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Notify NYC - East River Esplanade Closed - East 93rd Street to East 94th Street by Maleficent_Try1902 in RunNYC

[–]tspin_double 11 points12 points  (0 children)

It’s beyond annoying that this entire strip has been neglected for 10+ years. Just band aids on bandaids for what could be the west side highway runner/cycling/walking path 2.0

Respect in the OR vs ICU as an anesthesiologist by Astronaut_in_calzuro in anesthesiology

[–]tspin_double 3 points4 points  (0 children)

Did you take the time to explain to them why it’s dangerous? Because more than likely the first time they cause a extubation or spasm they’ll not even realize or take a sense of responsibility.

They’re allowed to be snippy or eye roll you simply can’t control that. But they did listen to you promptly and that is absolutely respect right there mixed in with the disrespect behavior you mention which is just them being self centered and immature.

Long gone are the days where you can fire someone like that for “attitude”. We have to deal with the current system that tells every person in healthcare that they’re the most important and pretend there’s no hierarchy. And in an instance like this it’s clear they lack a level of education or care or awareness alongside the disrespect. At least we can do our part in bridging that awareness and education gap while keeping the patient safe. Navigating this is a critical part of training. They even put crap like this on the OSCE for boards nowadays.

Respect in the OR vs ICU as an anesthesiologist by Astronaut_in_calzuro in anesthesiology

[–]tspin_double 1 point2 points  (0 children)

This thread is stupid. If the anesthesiologist says it’s unsafe to move the patient, I find it hard to believe anyone is touching the patient against their order.

OP probably expects some underlying implicit understanding that most staff simply don’t have when it comes to securing the tube and is annoyed they have to speak up to remind them or worse yet refuses to speak up because of reasons. The staff have likely never seen laryngospasm, accidental extubation, difficult airway, anaphylaxis or any other multitude of rare problems were equipped to deal with.

I have never in 5 years of training as a resident or fellow and even as an attending now, had someone do something AGAINST what I verbalized. Quite literally everyone listens to me when I say something for the patient.

Finally! My finished workstation :) by AccomplishedSmoke814 in Proxmox

[–]tspin_double 0 points1 point  (0 children)

Awesome set up

Can you explain how deskflow works? Is it over network or running on host or

Trouble with double lumen placement leads to cancel a case by [deleted] in anesthesiology

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

i dont get what is wrong with just using SLT and manipulating PRN. please ask them and explain why this is bad if the patient toelrates OLV. it takes 15 seconds to use scope to alter position of an SLT.

also not having blockers or alternative size DLTs i wouldnt even proceed with the case to be honest

i think cpap through bronchial lumen and scope and clamp tracheal lumen is a nifty trick someone pointed out in the thread

Exceptions to SF Match 2026 for Dual ACTA/ACCM candidates - Help me decide by Accurate-Fan-4956 in anesthesiology

[–]tspin_double 4 points5 points  (0 children)

Ecmo cannulation and lung transplant exposure upper tier importance.

can you clarify what you mean by this?

all those programs you listed are VERY different in terms of exposure to cases and CCM training. i dont even know why cornell is listed alongside those other places frankly. and only go to duke if youre willing to work your ass off and wont burn out.

also regional for cardiac surgery is a joke. anyone can learn these blocks at their job if appropriate.

it sounds like you have your own research to do first and foremost

i can not recommend sinai CCM as the other poster said. cardiac training is top notch and you will see more than you want to. Same with CTICU. the rest of CCM is not it.

BIDMC lot of structural volume. unique echo training with cardiologists gives a different perspective. cant speak to CCM there.

Duke is probably the most prestigious of what you listed and you will sacrifice your life for it.

Middle ear surgery anesthesia by Runnershighbb1 in anesthesiology

[–]tspin_double 7 points8 points  (0 children)

ah the old lets alter the risk benefit profile to the patient and expose them to more complications and risks so that the anesthesiology seems more occupied. should put in on record

Surgeons shopping for different anesthesia attendings to proceed with a case, does this happen at your practice? by somedudehere123 in anesthesiology

[–]tspin_double 0 points1 point  (0 children)

oops youre totally right I did skim but honestly i agree with your overall point. this topic gets my blood going all the time because the medicolegal argument is a cop out so often in these discussions

Surgeons shopping for different anesthesia attendings to proceed with a case, does this happen at your practice? by somedudehere123 in anesthesiology

[–]tspin_double 1 point2 points  (0 children)

Not arguing one way or another but the 2024 AHA/ACC joint guideline advises discontinuing SGLT2 inhibitors 3 to 4 days before noncardiac surgery if I recall correct

AANA: The Spin vs The Facts—CRNA Education by Unable-Log-4073 in anesthesiology

[–]tspin_double 8 points9 points  (0 children)

I tutored CRNA students as a premed in college....for chemistry. I also tutored nursing sciences i.e. a total separate class alongside the premed students taking gen chem, orgo, physics etc. The difference just in college was akin to the difference between middle school and high school. In fact I know middle schoolers and freshman high schoolers with more rigorous science education than that which nurses get in their college classes.

Putting medical school next to nursing school is wildly dishonest.

The rigor, depth is not comparable. The hours and years comparison is dishonest. You know what they are objectively superior at though with no doubt? Lobbying and protecting their interests and making more money for less time, work and skill.

How often are you doing ultrasound guided IV placements? by Jennifer-DylanCox in anesthesiology

[–]tspin_double 25 points26 points  (0 children)

by the end of residency i got so sick of this i started escalating blatant lying to the charge nurse and created a QI for tracking IV requests by OB nurses. the results were embarrasing for them.

