Recent content by sanityonleave

I agree they're capturing underlying illness, but I don't think a brachial embolectomy is a benign procedure -- especially if you're, I don't know, POD3 from your total arch. Even if you don't have a procedure, let's say we decide to heparinize due to the thrombus from the art line and now you...

I support your underlying point: if you need the line to take care of the patient safely, put it in. Anesthesia has become so safe that some providers are so scared of doing any procedure that has risk attached to it that we're becoming ineffective (or simply turfing what should be our domain to...

Just to add to the confusion: Micropuncture sheaths (like the Cook set https://www.cookmedical.com/products/e4790704-1c72-48bc-95f7-6c5bd6ea3b53/), which I think a lot of us use for brachial lines, are measured by their outer diameter (4Fr) - so that's the largest dimension in the artery...

I do a lot of ultrasound subclavians these days. They're great lines. I also use fluoro not infrequently in the OR for lines, esp in patients with abnormal anatomy. Also I'm firmly on the side of ultrasound for everything. Ultrasound is basically ubiquitous at this point - and if you're having...

I read the study. It's at best a proof of concept that we need some further study, but I don't see any way you can look at their data and claim it's reassuring. They have no information on if any of the patients in the study were actually talking their GLP-1 agonists (or if they had...

This is one of my biggest frustrations with the medicine behemoth. Why is it that if I want to change clinical practice, I need 3 RCTs and a signed letter from Jesus Christ himself -- but if some committee decides on an arbitrary recommendation they don't have to prove anything or collect any...

I'm surprised that folks here are using atropine for "scary" / hemodynamically unstable bradycardia... Maybe I'm just spoiled, but our pharmacy makes 10mcg/mL epi sticks and those are amazing for basically everything. I'd reach for epi every time over atropine for unstable brady. Why give a...

I bet NAPA would be quite happy to f*** you if they got an extra buck for it.

Thanks for the input. I wasn't trying to make the semantic argument myself so much as perhaps trying to parse the guidelines to understand why I got the answer I did from the CV consult service at my shop. I found them to be (unfortunately, typically - at least at my institution) dismissive of...

Full disclosure that I am not a CTA trained person. I am saying that because after I consulted cardiology postop and reviewed the images with them, they told me the patient did not meet criteria. She also had a totally normal TTE, though they did not measure the upper septum that I saw (nor did...

Correct! SAM with MR and obstruction. No HOCM, though - but she does have a chronic pathology that typically causes low SVR and thus can predispose to an LVOT gradient. She was given ~1L volume quickly with CVP 11>22 with minimal improvement in BP. Would you continue the volume challenge? LV...

Figured I'd revive this thread for a bit and give everyone a much-needed relief from the politics that have been dominating a lot of the forum -- Had some profound hypotension during a non-cardiac case last month. It's a pathology I'm aware of and this patient population is prone to it, but the...

I'm not going to wade too far into the political ****storm that is this thread, but I will throw a little more fuel on the fire because I happened to be reading a paper tonight that seemed very relevant: 2019 American Economic Review paper showing that black men randomized to be seen by black...

Seems to be the consensus overall. I have always felt like we have too high a threshold at my institution to put in a brachial/fem -- people flogging in lines in 2mm radials in sepsis bomb patients on 50+ mcg/min of norepi. One of my smarter CTICU colleagues is fond of saying, "If you can bill...

SDN Anesthesia Hivemind-- What is your threshold for gaining large-vessel arterial access in patients with significant (or significant anticipated) vasopressor requirement? There's obviously some (albeit not a huge volume) of data showing a significant discrepancy between radial arterial...