Posts by Scott Allen10

Sam Hall15 said:I’m honestly about to lock this thread if the OP doesn't set the record straight, because they dropped a total lie in their opening post claiming the training time is basically equal... let's be real, it's actually half that... and I don't even want to get into the weeds here because I don't want to sound like a snob, but any nursing student who fails an exam can usually just retake it and get a passing grade at a nursing college, provided they actually showed up to all their lectures and labs.

That's pretty much the reality of it... though, I'd say it's true because those pre-clinical and clinical med subjects you're thinking of—you know, things like surgery, internal medicine, pediatrics, anatomy, patho, pharmacology—which are the heavy hitters for med students aren't actually the core focus or the heart of what nursing studies are all about. You really have to make that distinction.
See, even though everything looks almost identical on the surface and it's hard to draw a line, nursing isn't clinical medicine in the way doctors practice it; it's patient care. So, for instance, a nursing student might not actually need to master internal medicine at the exact same level as a medical student... but when it comes to a course like "Care for Patients with Internal Medicine Conditions" (which blends clinical elements with specific nursing skills), they seriously need to know their stuff inside and out.
It's a whole different story in America, though, where the nursing profession hasn't been clearly defined in the public eye, so people often just view nurses as assistants to doctors... but that's a conversation for another day.

electricpanther82 said:cosmicowl64, I honestly had no idea heart surgery could even be done under local anesthesia; I always thought that was totally off the table. Is that doctor actually sane? Did he even bother explaining what kind of procedure this is and how they pull it off?🤷???

Installing a pacemaker-defibrillator isn't really considered major cardiac surgery anyway.
But even "real" heart surgeries—you know, the heavy stuff where they saw through your sternum and do bypasses—can technically be performed using regional anesthesia.
Of course, there are almost no actual reasons to do it that way, so it’s mostly just a niche thing for specific cases, but it is possible.
They set up an epidural catheter, similar to what you'd see for a painless labor, but they go higher up into the epidural space, which basically numbs everything from your neck and shoulders down... and then the surgery starts...😲....honestly, it sounds a little twisted; you'd have to be some kind of hardcore masochist to handle someone sawing through your breastbone and spreading your ribs while you just lie there, paralyzed from the neck down, blinking your eyes...😍....don't get me wrong, the anesthesiologist will give you sedation so you aren't fully conscious, but once they finish closing up the wound and stabilizing the patient's vitals (I once saw a training video from a major US cardiac center showing this), they wheel the patient out in a gurney straight to the shock room...😍....it's pretty wild...😍...

Anyway, I heard that urbanscout50 is actually looking into pulling off one of these crazy anesthetic stunts...👋....

Nicole Jones12 said:I wanted to open this up to everyone on the forum, so I really hope the mods don't mind me starting a new thread here.
So, fire away with whatever questions you have—I'm more than happy to help out.
My main focus is cardiology and emergency medicine, and I'm actually right in the middle of my residency at the moment.
It would be awesome if some of my other colleagues joined in too; looking at this PDF, I think there are plenty of them around here.🙂🙂

Oh, they definitely won't mind... though they might just keep this as its own standalone thing. Honestly, when it comes to emergency medicine in the US—especially those cardiac-related calls—the anesthesiology department usually holds the most expertise. Since we already have an anesthesiology topic that basically covers all that ground as a sticky, I'll just link this one to that.
Hope you dont mind....🙂

ambermason822 said:..... I haven't made it to my OB-GYN appointment yet because my period started that same day, plus my cardiologist told me it wouldn't be smart to get an abdominal ultrasound since we shouldn't be pressing on my stomach while everything is still so fresh, saying there could be some internal bleeding..

😂....man, that is just wild.....I mean, I know cardiologists live in their own little world, but I had no idea they could be such total clowns about stuff like this....

