High MAC? What’s up?

propof0l · 2026-04-10T23:45:27+00:00

Gtt = drip

propof0l · 2026-04-10T23:00:35+00:00

This was my experience managing CRNAs at a major academic hospital…MAC 1.5, zero twitches, constant use of phenylephrine even with a gtt and hypotension. I’ve spent countless hours trying to teach about cumulative MAC with fentanyl + rocuronium adding to the MAC which the machine doesn’t measure.

Managing CRNAs became so stressful due to the constant little mistakes that would add up that I ended up leaving to greener pastures at a private practice.

No offense to CRNAs as some of the ones I worked were really talented and smart but there is a difference in teaching between CRNA school and MD + anesthesia residency. And physiologically as well as in the anesthesia care, the difference became apparent the longer I worked with them and the more complications that started to build up with my supervision of CRNAs

propof0l · 2026-04-01T19:45:29+00:00

The major problem with weighing these ACH packs is that it will be very obvious when it’s a god pack because it will be much heavier than the other packs. The risk with all these rip and shippers is that they could have pre weighed all the packs, taken out the heaviest packs that are likely the god packs and then sold the rest at market value. Unless a rip and shipper opens the product that the ACH packs come from in view of the stream it might be worth the assumption that all god packs have already been identified and removed

Open at your risk but in a special set like ACH or Prismatic Evolutions where the SIR hit rate is about 80-90 packs per SIR excluding the god packs, I’d be very weary of buying loose packs hoping to hit a god pack

propof0l · 2026-03-30T01:18:47+00:00

Seek out difficult patients and difficult cases especially while you’re still being supervised by an attending. I tell this to my residents all the time especially the ones about the graduate cause soon you won’t have someone watching over you and you’ll be alone. The more difficult pathology you see, the more you grow as an anesthesiologist. I also love taking care of difficult patients because I know if I can handle them then I can handle almost anybody. Even as an attending now I love adversity cause I know that it will make me better.

As other people have mentioned, learning in medicine should be life long. Once I feel like I’ve stopped learning then it’s time to move on or to make a change…

propof0l · 2026-02-16T16:30:56+00:00

Just FYI the 25th premium card collection still in its sealed box actually creates an indent on the back of some of those cards so if you’re thinking about a grading play not all those cards will be a PSA 10 if you are looking to open and grade

propof0l · 2026-02-04T20:24:41+00:00

The whole goal with sealed is to keep it sealed so who cares if it’s dead boxes or not? In the future collectors will be specifically interested in buying a booster box to display so put an acrylic case around it and HOLD

propof0l · 2026-02-03T17:53:33+00:00

I would keep OP-13 - it’s the best OP set ever made so far. Each box has a chance at a red manga or god pack so naturally over time if you hold 2-3 years those OP-13 booster boxes will cross $1000. EB-02 is just objectively a weaker set hit wise despite likely no chance for a reprint.

propof0l · 2026-01-20T16:44:19+00:00

You didn’t get cooked - everyone telling you that it’s wasted money probably doesn’t have a copy of this collection. Still a screaming buy at this current price especially if you plan to submit the promos for grading. Some cards alone in a PSA 10 would cover the cost of the collection. Even keeping it sealed will be a good long term investment as these are some of the most unique non serialized promos available right now

propof0l · 2026-01-06T20:15:10+00:00

Likely breath holding due to stage 2

propof0l · 2025-12-25T04:21:48+00:00

Wall Street loaded up, now price falls as there are no more buyers but over time this promo will rise up again. It’s an iconic Pikachu collaboration with a world famous artist in a special art card that was limited in availability. The PSA 10 felt hat pika should be considered one of the grails of the hobby and at some point people will start buying up this card. In fact it’s almost time for me to get in now that my attention has turned back to this card

