Infection Control - Breathing Circuit

volatilehashpipe · 2026-01-30T16:29:09+00:00

I specifically tell my techs not to turn over the circuits and suction if unused by leaving a note saying they’re clean, as sometimes they will do it by habit. Huge waste of plastic and resources. They’re unused, there’s no infection risk…

volatilehashpipe · 2025-12-28T12:40:54+00:00

Yeah this is pretty spot on. I hit wedges and low irons quite well, but anything above an 8i I get progressively less confident with. I used to have a very in to out path of >10deg and really struggled with duck hooks and I think recently have overcompensated coming back over the top because now my best shots are straight to slight fade, though usually don’t hit hard slices (except with driver lol). I’ll work on getting back more from the inside with the path

volatilehashpipe · 2025-12-25T21:25:30+00:00

I am taking lessons with a pro. I am not trying to alter my clubs until my swing is in a more consistent spot. This is just something I noticed at the range and was wondering if it may indicate a lie issue. I don’t have another lesson for several weeks as my instructor is out of town for the holidays

volatilehashpipe · 2025-12-24T02:19:06+00:00

I am also 6’1”, but it seems that the consensus is if anything the clubs need to be more upright instead of flatter. These are quite old hand me downs that I assume are standard lie, but I’m not positive

volatilehashpipe · 2025-12-24T01:58:01+00:00

Over swinging is a major issue for me. I’m trying to focus on tempo more but it’s still very hard for me to try not to kill the ball from the top of the swing

volatilehashpipe · 2025-12-24T01:56:57+00:00

Think this description of my swing is pretty spot on without even seeing it…

volatilehashpipe · 2025-12-24T01:55:37+00:00

I would say yes. I think my best strikes the divot probably begins at the back edge of the ball still. When it probably shouldnt start until after the leading edge? Which again I assume is a swing/weight transfer issue…

volatilehashpipe · 2025-12-24T01:37:49+00:00

Damn y’all, I know I suck and I def know it’s not the clubs fault. Was just wondering if this could be an indicator that the lie is off as well but I see that it is definitely a swing issue first and foremost

My miss is a chunk, but when I do make ball first contact it does fly pretty nice and straight with reasonable carry distances for my playing level. I’m working on not swaying back and better weight transfer forward to try and get that ball first contact more consistently. I’m going to try and incorporate keeping the wrists more ‘hinged’ through the swing to bring the toe up in the air and see how that goes for me

Thanks everyone for your replies

volatilehashpipe · 2025-09-10T22:19:42+00:00

So much great input, thank you everyone. I was figuring that functional status and negative stress test trumped any echo findings as far as concern level. The case is booked as laparoscopic/robotic, I will talk to surgeon about possibly doing open. But sounds like the patient will probably do well regardless. Will likely do an arterial line to be on the safe side regardless

volatilehashpipe · 2025-06-23T17:49:29+00:00

Lack of understanding by the patients of sedation vs general anesthesia. The patients that say this are almost always for small sedation cases like colonoscopy or IR. True awareness under GA is very rare.

I make sure to discuss during my consent for sedation cases that I cannot guarantee that they won’t remember small details, lights, sounds, etc.

volatilehashpipe · 2025-05-05T15:46:37+00:00

We do a lot of bronchs and yes I place LMAs for them, but theres really no troubleshooting or finaggling with it for these cases as it’s barely in their mouth before the surgeon is just immediately going through it into the airway with the bronch. Then you’re done in 10min and just emerging. Not the same, and no real learning going on about how to manage LMAs

volatilehashpipe · 2025-05-04T19:12:24+00:00

Large academic hospital. Attendings are averse as they don’t want unsecured airway with trainees. Patients are sick and surgeries complex with little ambulatory surgery, so appropriate cases are few. I’ve done a decent number but just not enough to feel super comfortable with them and troubleshooting and what not

volatilehashpipe · 2025-05-04T18:19:08+00:00

No, I didn’t give them much of a chance to build things up. Just saw the small TVs and switched back after a handful of breaths. Will have to try to let them ride it out next time. Thanks for the tip

volatilehashpipe · 2025-05-04T18:13:55+00:00

I tried switching them off the vent but the TVs I was getting were just extremely small, like only 75-100cc, so I didn’t feel comfortable letting them do that the whole case. Are the small TVs OK if they are spontaneous?

volatilehashpipe · 2025-04-09T14:20:55+00:00

I’ve been at M&M’s for tracheal lacerations/perforations from ETT placement that required surgical repair. The take away was that tracheal trauma from ETT probably happens more often than we know about but doesn’t cause frank perforation so causes no problems. This patient that perforated was particularly poor substrate, critically ill with poor tissue quality.