Honestly, what does a cardiologist even know about gynecology or abdominal ultrasounds? It’s honestly baffling to me how someone with actual medical training can spout such nonsense....
So, you really need to follow through with that OB-GYN visit. They're the ones who can actually verify how your surgical site is healing and make sure your whole reproductive system is bouncing back okay after the delivery.

I'm also not totally clear if you actually had a pulmonary embolism or if that was just a guess from the doctors? That high CRP reading might be explained by the body's inflammatory response following an embolism....though maybe it's a wound infection, but that doesn't sound quite right to me either...

Anyway, look, it's going to be hard for us to give you any real, solid advice here, and I hope you get that...Just go see the OB-GYN so you can get some real answers and stop worrying...and hey, if that clown of a cardiologist keeps talking nonsense, just find a new one and don't look back...

Melissa Howard90 said:I was wondering if anyone here has actually tried these products? I gave the vanilla shake a shot and honestly, it wasn't half bad—definitely better than that Herbalife stuff I couldn't stand! But does drinking this stuff even make sense? I'd love to hear what you guys think!!🙂

Look, I've definitely dealt with stuff like this before on this forum... mainly by scrubbing these posts, locking them down, or just moving them over to different sub-forums...

I'm gonna go ahead and close this thread now, so maybe try searching for answers on the Nutrition or Holistic Health boards instead.

I want to hear everything about this girl—whether she’s had great luck or total nightmares with doctors over there... please just keep all that chatter on the "Looking for a doctor..." megathread instead.

Sam Hall15 said:Why don't you agree? Science shows survival rates are higher in ICUs led by intensivists rather than other types of doctors, and even though we're talking about non-anesthesia populations—and looking at how things work primarily in North America—I still think having them can help treat patients in the ICU if there's someone, or better yet, several people, who take extra training in that field to stay more up to date than, say, those who don't find critical care particularly interesting. An anesthesiologist-intensivist actually has a much broader scope of practice; they’re ideal for mixed ICUs (like internal medicine/surgical units) and make better consultants in pediatric and neonatal ICUs, etc. Having an intensivist present doesn't diminish the responsibility of the on-call doctor who hasn't sub-specialized, nor does it limit their range of action. Honestly, those anesthesiologists can handle any ICU without breaking a sweat.

Hold on a second... I think we might be talking past each other here...🙂....Forget the science, forget North America, and stop looking at ICUs through this theoretical lens....

The reality on the ground here is this:
anesthesiologist = intensivist
Through their residency, an anesthesiologist picks up almost all the knowledge and—more importantly—the hands-on skills needed to manage a patient in the ICU. I mean, what’s the point for an anesthesiologist who’s been pulling ICU shifts for twenty years and knows all the tricks by heart to go through a sub-specialty program just to sit through lectures on stuff they've already been doing for decades? You won't convince me otherwise. What's worse, parts of that sub-specialty training have to be supervised by people who barely even touch critical care. They have no clue. They’re just some big-shot professors in neurology or internal medicine who act tough and toss around "intensive care" titles.

As for the other specialties that should technically cover critical care within their scope—pediatricians, neurologists, and internists—for the vast majority, with maybe a couple of exceptions, they either only dabble in intensive care or don't touch it at all. Most of them just see that part of the job as a massive headache and a total waste of time. So, if one of them actually decides to go for an intensive care sub-specialty, they end up like Alice in Wonderland—they don't really know what they're doing, they can't practice the skills, and most importantly, they aren't going to actually perform intensive care once they head back to their home departments...
I mentioned a few exceptions. Among the non-anesthesia doctors who are actual intensivists, you only see them in:
- the infectious disease ICU at a major hospital like Mayo Clinic
- pediatric/neonatal ICUs at places like Children's Hospital of Philadelphia
- pediatric ICUs in a city like Miami
- parts of the neurological ICU at a major center (though the intubations there are handled by anesthesiologists from Neurosurgery)
and maybe one or two other ICUs in the US
...and that's pretty much it... nothing else...
Every other neuro/internal med/cardio/infectious disease ICU is basically a joke where it's impossible to fully manage a patient's cardio-respiratory needs, which is the whole damn point of an ICU. Regardless of whether someone finished a sub-specialty or not.