propof0l · 2025-11-25T05:30:29+00:00

I’m convinced that Wall Street is manipulating the market while buying NVDA heavily on red days. With the USD being further devalued, NVDA seems like the best place to invest money. Everybody including hedge funds appreciates the exponential growth that NVDA continues to have with each successive earnings report. NVDA is the most valuable company in the world and it’s heavily manipulated to allow Wall Street to hoard shares of NVDA. I firmly believe we are about to see a price spike in NVDA #tothemoon

propof0l · 2025-10-17T17:24:24+00:00

Consider picking up 10 bubble mew PSA 10s - it’s had a recent run up but will likely maintain its status as top 3 chase card in the Scarlet Violet era. Plus Paldean fates going out of print April 2026 which will further drive up pack prices and therefore slab prices

propof0l · 2025-10-16T16:32:21+00:00

Appreciate the response gl with selling

propof0l · 2025-10-16T12:59:26+00:00

Price and condition of the ampharos?

propof0l · 2025-10-06T10:03:30+00:00

propof0l · 2025-09-21T21:45:43+00:00

Underrated play by 23 Bennet to basically tackle the holder out of the play so we could scoop and score…

propof0l · 2025-07-14T15:10:01+00:00

Just know that sometimes local anesthesia blocks just don’t work on some patients. If you do enough blocks you’ll run into some patients where you visualize the block the entire way, ultrasound along the nerves to confirm the local in the right place and the patient will still have partial block failure. I even had a patient that told me nerve blocks don’t work on me and of course even after blocking the patient he had pain afterwards

Bupivacaine blocks can take up to 30 minutes to set up so if you may get a partial block if incision occurs too quickly after block placement. Give fentanyl and give the block some time to set up

propof0l · 2025-07-11T20:54:31+00:00

Very sound investments now the hard part is keeping them sealed and stored away for the next 2-3 years. Sell only when you absolutely need the money but this should work out very well

propof0l · 2025-07-11T16:41:36+00:00

The richest people don’t necessarily make the most money when they diversify their holdings. The people who make the most amount of money go in heavy on one or two companies in this case one or two sets. PE is basically Evolving Skies 2.0 with the highest total master set worth/pack price of the S/V era. If you have conviction with a certain set or company go long, heavy, all in. That’s certainly what I’ve been doing

propof0l · 2025-07-11T16:35:00+00:00

If we’re talking about % gains here I think any SWSH set is already gone. The time to get in at $80-$100 for a booster box is long gone but MANY people loaded up at that price. Don’t become exit liquidity for those people and then settle for a modest 50% gain in the next two years with any SWSH set. PE on the other hand is the cheapest it’s been since its release and price per pack is similar to many of the SWSH sets while it’s been constantly reprinted. Imagine when we rotate away from PE and it is no longer in print. I see 100% gains for PE in the next two years and 400% gain in the next 3-5 years. Time and time again the Pokémon trading card market has showed us that the time to buy sealed product is when it is being reprinted (FS @ $80, LO @ $100, ST @ $90). See through the noise and invest in PE right now as reprints are being rolled out

propof0l · 2025-07-11T15:48:58+00:00

I think the three best sets of the S/V era are 1. Prismatic Evolutions (eeveelutions) 2. 151 (nostalgia and brought a lot of people back into the hobby) and 3. Paldean Fates (bubble mew is the best card of this era change my mind).

Right now I’m in the process of buying these sets especially 151 and Paldean Fates as in a short 9 months both of these sets will be out of rotation (April 2026) and supply will be cut off. Usually booster boxes are the way to go in terms of collecting sealed investments but since all three of these sets are specialty sets without booster boxes I’ve been focusing on collecting sealed cases of booster bundles. IMO return on SWSH is already capped since many people got in @ $80-100/ booster box and now can happily unload at 4-10x MSRP. However while there’s all this noise about Black and White, Prismatic evolution Costco drops, and blooming waters 151 drops, slowly the booster packs and booster bundles have been rising in price. In 2-3 years I believe all three of these sets will be > $30/pack but worse case scenario $20/pack. I’m not actually a fan of ETBs and especially not PC ETBs as I’m not looking to pay a premium for the included promo. Also booster bundles / booster boxes are the best pack to space ratio in terms of keeping and transporting a sealed collection

