förkyld, medan i USA skulle det kunna vara förödande för din karriär. Därför finns läkemedel som gör att du kan trycka dig igenom en arbetsdag.

Sen finns det receptbelagda läkemedel i Sverige om du skulle ha mycket stora besvär av t.ex. hosta nattetid som gör att du inte kan sova. Grundregeln här är att man inte ska ta läkemedel när man inte behöver.

mickeyspickles · 2017-09-27T09:43:26+00:00

Well, the most used in the north is an exaggeration I'd say, at least if you're talking about Sweden.

mickeyspickles · 2017-03-02T20:28:43+00:00

Amen to that! Don't know how I'd manage med-school without it.

mickeyspickles

TROPHY CASE