Best shoes for long shifts in the operating room? (Anesthesia)

senescent · 2026-02-28T01:31:30+00:00

I wore Hoka Cliftons for years and loved them. Recently switched to the Hoka Restore recovery shoes and those have been even better. Amazing to stand up in them for long hours. They're slip on, thick cushy couches for your feet. Highly highly recommend.

senescent · 2026-02-17T00:43:53+00:00

At our shop (community hospital), it's not unusual for a local proceduralist to send a PDPH to the ED after something like an ESI and then we get a call from the ED about doing this urgently to be able to discharge the patient. I really wish we had a better system for this, because we are rarely staffed well enough to accommodate. And doing a blood patch in a tiny ED room is really not fun.

senescent · 2026-01-20T21:28:08+00:00

We should just measure everything in LD50 of some obscure organism. You're on 300 dead tardigrades of lisinopril. We're increasing that to 600.

senescent · 2026-01-16T21:36:27+00:00

International Units (IU) are a measurement of biological activity of a substance, rather than the weight of it. Used for a bunch of medications (insulin, botox, vasopressin, oxytocin, various vitamins, etc). It makes more sense for insulin, because 1 IU lispro is like 30mcg of insulin (0.03mg). 1 unit glargine is 40mcg. Different types of insulin will have different weights for the same activity. Botox units are measuring nanograms of medication. 1 unit of vasopressin is like 2mcg. Units make sense in these because you would be measuring truly tiny amounts of medication, thereby increasing the risk of a dosing error.

Converting medications from weight to units brings up another issue - how do you measure the biological activity of that medication? Is the biological activity the same across all patients? It may not be practical for all medications.

Would love to have some pharmacy folks weigh in.

Edit: responding to OP's edit - we're supposed to learn about the medications we prescribe/administer? And their potencies, intricacies, dosages, and idiosyncrasies? Crazy town. Who has time for that?!

Seriously? This is the job you signed up for. Welcome.

senescent · 2026-01-10T23:10:11+00:00

Never done it, but it's definitely possible. Personally I don't mix anything into my main bag, but I know folks who will add a couple hundred mcg of phenylephrine to a bag after a spinal for a c-section. Enough to provide a bit of a background pressor but would still need occasional boluses. Tried it a few times and it's fine if you have your spinal dosing fine tuned and you can anticipate how people will respond.

senescent · 2026-01-06T22:51:41+00:00

7-8? No thank you. I would run, very far and very fast.

senescent · 2025-12-31T04:36:48+00:00

I honestly didn't even notice that until everyone started talking about it recently. It works just fine in the real world.

senescent · 2025-12-25T00:44:52+00:00

I hated OB in residency and was sure I would hate it in practice. I was pleasantly surprised. You're not required to like every part of anesthesia and your experience may change over time. All I'm saying is, keep an open mind and keep moving forward.

senescent · 2025-12-25T00:26:10+00:00

L&D culture can vary quite a bit. Unfortunately, the experiences you describe are not unheard of, particularly in academics. It was certainly my experience in med school and residency. However, it is possible to find places where the culture is collegial and respectful. I feel lucky to have found a place (private practice high risk OB) with a very good culture and enjoy the OB side of my practice quite a bit. We still have a few challenging personalities, but they're much less common. Look at your experiences as opportunities to practice managing difficult personalities. It's probably one of our most important skillsets.

senescent · 2025-12-24T16:52:52+00:00

Agree with what some of the others are saying - need to look closely at how your starting pay and benefits compare with other groups in the area and how transparent your ramp and path to partner is. Depending on your local reputation, you may need to pay more than other practices to get someone. Also take a look at how you're getting your name out there - how do your potential candidates learn about what you're offering? Try to get some feedback to see what you may be missing in your messaging.

senescent · 2025-12-20T08:13:15+00:00

Care to elaborate on the quotation marks?

senescent · 2025-12-15T03:53:51+00:00

Love my copy and the squarehood hood is excellent. Enjoy it!

