Regarding crush induction—which anesthetic do you all actually enjoy using? Personally, I’m quite fond of Diprivan (assuming the patient is hemodynamically stable, of course)—mostly because I can't stop thinking about its antiemetic properties and how much it helps dampen that hypopharyngeal irritability.
By the way... in your hospitals, do you still bother giving Reglan or Peporan during premedication for patients with heart failure... even if they’ve already been NPO?
Scott Allen10 said:not much of a difference as far as I'm concerned...😉...
And as for MH... well, for a little while now, I’ve been the proud—though admittedly indirect—owner of a firsthand account involving a fatal induction via Lepotosukcin due to the onset of malignant hyperthermia... even Dantrolen was useless there... practically before you could even turn around...😢....
Whoa, man... I honestly don't know whether to envy you or pity you😱 I only know about MH from textbooks
Sam Hall15 said:Regarding the PACU—Alexander Wright, do you and the anesthesiologist stay on-site, or is there at least someone specific always hovering nearby?
We certainly do; our surgical suite is designed such that you can get from the most remote OR to the recovery room in under 15 seconds—which, honestly, is probably for the best when things go sideways. 🙂
Sam Hall15 said:Well, yeah—but let's be honest, side effects from succinylcholine aren't exactly something you see every day. Why would we use it more often in a developed, Western nation? Though, I have to say, it does grate on my nerves a bit how much we still lean on thiopental while they seem to use propofol for absolutely everything over there... it’s not even in the same league as halothane... and while I personally prefer Esmeron, succinylcholine still has its place in the toolkit, I suppose...
It’s funny how everyone loves to trash halothane—constantly bringing up halothane hepatitis and arrhythmias—when the actual truth is a little more nuanced. Personally, I’ve never actually worked with halothane, but the veteran anesthesiologists always mention that it wasn't nearly as bad an anesthetic as the pharmaceutical industry wants us to believe. If there aren't any glaring contraindications for using halothane (say, neurosurgery, NYHA Class III patients, or pheochromocytoma), then there’s really no reason to shy away from it. The real reason they’re shoving sevoflurane down everyone's throats everywhere is simply because it’s obscenely more expensive than halothane. *Sapienti sat.*
Sam Hall15 said:A question for our dear resident expert—not that I’d name names... 😁 how many hospitals in the US actually have a dedicated PACU? Feel free to roast me if you don't have the exact numbers handy...
Well... look, I’m certainly no expert, but I can take a stab at this. At my hospital, we have a proper recovery room, and honestly, it caught me off guard when I realized some places don't even have that. In our PACU, there are always at least two nurses or techs on duty.
As for Lystenon / Lepotosukcin... even though it comes with its own set of contraindications, I’ve chatted with quite a few veteran anesthesiologists who were unanimous on one thing: if you actually understand the nuances of when to use it, you aren't going to run into trouble.
There’s actually a little "green box" in the latest edition of Morgan that mentions a non-depolarizing relaxant being developed under the code AV430... I did a bit of digging and found it finally has a name: Gantacurium.
http://en.wikipedia.org/wiki/Gantacurium_chloride
It’s still in the clinical trial phase, but the potential is promising... Some aspects are frankly brilliant—a faster onset than Esmeron, a very short T1/2, and no need for a separate reversal agent to handle decurarization. If you just let metabolism do its job, strength returns in about 2-3 minutes; however, if you administer cysteine as an antidote, you're looking at full recovery in about 45 seconds.
Scott Allen10 said:I know a few of them... honestly, the only thing that really eats at them is the fact that succinylcholine isn't used anymore—not that you could even get your hands on it if you wanted to.🙂
How can you say there isn't... we have it right here in the States. 🙂 I mean, hand on heart—if I had my way, I’d definitely prefer having more Esmeron on hand. 🙂
Ah... a real anesthesiologist just sticks to thiopental, succinylcholine, and pavulon—pulling the tube out with that final stitch, being as stingy with fentanyl as a budget shopper at Walmart, and honestly, two vials of orange Braunol is more than enough for a liver transplant 🙂
So, here’s the short version—about a month ago, I parked incorrectly near Rib. Right on the sidewalk.
The city tow truck hauled my car away, and instead of just paying the fine and moving on, I decided to file an official appeal.
Here’s the context—and please bear with me—I’m a doctor. I had to rush over there on my own time, outside of my regular shift. There’s a massive shortage of specialists around here, and since I live pretty close to the hospital, they called me in to handle some discharges for three kids. It was basically to clear out beds so the people waiting in the ER wouldn't have to sit in a crowded waiting room all day while we processed the little ones. Naturally, I didn't receive a single cent of extra compensation for this—that's just how the American healthcare system rolls, unfortunately. The hospital has its own parking lot, but at that exact moment, it wasn't feasible to head there because of those massive traffic jams stretching from the north side toward Kišpatićeva—anyone who has driven through that area knows that around 10 AM, the lines can stretch halfway down Barutanski Jarak. Along with my appeal, I included an official letter from the hospital explaining the situation, just to prove I wasn't making up some convenient excuse.
I also made sure to state clearly that I know I messed up, but—look—I’ve never had a citation before, and the reason was genuinely valid.
And what does the Department of Justice do? They reject my appeal!
What am I supposed to do now... just pay it? And then next time someone needs a hand, I’ll just have to say, "Sorry... everything has to be strictly by the book," because I'm technically off the clock. What are my actual chances if I take this to the Supreme Court? If I really do have to cough up the money, can I just skip the tow company and the DOJ and donate that amount to charity instead? Like, maybe the Anne Rukavina Foundation or something?