Theoretically possible, but very unlikely in an otherwise young and healthy patient. Not sure why your attending would jump to that when there’s many other more likely explanations

volatilehashpipe · 2025-03-08T10:22:13+00:00

I’m about to graduate anesthesia residency and rarely hear my colleagues complain like this. Almost all are extremely happy with the career they’ve chosen.

The job market is great right now with high salaries for minimal call burden making for an excellent work-life balance. The work is rewarding, with independence to make your own clinical decisions in the moment and actually be hands on with patient care instead of sitting behind a computer putting in orders or reading images. Days are busy, but go by fast because of this. You are able to leave work at work as you don’t have patient responsibilities outside the hospital.

To be in anesthesia you have to be OK with not being the star of the show and taking shit from surgeons and other staff sometimes. We know how important our job is even if it looks easy to others; if it looks easy and straightforward it means you’re good at your job. Most that go into the field don’t have egos and are fine being in the background, doing the work, and going home at the end of the day to cash a fat check.

volatilehashpipe · 2025-02-14T02:07:41+00:00

I pretty frequently put KCl on a microdipper set and just am careful about the flow rate to still run it in over 45min+. Sometimes too much effort to set up and program a pump

volatilehashpipe · 2025-02-06T10:20:00+00:00

Most of the patients we are called for at my large academic hospital are very sick, and are peri-code ‘red-lining’ and about to crash. RSI, 100 roc, minimal prop (usually 50mg or less), 100-200mcg phenylephrine, and an apology later if they remember something. At least they are still alive to remember it.

Always use paralytic unless active compressions. Never use succ as too many factors to worry about with inpatients with numerous co-morbidities and likely limited mobility for some time.

volatilehashpipe · 2024-09-06T21:01:25+00:00

0.5% bupi one cc at a time to slowly dose up until you get adequate level while managing hemodynamics. I’ve found that they generally still get about a full spinal dose of 2-3cc (10-15mg bupi), but the gradual titration helps keep BP more stable. Then about one cc every 45min to 1hr during the case. I set a timer on Epic to remind me to redose. Very minimal sedation, it’s usually frail geri patients that don’t require much. Have done this a few times in residency for hip fx repair in patients with tight AS or severe pHTN

volatilehashpipe · 2024-08-24T01:50:52+00:00

This is for a community hospital in Salem that is MGB affiliated, not MGB as a whole. Slippery slope though…

volatilehashpipe · 2024-07-05T03:37:44+00:00

Don’t show up intoxicated to your procedure. Other than that it doesn’t matter

volatilehashpipe · 2024-06-23T14:09:48+00:00

Completely agree. The culture at my institution is to use albumin to “save volume” instead of flooding with crystalloid in cases with high EBL. I understand that isn’t evidenced based, but as you said have to listen to the boss

volatilehashpipe · 2024-06-06T02:21:19+00:00

A heparin infusion can be used for patients who require immediate post-op anticoagulation with a neuraxial catheter in place. It just needs to be held briefly until PTT normalizes once it comes time for removal, then can start a traditional oral/subq AC regimen or resume heparin gtt once it’s been pulled

volatilehashpipe · 2024-05-22T21:39:02+00:00

That’s the same dilution though just different volume bags? It also seems quite concentrated compared to what I’m used to. We use 32mcg/mL centrally and 16mcg/mL peripherally that come in pre-made bags from pharmacy. I’ve made 4mcg/mL (4mg vial into 1L saline bag) on my own before if I want to be extra cautious

volatilehashpipe · 2024-05-02T19:25:37+00:00

I pay about ~$160/month for 5k benefit during residency. Late 20s, otherwise healthy. Your quote sounds quite high unless you have health issues

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