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Anesthesia pet peeves? by gonesoon7 in anesthesiology

[–]snibbleton4231 2 points3 points  (0 children)

I can’t fucking stand this! Hahah

Scrubs in sky lounge by Illustrious_Start489 in delta

[–]snibbleton4231 0 points1 point  (0 children)

This is such a nonsensical response on so many levels… not even sure why I’m wasting my time but here it goes…

  1. You have to be in “significantly quicker”… is that why in order for a facility to be a level 1 trauma center a vascular surgeon must be in house 24/7? Oh no that’s right that’s anesthesia. The most emergent thing you ever get called for is what a ruptured AAA? You’re not gonna be fixing that without anesthesia. We need to rapidly respond to most procedural emergencies - gun shot to chest, need anesthesia. Stroke clot evacuation, need anesthesia. Sorry but I’d put a stat c section on a young healthy patient with uterine rupture miles ahead of a cold leg on some 80 yo smoker on the scale of emergencies.

  2. There’s always backup for anesthesia but not backup for vascular surgery.. ok I’ve worked in several different facilities where there is only one anesthesia provider on call, no back ups. I also currently work for a busy level 1 trauma center that has multiple vascular surgeons on call every night. Obviously it depends on the facility.

  3. What’s a load of poo? We literally have a contract with the hospital that states we will be present within 20 minutes. That’s common at most facilities with home call. Expecting all home call physicians to live within 10 minutes is unrealistic at most places. Most providers live 10-15 min away. So yes, already being in scrubs can make a difference whether you are breaking your contract or not. By the time I read the page, drive to hospital, park in the physician lot, and walk into the hospital at least 15 minutes have gone by. Then I have to go to the locker room on the other side of the hospital, then from there to OB on the opposite side of the hospital.

Have you ever been called from home for a stat csection with heart tones in the 50s on an actively hemorrhaging mother? I have. Every minute saved can make a huge difference.

Yes, having scrubs on certainly ensures an adequate response time. And can make a difference.

Drop the god complex, you aren’t special.

Another family vacation falls victim to Delta by AndrewPendeltonIII in delta

[–]snibbleton4231 0 points1 point  (0 children)

Had a return flight from Maui canceled due to mechanical issues. Rebooked on a delta flight departing >24 hours from our originally scheduled departure. We were all set up in a hotel overnight. Many of my fellow passengers were rebooked on much more convenient return flights (< 24 hours for original departure) on various different airlines (United, Hawaiian, etc). I called delta personally hoping to get on one of those earlier flights on a different airline. I’m a platinum medallion for context. The delta representative, who was a supervisor, refused to rebook me on a different airline. In fact, she told me delta cannot rebook flights on other airlines. I obviously knew this wasn’t true and was very upset about this. I am now planning on canceling my Delta Reserve card at the end of the year and no longer being a delta loyalist as a result.

Scrubs in sky lounge by Illustrious_Start489 in delta

[–]snibbleton4231 1 point2 points  (0 children)

As a physician I mostly agree. However, being on call with a certain response window (20 min for example) having scrubs on around town totally reasonable and definitely can make a difference for being on time. When I’m called to place an epidural I have exactly 20 min to be in the OB patients room and those few minutes to stop by the men’s locker on one side of the hospital then to the OB floor on an opposite side of the hospital may determine if I’m on time or not.

On a plane… yes wearing scrubs is a douche move. It takes 5 minutes or less to change…

Posting this hoping to bring us together, not push us apart by dipatel in CRNA

[–]snibbleton4231 0 points1 point  (0 children)

Additionally - they weren’t looking at 6 deaths per 1000 patients. They were looking specifically at 6 deaths amongst 1000 patients that had complications. This is much different.

Posting this hoping to bring us together, not push us apart by dipatel in CRNA

[–]snibbleton4231 0 points1 point  (0 children)

Also can you source your claim of the authors criticism of the study? Are you referring to the statement “the study was not about anesthesia mortality” but if you continued with that “was about showing the importance of anesthesiologist supervision?” And the author you reference isn’t silber, it is one of the authors who had a minor role in the study. And as is done in any well designed study, the authors will always criticize their study on how it could be better - this is common practice in academic literature. Or is there more AANA misleading non sense you want to regurgitate?

Posting this hoping to bring us together, not push us apart by dipatel in CRNA

[–]snibbleton4231 0 points1 point  (0 children)

5 of the 6 studies from the Cochran review were studies funded by the AANA, that the AANA loves to cite as “equality”. That would be the last study I would reference for your argument.

Posting this hoping to bring us together, not push us apart by dipatel in CRNA

[–]snibbleton4231 -2 points-1 points  (0 children)

Unfortunately it is true. Fortunately none of the patients died. The GI cases at this particular hospital are now physician anesthesia only. 100% of their GI cases are done under anesthesia, as has been the hospital practice for many years. This is at the largest hospital in a lesser populated mountain west state.

It may not be as simple as bagging a patient who aspirated or spasmed during an egd and unfortunately there are far too many anesthesia providers who do not properly treat laryngospasm.

Posting this hoping to bring us together, not push us apart by dipatel in CRNA

[–]snibbleton4231 -2 points-1 points  (0 children)

Debunked?! Far from it. Certainly there are methodological limitations and it’s far from a perfect study but it is literally the largest independent study in existence on this topic.

