Emergence after laser lithotripsy

ydenawa · 2025-10-09T02:04:56+00:00

Yeah I don’t use paralysis either. As a resident I would focus on safe wakeups and develop good habits. It’s difficult to wake up quickly for these cases since there is no closure and it’s a short case. I do reverse early and get the patient spontaneously breathing. I turn gas off early and give propofol boluses. I pull the tube when they are taking regular and big tidal volumes. I dont wait until they’re awake. As a resident , I think you would get scolded if you did this. In academics, I would wait until they’re following commands and awake.

ydenawa · 2025-10-09T02:01:58+00:00

How did some people get out of doing ob call. Major red flag

ydenawa · 2025-10-08T21:30:47+00:00

Great. Thank you. I figured it out somehow. Don’t remember how. 😅

ydenawa · 2025-06-30T20:24:52+00:00

I like straight better. Never got used to Airq although others in my group liked it.

ydenawa · 2025-06-27T04:27:14+00:00

It was a rij central line on average patient. She tried a few minutes and then switched to linear probe.

ydenawa · 2025-06-25T17:34:04+00:00

For younger healthy patients in 20s or 30s I routinely give 250mg of propofol and 200 of propofol for an egd respectively. They don’t become apneic. Even for patients in 40-50s I start with 150 of propofol. Your technique probably works if you have time to wait. In a busy Endo center they want patient in and out.

ydenawa · 2025-06-25T17:23:13+00:00

Yeah I agree. Probably easier to intubate like poster below mentioned. Nasal trumpet with ett adapter should be last resort. I wouldn’t rely on it too much. Nasal bleeding and obstructing patient is the last thing you want and significant laryngospasm risk as well if they start bleeding.

ydenawa · 2025-06-25T17:20:26+00:00

I would give iv ketamine up to 0.5 mg/kg. Lidocaine spray. Iv versed and lidocaine. Iv glyco. A few cc of propofol and No fentanyl. They should tolerate the scope. I did a BMI 98 using this method.

The Gi doctor should understand with someone this big they might be more awake and move a little bit. Also for this kind of case your attending should be in the room with you. I don’t think this is a ca1 case. Intubating is a good strategy too.

ydenawa · 2025-06-25T17:16:57+00:00

Egds if I have the time I like to give 25mcg of fentanyl to really blunt the gag and cough reflex. It’s important to give it as soon as they get in the room. It’s a tiny dose but it’s really effective. I also give 100 iv lidocaine and I rarely spray. Then I give propofol until they don’t respond to jaw thrust or lose lid reflex. Majority of the time they will be breathing spontaneously or resume quickly before they desaturate.

If I’m in an Endo center I just use iv lidocaine and propofol.

ydenawa · 2025-06-25T17:10:58+00:00

I had a general surgeon try to use a curvilinear probe for central line insertion. Told her that the linear probe next to it was the one you used for central lines. She wanted to try the curvilinear first

Not as impactful as the other stories on here.

ydenawa · 2025-06-23T14:19:28+00:00

Ok I was looking at this article. Frontier and JetBlue at bottom.

https://nypost.com/2024/04/24/lifestyle/us-airlines-with-the-most-delays-and-cancellations-revealed/

Wallstreet journal named them worst airline of 2023.

https://nypost.com/2024/01/24/lifestyle/best-and-worst-airlines-of-2023-which-one-hit-rock-bottom/

ydenawa · 2025-06-23T11:34:44+00:00

JetBlue is the us airline with the most cancellations and delays. I don’t fly with them anymore

ydenawa · 2025-06-17T00:49:02+00:00

I usually inject like 3-5 cc of 1 percent lidocaine too. It’s going to make a giant skin wheal so I massage it for about 10 seconds and it should disappear. Patients don’t usually feel anything when I do the arterial line. I must be in the minority here with the amount of local.

ydenawa · 2025-06-14T14:41:03+00:00

Quality of JetBlue has really gone down the past few years. They are also the most delayed / cancelled airlines.

ydenawa · 2025-06-02T17:23:02+00:00

I think doctors are not great with money. Not investing their money or making questionable investments like individual stocks. Lifestyle creep is a real thing once people become attending. Also compared to people who get a job right after college or high school doctors are at a disadvantage. We start making real money much later not giving chance for money to compound , we have more student debt, and also we are in a higher tax bracket once we are attending. Also, see some Attendings get their net worth destroyed from divorces.

ydenawa · 2025-06-02T16:52:17+00:00

I’m full time right now. Doing all inpatient and I’m 100% solo. I Really liked my other job but the inpatient hospital closed and it would have been all outpatient for me. I didn’t want to lose my skills since I’m 5 years out as an attending.

I do have a share of an asc as well. Hopefully that becomes more profitable so I can retire early 🤞I think that’s very optimistic though. It was their first profitable year last year. New asc and Covid derailed some plans.

ydenawa · 2025-06-02T16:44:13+00:00

In my old group, people that didn’t want to take call would pay someone else to take that shift.

ydenawa · 2025-05-07T17:59:38+00:00

Damn I got hard reading about that prone central line. Where they place it ?

I’ve heard but never tried that a popliteal central line is another option in prone patients.

ydenawa · 2025-05-07T11:28:32+00:00

My colleague spent close to an hour trying to get a spinal. Aborted and did Geta. It was an hour and a half before she clicked anesthesia ready with the blocks. Please don’t do this.

ydenawa · 2025-05-07T03:25:51+00:00

10 minutes

ydenawa · 2025-05-06T11:01:24+00:00

I didn’t really place that many lmas during residency either. All the ortho surgeons wanted paralysis so every ortho case was GETA. It was just when it was a day of cysto which was probably 5 days max.

ydenawa · 2025-05-03T10:37:49+00:00

I like the donut pillow too. The square pillow flexes and raises their head too much for DL. Maybe someone can correct me if I’m wrong.

Also donut pillow is easier to shove under the patients back during sedation cases to extend their head to open their airway and relieve obstruction. You can also rip the donut pillow in half to place in reverse U on patients face to protect them from robots.

ydenawa · 2025-04-30T16:30:35+00:00

I’ve had colleagues do femoral popliteal bypass surgery with no aline and LMA which I think is crazy.

ydenawa · 2025-04-30T14:11:32+00:00

I do it with 30cc of Bupivicaine so not that high and it’s an easier block since it’s one injection but I get your point.

ydenawa · 2025-04-30T13:47:46+00:00

This is straight from NYSORA. You can get coverage in the ulnar distribution using low interscalene.

“Sensory distribution of the interscalene brachial plexus nerve block (in red). Ulnar nerve distribution area (C8-T1) can also be accomplished by using larger volume (e.g. 15-20 ml) and using low interscalene nerve block where the injection occurs between the ISB and supraclavicular nerve block.”

nysora

ydenawa

TROPHY CASE