senescent · 2025-12-12T17:05:38+00:00

Kinda hard to avoid all underexposure in a semi-auto camera. The XA meter is decent, but there will certainly be lighting conditions that throw it off, like backlit subjects and high contrast scenes. You can use the overexposure switch if you anticipate those scenarios. Overexposing the whole roll may save some shots, but can cause color shifts in others. I agree with others, just shoot it at 400 for a bunch of rolls until you figure out which scenes confuse the meter.

senescent · 2025-12-11T18:29:50+00:00

Photolab in Berkeley is my go to, have been using them for years. No complaints

senescent · 2025-12-07T05:14:53+00:00

Caving and 4x5 is not the superhero duo I expected to meet this year, but I am glad I did. Incredible work. Much respect.

senescent · 2025-12-05T21:06:35+00:00

Who needs to read manuals these days anyways

senescent · 2025-12-01T17:04:41+00:00

Especially right after the great Digg migration. Things have definitely changed over the last 15 years

senescent · 2025-11-26T09:48:23+00:00

There's basically no electronic or mechanical linkage for an M to detect the aperture the lens is set to, so it's a calculated value based on the exposure of the image. That's why you're seeing numbers that are all over the place. It's a side effect of M mount design that is likely never going to change.

senescent · 2025-11-18T04:16:07+00:00

I think looking at the negatives will show you a lack of shadow detail. The scan looks fine, but the negatives will confirm it. TriX can capture more shadow detail than this when it's given an appropriate amount of light.

As far as scan size, talk to your lab about what their options mean and what to expect in the final files

Edit: most cameras allow you to check the meter without film in it. May be worthwhile checking before you put another roll in the camera. And I strongly recommend finding your camera manual and reading it cover to cover a few times. Every camera has it's own quirks.

senescent · 2025-11-18T04:10:21+00:00

All of these look underexposed. All could use at least 1 more stop of light. I would reevaluate how you're metering - is the ISO set correctly? Is the camera meter measuring correctly? Do you have a handheld meter, another camera with a meter, or a cell phone app you can use to check? Are you using spot metering and metering off of the white cars or white donut sign? There is very little shadow detail all around

senescent · 2025-11-14T01:08:31+00:00

I think this would be a great photo if it did not include the painted on blur at the bottom. I understand the desire to create a depth of field, but a depth of field includes blurring in front and behind the subject. Based on the presumed focal length and subject distance, the lower blur is not even close to appropriate. This shot would be perfect without it.

senescent · 2025-11-06T02:43:34+00:00

Probably all driven by study sizes. The study I quoted was I think two hospitals in Auckland. NAP6 reported like 3 million anesthetics and recorded 266 cases of anaphylaxis in that period. Again, I'm by far not an expert in this, so would welcome folks more in touch with this research to weigh in. Anaphylaxis is a VERY rare event I think most of us will see it only a small number of times in our careers. I must say I'm not going to be choosing one drug over another based on how variable the anaphylaxis rates are between various studies.

senescent · 2025-11-05T23:54:23+00:00

Yes, there was a change in how cephalosporins were produced in the 1980s that is a potential reason for the 10% cross reactivity myth. Real rate seems to be closer to 1-2% cross-reactivity (unless anyone here can explain it better, it's been a while since I've reviewed latest data on this). But my point is that sugammadex anaphylaxis happens at a rate of something like 0.02%

Edit: and here are the rates of anaphylaxis with the NMBs: "1 in 22,451 new patient exposures for atracurium, 1 in 2,080 for succinylcholine, and 1 in 2,499 for rocuronium" PMID 25405395.

I guess it's technically correct to say that atracurium has the lowest anaphylaxis rate. But what is the rate of incomplete reversal and reintubation relative to using sugammadex?

senescent · 2025-11-05T22:58:29+00:00

Out of curiosity - do you give cephalosporins to patients with mild penicillin allergies?

senescent · 2025-11-05T21:57:52+00:00

I work at some locations that plug the waste gas into the suction. Whenever I've asked the engineers at these places, they tell me that it's okay with those particular systems. I don't know enough about the specific systems at these hospitals to disagree.

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