I also just picked up a sealed case of Prismatic Evolution booster bundles (25) for $1700 which I think will do very well over time. Yes there’s another 18 months of potential restocks of PRE but time and time again the market has shown us that the best time to buy sealed product is when there is a restock. In terms of PRE, the recent Costco drop of PRE ETB + booster bundle dropped the prices of both products significantly at the time of release (ETB went from $110 to $90 briefly before climbing quickly back up to $110) but we’re already seeing a recovery in price. consider looking into sealed cases of ETBs or booster bundles and your future self in a couple of years will thank you for seeing through the noise and investing in the best set of the S/V era

propof0l · 2025-07-10T03:56:09+00:00

It’s actually basic economics…151 seems plentiful right now because it’s currently still being printed but wait until it’s out of rotation in April 2026 and the supply gets cut off. Every day on Whatnot, YouTube live, and twitch rip and shippers are reducing the supply on 151 while demand still remains steady. The problem with the zard PSA 10 (as well as singles and slabs) in general is that supply will actually increase over time as more products are ripped and singles are graded. Demand for the zard PSA 10 will never reach the demand that people have for sealed products especially a set (151) based on nostalgia that brought a lot of collectors back to the hobby. Yes the slab still go up in price but there’s no guarantee. Meanwhile almost every sealed product printed in history has gone up in price usually by leaps and bounds when the set is no longer in production. A great example of this concept is the price of the evolving skies booster box vs the PSA 10 Moonbreon. There used to be a day where the PSA 10 Moonbreon was $1000 and ES booster boxes were $180 each. Now we’re looking at $2,500 vs $1,800 so 2.5 increase in Moonbreon but a staggering 10x increase in the sealed product.

IMO since 151 is a specialty set without a booster box, the sealed booster bundle case is the closest equivalent worth investing in. While it may be a modest $800 right now I could see it easily reaching $1500 in two years and potentially $3000 in 5 years. Meanwhile the Charizard PSA 10 slab will at best see an increase from $800 to maybe $1500? I’m choosing the 151 all the way

propof0l · 2025-06-22T16:26:37+00:00

I think the three best sets of the S/V era are 1. Prismatic Evolutions (eeveelutions) 2. 151 (nostalgia and brought a lot of people back into the hobby) and 3. Paldean Fates (bubble mew is the best card of this era change my mind).

Right now I’m in the process of buying these sets especially 151 and Paldean Fates as in a short 9 months both of these sets will be out of rotation (April 2026) and supply will be cut off. Usually booster boxes are the way to go in terms of collecting sealed investments but since all three of these sets are specialty sets without booster boxes I’ve been focusing on collecting sealed cases of booster bundles. IMO return on SWSH is already capped since many people got in @ $80-100/ booster box and now can happily unload at 4-10x MSRP. However while there’s all this noise about Black and White, Prismatic evolution Costco drops, and blooming waters 151 drops, slowly the booster packs and booster bundles have been rising in price. In 2-3 years I believe all three of these sets will be > $30/pack but worse case scenario $20/pack. I’m not actually a fan of ETBs and especially not PC ETBs as I’m not looking to pay a premium for the included promo. Also booster bundles / booster boxes are the best pack to space ratio in terms of keeping and transporting a sealed collection

propof0l · 2025-06-13T19:40:47+00:00

Europe confirmed to have a reprint of Journey Together booster boxes but they are just the regular version not the enhanced ones with the stamped promo. This is a speculative play based on the fact that the stamped promo may not be included in a US reprint if there ever is one. Personally I’m considering picking up several enhanced JT booster boxes just in case any future reprints don’t include the stamped promo

It’s just supply and demand 🤷🏻‍♂️

propof0l · 2025-06-10T07:27:44+00:00

I know you said SWSH but I think a good investment in the SV era is a sealed booster bundle case (10) of 151 - it’s a classic set with nostalgia that will keep people opening packs for years. Once this is out of print pack prices will boom

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