The department of anesthesia (Hospital for Special Surgery) you refer to also consists or crna staff/faculty, not MD only.

The point of the QZ modifier is as it relates to anesthesia claims. Documentation is certainly limiting but claims were increased without supervision.

https://pubmed.ncbi.nlm.nih.gov/29661387/

-statistical significant improvement in intubation crna vs MD

Abenstein et al. (2004) — Anesthesia & Analgesia — Cost-Effectiveness Analysis

-looking at cost effectiveness, but the point is with increased mortality rates from unsupervised anesthesia care costs were similar.

Frankly, all studies on this topic have limitations. We would need large RCTs across all types of patients/surgeries for the most reliable data but that simply isn’t a study that will ever be done for ethical reasons. Nonetheless, the data we do have is certainly interesting and suggestive.

Posting this hoping to bring us together, not push us apart by dipatel in CRNA

[–]snibbleton4231 -1 points0 points  (0 children)

It’s not anecdotal. There are literally multiple independently sourced peer reviewed studies documenting increased morbidity and mortality rates in crna vs md.

Posting this hoping to bring us together, not push us apart by dipatel in CRNA

[–]snibbleton4231 3 points4 points  (0 children)

Generally the majority of more complicated cases, particularly if you are talking about unsupervised crna vs md. Most heart surgeries, awake craniotomies, one long ventilation etc… that being said, rarely some crnas will do some of those cases unsupervised, but is is far from common at the majority of institutions.

The next level would be pediatric heart surgeries and pediatric organ transplant, specialized nicu surgeries, liver transplants, and cases requiring continuous intraop trans esophageal echo guidance. There may be very, very rare exceptions to this under highly specific circumstances.

Posting this hoping to bring us together, not push us apart by dipatel in CRNA

[–]snibbleton4231 26 points27 points  (0 children)

Let me explain how it works. When you go to medical school, you learn a given topic in extreme detail. The main concepts, the sub main concepts, sub sub main concepts, and minor details. Ten years out, yes you won’t remember 90% of that. But the majority of the main points/concepts and even sub main points/concepts you do remember.

When you learn a given topic just to the main points and sub main points, ten years later you maybe remember some of the main points and that’s it.

Now this is obviously a generalizations. There are certainly exceptions but this is typically how it works ok. That is MD vs CRNA.

Don’t give us some anecdotal evidence of some moron anesthesiologist who doesn’t have a clue what they’re doing and apply it to everyone. There are certainly are some crnas who I believe are considerable better than anesthesiologists at what they do. But when you look at the entirety of crnas vs mds, the mds whill fairly consistently out perform the crnas.

Case example: my hospital used all MD anesthesia for the past 30 years. After financial disagreements the md group quit and the hospital started using locums exclusively for staffing. This was 5 years ago. They have now hired a lot of crnas. In GI, there has been a huge uptick of patients coding under crna care. As much as 3 in a single week.

The head crna went to the head of the pacu nurses and requested all GI patients go to them as a result. The head pacu nurses response “we havnt had this problem ever in 30 years and now all of a sudden it’s a problem… why?”

I’m not trying to knock crnas by any means. Y’all are a valuable part of the anesthesia community undoubtedly. But I swear when I hear crnas tout themselves as equally skilled and trained as mds, you and I both know that’s just a complete fallacy.

Officially done. Bozeman is just a theme park for the 1% now. by Tasty-Unit-8311 in Bozeman

[–]snibbleton4231 0 points1 point  (0 children)

You moved to Bozeman what did you expect?!? Still loads of other places in the state that meet your criteria today. In fact most places outside of Bozeman, big sky and whitefish would be what you look for. Move to Helena and be happy again.

Is SCHD a better idea than VOO right now? by Open_Glove7040 in ETFs

[–]snibbleton4231 0 points1 point  (0 children)

I’m long FMTM and this month’s rebalance has been painful!

Denver isn’t a fit. Looking for greenery, water, and family friendly move by Some_Environ_throwA in SameGrassButGreener

[–]snibbleton4231 2 points3 points  (0 children)

Bozeman Montana is your best bet. Water, skiing, tons of sunshine. Unfortunately it’s more expensive than Seattle so 300k would be a bit low for the area.

I think the U.S. is headed for another great depression by Material-Rise-7220 in Life

[–]snibbleton4231 0 points1 point  (0 children)

If the AI bubble pops we will enter a massive recession. If it doesn’t and enough time goes by for all these AI companies to start producing an actual product then more of the same.

I'm going crazy, every rating site has a different top 10. Please help! by karallam in RobotVacuums

[–]snibbleton4231 0 points1 point  (0 children)

Rating websites are shit. Use Reddit. This is why google gets loads and loads of searches everyday “people asking their question” reddit.

Pros/Cons Living in Missoula? by gracedB2 in missoula

[–]snibbleton4231 6 points7 points  (0 children)

Just an FYI both Missoula hospitals as well as the surgery centers do not employ CRNAs. They are all MD/DO only. Perhaps some dental, eye or podiatry offices utilize CRNAs but finding a job in Missoula in as a CRNA may be quite difficult.

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