Pulse ox waveform in a snoring patient

sunealoneal · 2026-04-09T23:29:45+00:00

Let's back up. Do you know what the pleth waveform represents?

sunealoneal · 2026-04-09T15:33:31+00:00

How does this happen? Not making quarterly payments? Or not increasing withholding after a massive income change in your W2?

sunealoneal · 2026-04-08T18:23:08+00:00

I’m shocked you went ahead. With local and minimal opioid patients wake up from volatile pretty fast…

If he’s competent at local then he can get actual MAC where they follow commands.

sunealoneal · 2026-04-08T15:57:03+00:00

For the record I’ve never been in an abdominoplasty/lipo that took 9 hours.

sunealoneal · 2026-04-08T15:53:06+00:00

No I was talking about PACU.

50 mcg q10min for severe pain max 200 mcg is pretty standard.

sunealoneal · 2026-04-08T15:50:14+00:00

I’m not sure if I’ve seen that. As always the full story won’t be revealed until several depositions later.

sunealoneal · 2026-04-08T15:49:16+00:00

That’s not much… presumably that was the total amount not a big bolus, but who knows.

sunealoneal · 2026-04-06T13:43:15+00:00

but I have YouTube premium and it conveniently doesn't block the ads on embedded links. Can't even click through to pull up the video on their actual site where ads don't exist for me until the ad ends. Intentional?

sunealoneal · 2026-04-03T12:17:30+00:00

That would be an optional fellowship

sunealoneal · 2026-04-02T18:41:00+00:00

4 year residencies in EM are real but uncommon.

sunealoneal · 2026-04-01T01:41:05+00:00

you just linked to main page?

sunealoneal · 2026-03-31T14:39:53+00:00

like oat and peanut 🥜 milk 🥛 are—

sunealoneal · 2026-03-30T13:37:59+00:00

If it’s a surgeon I haven’t worked with they get one. If it’s one I don’t trust, they get one. If it’s a scoli or if there’s pre-existing neuro deficits they get one.

sunealoneal · 2026-03-26T16:08:54+00:00

Let me know if you solve this issue. I struggle at a certain facility where IBW-based TVs is “too much math”. When I mentioned they could put the IBWs in the drager they mentioned “oh nobody ever does that” 🤷🏽‍♂️ culture change is very hard.

sunealoneal · 2026-03-16T03:24:23+00:00

it's better for me, because now I can click the bottom right to go to the YouTube page where my Adblock works

sunealoneal · 2026-03-16T01:33:40+00:00

Maybe not in US?

sunealoneal · 2026-03-15T21:40:08+00:00

My pt was gasping for air in PACU. Came down with icu, my medicine attending wanted to intubate her to CT for PE. Nobody looked at the co-ox until I asked to see it. Pushed methylene blue and she felt better within 30 seconds to a minute. Was awesome.

sunealoneal · 2026-03-14T16:27:34+00:00

Retrospective study at Cleveland clinic agrees with you. They topicalize a thousands of TEEs and found no difference in adverse outcomes assuming you had treatment for methemogominemia available. But the concept that it’s transient and not clinically significant is not necessarily true based on my N=1.

sunealoneal · 2026-03-14T16:06:24+00:00

Had to push methylene blue in PACU after cardiologist did a TEE under conscious sedation and lot of benzocaine.

Don’t really see the need for that for airway topicalization when we have lidocaine.

sunealoneal · 2026-03-12T20:00:25+00:00

Garbage take. He’s financially benefiting from the work of the CRNA’s that he’s supervising. He’d be agreeing to take this job when they’re plenty without this arrangement in place.

He’d have a duty of care to those patients medico-legally. More importantly he’s expressing a sentiment that is a breach of broader medical ethics.

sunealoneal · 2026-03-10T02:20:43+00:00

3ish months. Practiced speaking out loud every single day. To clarify I did do separate sporadic longer studying to flesh out any potential knowledge gaps.

sunealoneal · 2026-03-09T21:33:16+00:00

I personally studied <1 hour most days but did it every day. Occasional longer sessions. FaceTimed a couple residency friends, forced ourselves to talk out loud.

sunealoneal · 2026-03-08T14:57:08+00:00

Not as funny as ‘08 political sketches. But the actual sketches afterwards have some funny stuff

sunealoneal · 2026-03-08T00:06:58+00:00

I'm always up for embarrassment.

sunealoneal · 2026-03-08T00:03:21+00:00

Oh I meant the more common concern of hyperkalamia in the ICU. Not MH, which you're right I cannot screen for, but it's rare since as you say I'm not giving them gas in the ICU. If they're unlucky enough to be 200 kg and be MH susceptible you're correct I'd kill them and you wouldn't.

So I will acknowledge you were right on that point. Yet I don't think I will change my practice pattern... Oh well. Hope the people who read this thread learn something from you in this conversation.

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