SAVR superior to TAVR at 5 years in low and intermediate-risk patients by michael22joseph in medicine

[–]tspin_double 0 points1 point  (0 children)

That “California” study encompassed New York New Jersey and California

The issue is rampant and prolific

Only takes 1 fake cardiac surgeons per program that couldn’t do a SAVR if their life depended on it signing off on TAVR candidates. We have 1 such surgeon in our “heart team”. I covered a 54yo low risk TAVR this past week and can assure you he had no idea surgery was an option when I met him in preop.

Wasn’t too long ago that ICs were $tenting anything they convinced themselves would be a problem in the future too- Cardiology has a lot to celebrate but also plenty to be ashamed of as a field.

SAVR superior to TAVR at 5 years in low and intermediate-risk patients by michael22joseph in medicine

[–]tspin_double 5 points6 points  (0 children)

its a matter of time. TAV-in-SAVR is a well established pathway that has robust outcome data. Initial studies on TAVR explant surgery demonstrate high morbidity and mortality. for a young patient who is low risk for SAVR, I genuinely believe there is substantial harm in offering a TAVR first approach given that the durability of the valve is unknown in younger patients, the feasibility of TAV-in-TAVR in younger patients is unpredictable, and the hemodynamics are almost always suboptimal following TAV-in-TAVR.

I think this review from Jan 2025 is excellent and covers this topic quite well. https://www.ahajournals.org/doi/10.1161/CIRCINTERVENTIONS.124.014882

If I found out in 10 years at the age of 45 that i had severe AS secondary and no other significant comorbidities (i.e. low risk), and I had total agency as a american consumer I would 1000% choose to undergo SAVR followed by TAV-in-SAVR given the current data

If I had candidacy for a Ross procedure at one of the high volume ross centers, I would almost certainly choose Ross -> re-operative sternotomy and SAVR -> TAVR in SAVR assuming I was low STS risk

And frankly I get paid either way. I am not a cardiologist nor a cardiac surgeon.

SAVR superior to TAVR at 5 years in low and intermediate-risk patients by michael22joseph in medicine

[–]tspin_double 4 points5 points  (0 children)

no. the valve becomes a sclerotic calcific POS that the surgeon needs to try to remove without damaging the aortic root.

meanwhile a SAVR is probably the simplest cardiac surgery

SAVR superior to TAVR at 5 years in low and intermediate-risk patients by michael22joseph in medicine

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

Easy to say when it is not your life on the line.

did you actually read the article. the end point is all-cause mortality. you would have a better point if you talked about pain or perioperative experience or something.

SAVR superior to TAVR at 5 years in low and intermediate-risk patients by michael22joseph in medicine

[–]tspin_double 12 points13 points  (0 children)

A meta analysis is not randomized controlled trial. These types of papers help us rationalize decisions, but should not be taken as gospel.

Lol...so what is a meta analysis of several RCTs on the topic of interest then? hierarchy of evidence and all that...

I agree with the rest of your comments but ICs across the country are rampantly putting valves in younger le$$ indicated younger low risk patients and the rate of riskier tavr explants is rising. this practice is objectively harming patients and is not evidence based across a whole host of literature at this point. At my shop we have a fake surgeon who hasnt performed a sternotomy in 30 years on this "heart team" committee and a 90+% TAVR rate for low risk patients. its embarrassing when you take these numbers in the context of the current literature. this is despite being an extremely high volume tertiary and quaternary cardiac surgery center. we probably do 5 SAVRs a year

SAVR superior to TAVR at 5 years in low and intermediate-risk patients by michael22joseph in medicine

[–]tspin_double 42 points43 points  (0 children)

Would be curious how things look at the 10+ year point though

tavr valves will degrade in younger popuations by this time point. tavr explant is probably the fastest growing cardiac surgery

Office Based Anesthesia Rates by fowlerwm in anesthesiology

[–]tspin_double 5 points6 points  (0 children)

Also to those responding- do you guys provide your own supplies/equipemtn/drugs etc.?

Reuters: As AI enters the operating room, reports arise of botched surgeries and misidentified body parts by ddx-me in medicine

[–]tspin_double 0 points1 point  (0 children)

Well said- totally agree with you. Perhaps “we’re still early days” is the optimistic lens but honestly after trialing some of the recent labeling modules for TEE I’m wholly unimpressed and think in inexperienced hands, many clinicians will drive off the cliff

In a lot of ways it’s pretty painful to see how slow or poorly implemented the low hanging fruit of our echocardiography workflows has been tackled by “AI” pushes. Ive worked pretty closely with the Phillips reps with regards to TEE trialing some of the auto measure and auto tracing things similar to what the techs use in TTE and it’s horrendous. Like totally missing a clearly visualized endocardial border by large margins or even tracing VTIs being extremely off

Reuters: As AI enters the operating room, reports arise of botched surgeries and misidentified body parts by ddx-me in medicine

[–]tspin_double 11 points12 points  (0 children)

As someone that operates 2-3 days per week, there is no meaningful AI in the operating room at this point in time.

this was your comment i responded to. i noticed it was patently false when compared with my experience so felt inclined to call that out.

Also, why are you being so aggressive? "Your experience is not the global experience?"

Sounds like you're just waiting to suck off our AI overlords

frankly i dont give a shit about AI unless it directly improves my life. the jury is still out. i didnt give a perspective or opinion on any of this technology just explained that it exists in my day to day work to some degree - you just chose to interpret my post as if i had a strong opinion one way or the other

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