I’m honestly just bewildered... I can't tell you how many times I've examined patients who didn't even have insurance, even when it wasn't strictly a legal emergency—like a case of strep throat, which isn't exactly life-or-death. I sincerely hope that one day, the guy at the DOJ finds himself in a spot where he needs a favor from someone who follows the law to a T. What is the point of any of this?
The biggest absurdity of all... when a patient parks illegally, they get let off the hook if the hospital provides a note saying it was an emergency... but for me, it's a different story.
I can't wait for the EU to finally let me move out of this country.
Look, before you jump to any conclusions, go get some blood work done first. It’s entirely possible you had chickenpox as a kid without ever noticing a single rash or breakout. If the tests show you haven't actually built up immunity, then yeah, maybe look into getting vaccinated. But just a fair warning—those shots can come with quite a few side effects.
rowdytinker95 said:Just so you know, I didn't pay much for my Cisco Networking Academy training—it was basically $233 peanuts
But look... you’re actually in IT, so I assume there's some actual value in a Cisco Networking Academy course for you (hopefully)—which means that certificate might actually carry some weight (especially with an employer)
Patrick Hernandez73 said:Look, $200 it’s a minor thing to give up if you have a job waiting for you—I mean, that certification is basically a breeze, especially those first four exams (Windows basics, Word, Excel, and just general internet stuff).
The only thing I actually remember from graduation was the cocktails at the ceremony. 😁
Well... I have a job lined up regardless—mostly because I’m in a high-demand field where they can't afford to turn people away—but honestly, demanding an ECDL is pure idiocy. It’s literally just the absolute fundamentals. Everyone of us who finished our degrees already proved we could handle PowerPoint, Word, and digging through academic databases during our undergrad years just to put together basic seminars.
So, apparently, there’s this new prerequisite floating around for getting hired—passing an ECDL starter pack consisting of four exams. I’m sitting here wondering if my eyes are playing tricks on me, or if I actually have to cough up 600-$233 just to pass the thing. I mean, come on. If it were 200... maybe. But 600? Give me a break.
So... I just finished my clinical rotation in Family Medicine... I have to admit, I walked away genuinely impressed by the sheer depth of knowledge my preceptor possessed. She was handling everything herself—minor surgical procedures, home visits, wound irrigation—and she did it all with incredible skill. There was this one patient in the clinic where she nailed the diagnosis, only for some arrogant specialist to scoff at her, basically implying, "What does a primary care physician know?" But she didn't back down; she actually called the Chief of Department's office to demand a second look. In the end, that condescending specialist had to eat humble pie and apologize because she was, quite simply, right. The real issue here (and it’s a mindset deeply ingrained in medical students too) is this pervasive myth that Family Medicine is just a glorified job of writing referrals. But over the last month, I’ve seen firsthand how demanding and complex this field actually is. While a nephrologist might focus on one narrow niche, a family practitioner has to manage the whole human being—and usually without a mountain of extra diagnostic tests at their disposal.
Now, regarding what I might actually specialize in... out of everything I've shadowed so far, Family Medicine has made the strongest impression on me. Except for one glaring thing... the endless, soul-crushing paperwork. It’s brutal. Working with patients is wonderful, and there’s a genuine intellectual thrill in treating the entire person rather than just a single organ system. But then, a parent walks in with a three-year-old suffering from tonsillitis... you do a quick exam, see the exudative tonsils, prescribe the antibiotics... and then you spend three times longer filling out the paperwork for the parent's sick leave. Honestly, who is the crazy one here? In my opinion, being a primary care physician—especially if you're practicing outside of a major metro area like New York or Chicago—is much harder than being a hospital specialist who can just call for a consult every time a problem gets complicated. In the United Kingdom, GPs are top-tier... their knowledge base is massive; they even handle almost all prenatal care, barring the high-risk cases.
Essentially, you aren't looking for a cure—you're looking for management.
The standard toolkit mostly consists of anti-inflammatories—think corticosteroid creams for milder skin rashes combined with NSAIDs to handle the joint and muscle pain. Now, if things get a bit more serious, doctors usually pivot toward corticosteroids or immunomodulators/cytostatics (things like azathioprine, cyclosporine, or sulfasalazine). But, and this is a big "but," those come with a laundry list of side effects, so a physician really has to be careful about how they prescribe them.
As far as the diagnostic side goes, a primary care physician can't just call it based on a butterfly rash and some arthritis alone—not without seeing positive lupus markers in the bloodwork, such as ANA or LE cells. That said, if the clinical presentation is textbook, there’s probably a 90% chance they’ll nail the diagnosis regardless.
Back when I was living in the States, I picked up this North Carolina Tar Heels tumbler—it was absolutely top-tier—but the idiot ended up losing it somewhere on campus. Do you have any idea where I could track down some decent NCAA tumblers around here? And please, I’m not looking for those cheap, flimsy ones with the annoying plastic lids; I want something actually high-quality.
So I'm browsing through these Hardwood Classics online, and it’s almost entirely just replicas from the sixties... nothing from the eighties to be found. 😢
Hey, I was wondering if anyone knows where I can pick up some vintage NBA jerseys here in the States? I'm specifically hunting for some 80s Atlanta Hawks gear—ideally something with the number 21 🙂—and maybe some old-school Seattle SuperSonics jerseys too. I actually used to own a Shawn Kemp jersey once, but I ended up gifting it to a buddy of mine from England. He was the one who first introduced me to basketball when he came out to visit me here in the US, so in a moment of pure sentimentality as we were saying our goodbyes, I just handed it over to him.