Recent content by Beeftenderloin

I don’t think the blood is 5 minutes away. It’s in the hospital that is a 5 minute drive away. So probably more like 15-20min on a good day. It takes every bit of 5 minutes to get 2 units of emergency release blood from blood bank to OR where I work, and that’s in the same building just 2 floors up.

Ironically I grew up in the Bay Area and now live in Illinois. Definitely won’t be in Illinois forever, but when I move, I’m certain it won’t be back there.

It’s fine if it’s worth it for you. But to the point of OPs original dilemma/question, the reality of the value proposition that is living in the Bay Area is that if you aren’t independently wealthy or working in a field that pays considerably more than anesthesia, it’s coming out of somewhere...

This may be the first thing you’ve said that most of us will agree with. We would in fact be shocked to learn that.

I have questions. How many units of blood are there in house? How far to nearest referral center? If patients are actually appropriately selected, I’m sure escalations of care are rare, but not never. I’m curious what kind of contingencies are in place for the unanticipated PPH.

The ASC of childbirth. It will be like any other ASC. OB/midwives will constantly be pushing the boundaries of who is appropriate for this to drive revenue when they can’t get enough healthy patients. “Oh she’s not pre-eclamptic, just gestation HTN” “Her BMI is only 39.9” “But all 4 of her...

If the site is compressible, who cares? Cutting open their shoulder with an INR 1.6 is another story.

100mg is now my “routine dose” for any surgery longer than 90-120min. As others have said, improper storage markedly and reliably reduces potency/clinical effect and it’s almost always stored improperly at some point along the distribution chain.

We very recently had a massive aspiration event requiring emergent intubation, near arrest, long ICU stay. They were doing this exact case under standard deep MAC w/ propofol. N=1.

I do a thorough chart biopsy before saying hello, briefly. But overwhelmingly, the most important factor in choosing my induction dose/strategy is the eyeball test.

If you walk in the room and see anyone who isn’t an anesthesiologist (and even some who are) bagging with a 1 hang mask seal, it’s all but guaranteed every breath is going in the stomach/room. We’re the only ones who learn properly in the OR with the feedback of a compliant bag, continuous...

The more I learn, the worse this gets. A standard cuffed ETT costs less than $2. Life saving interventions isn’t the place to cut corners.

I’ve never seen a crash cart that didn’t at least have a BVM, OPAs, standard laryngoscope, tubes and stylets. Arguing against low cost redundancies in the name of patient safety, in favor of “this is how we do it because this is how we’ve always done it” ESPECIALLY in a facility using locums...

This place seems like a disaster. The start/cut times are just the tip of the **** iceberg. If the pay isn’t astronomical and you aren’t geographically locked in for some reason, I’d start looking for new work ASAP.

If they have strict cut times for the surgeons they better have strict last stitch times as well. What if it’s an unanticipated difficult airway, what if lines are challenging, DLT just isn’t going and you need to pivot to a blocker. Are you supposed to get in room 45 minutes early, just in case...