Recent content by lunaire

That's why IM critical care fellowship is two years. Anesthesia CCM fellowship is 1 year. Generally, we graduate residency with good procedural skills, but relatively behind on inpatient & ICU medical knowledge base. I personally studied my ass off in that one year, and still graduated with a...

LOL, poor choice of words, lower dose hypnotics, wait a bit longer for effect, then rapid sequence dose paralytics without mask ventilation. Yes Perhaps I am anticipating the future too much. The intent of the milrinone is altering the PA pressure and low normal cardiac index, if patient is...

This dude has no emergent need for surgery that I see. Keep PA cath in, medical optimization in cardiac ICU, diurese, maybe start milrinone. See what happens when LVEDP is upper range of normal. Slow induction - midaz/fent heavy, with etomidate & paralize. rapid sequence. Keep an eye on BP and...

I would say intubation, central line placement, a line, basic POCUS, leading CPR/ACLS at the beginning of fellowship At the end, add chest tube placement, therapeutic bronch, PA cath placement, basic TTE/CCeXAM, spinal taps, paracentesis. Depending on your ICU/future career goals, can also add...

Just to add to the resternotomy - anybody can get training in it, and if you are primarily in the cardiac ICU, you probably should be able to open up the chest. High volume cardiac centers would usually have the surgical/ICU NP open the chest in the event of refractory cardiac arrest, well...

If you lack the experience, you NEED to lean on the consultant services and colleagues. By all means study, but understand that each of the ICUs you are describing would usually require months of fellowship rotation to really get the basics, and then there's the more advanced stuff that they are...

I find the PA cath to be one of the easiest diagnostic tool to be misread. You need to interpret the numeral values. You need to actually take in all the values with clinical context (instead of just cherry picking a single one). You need to be identify the waveforms properly. etc etc... I think...

End stage fibro's post is excellent on general medical billing. Here's a little extra on the surgical side (especially cardiac - my realm): Surgical cases requiring hospitalization is basically paid a flat global fee. Consultants outside of the surgical service can be brought in and bill for...

Curious about your standard practice on the duration of inpatient CPR, before calling it. Specifically, how long would you continue CPR in the setting of: 1. Unclear etiology non-shockable rhythm, typical 45-65 y.o patient 2. Unclear etiology young patient, potential eCPR 3. Poor prognosis full...

Well, as a critical care guy, I actually like the extra burden of long term outcome. That's what drew me to critical care to begin with... The morbidity/mortality outcomes are excellent learning points. The good outcomes are great motivators. To each their own, I guess.

We used to do this in my old hospital -- patient would get transported to preop holding, then one of the anesthesiologist will insert an ultrasound guided midline or PIV. This is totally not financially worth it, no matter how you bill for it. If you are doing this service for the hospital...

I think there's enough locums opening out there to live out your career solely doing that. If you start off doing locums, you do not necessarily need to fear the transition to a regular W2 job, you can just keep doing locums until you retire. The different treatment of locums and lack of...

Reminds me of the time when my anesthesiology attending had a broken arm, and we had to emergently intubate the patient on the table. Also the few times when I had to bail out failed intubations by other CCM attendings, that turned out to be quite easy. My experience in the last few years have...

Speaking of revenue, generally the lion share of billing comes from the initial cannulation, with daily management being a diminishing return proposition; especially for the hospital. I imagine a really slick intensivist program that is able to cannulate and maintain a sensible length of...

You should look into the academic programs as well. IMO they pay better, relative to other state's academic salary. I think Mt Sinai may be hiring, and they're right at the beach.