I didn't quite catch what you meant about anesthesiologists being in ICUs run by other specialties. I hope you aren't seriously suggesting that an anesthesiologist would work under a neurologist or an internist in an ICU?... Joe, please, don't ever suggest that to anyone...😁...you'll end up getting scalped....🙂

Sam Hall15 said:you know, we could probably fix this if we had a solid system where anesthesiologists focused specifically on the ICU—like, instead of just floating around, they’d be assigned to specific patients across all departments alongside the on-call ICU doc, deciding everything during morning rounds for people they actually know, which makes adjusting care throughout the day a breeze. I'm sure there are plenty of anesthesiologists out there who have a subspecialty in intensive care, or even if they don't, they're basically more of an intensivist type anyway, and let's face it, who doesn't love playing around with mechanical ventilation??? 😁

Hmm... I don't think I'm gonna side with you on this one... Joe, no way!.... Personally, I feel like this whole "everyone manages their own patient" setup is a total disaster for any ward, but that's a whole different conversation and I don't want to go down that rabbit hole right now...
As for the ICU specifically, what you're suggesting just wouldn't fly in practice here. In the ICU, the responsibility for a patient lies solely with the attending physician on duty. Nobody else. Once an anesthesiologist moves a patient from the OR or the ER into the ICU, their job is to hand that patient over both verbally and in writing to the ICU doctor, and then it's goodbye... they move straight back to the surgical schedule, and given how fast things move in the ICU, that anesthesiologist won't have anything to do with how that patient is treated after they leave.

When it comes to subspecialties, in this country, it's pretty much a meaningless designation for now. The people taking those subspecialties are usually anesthesiologists who have already been working in the ICU for 10 or 20 years, so they aren't exactly gaining new wisdom... meanwhile, neurologists and internists who try to get into that specialty end up in a bit of a mess because most hospitals won't even bother since we basically lack competent neurological or internal medicine ICU specialists.

Sam Hall15 said:Generally speaking, I don't think poor ventilator synchronization is much of an excuse to throw in a relaxant, unless things are truly extreme.

Hmm... you know, sometimes that "extreme" can happen way more often than you'd think. It’s true that those stretches aren't super common in the ICU, but honestly, you can't just wish away the chaos. When you're dealing with neurosurgery traumas where you absolutely need "peace in the brain," or major multi-trauma cases—especially those nasty lung contusions or ARDS—you almost always need fully controlled ventilation and regular relaxation, especially during those first few critical days.

I mean, I mostly agree with you. Usually, sync issues with the vent aren't the main culprit. It’s rarely an issue if there's an anesthesiologist on duty who actually knows how to handle pressure-assisted modes—someone who actually understands the nuances of BIPAP, CPAP+ASB, or APRV. But man, when you get some of those "old schoolers" on shift, that's when the "syncing" problems really start, because the older docs usually don't want to bother with the fine-tuning of different ventilation modes; they just want to stick to the basics and say, "just give me CMV or SIMV, set this tidal volume, and crank the frequency to this"... 😁

Chloe Johnson24 said:... how long did I sleep after my surgery (that Bentall aortic root replacement) basically, how long does it take for a patient to wake up in the ICU?

Honestly, if things are looking stable, the ECG looks good, and there isn't crazy drainage coming from the chest tubes... there’s really no reason to keep someone sedated on a ventilator longer than necessary. We just stop the Propofol infusion and wait for them to start "breathing through" it on their own. It’s super individual, though. I’ve seen people start triggering the vent and opening their eyes almost immediately after we cut the Propofol, but then you have others who sleep like a log for hours—to the point where you actually start worrying they might have had a stroke and find yourself checking their pupils and wondering if you need to call a neurologist....😁....

urbanscout50 said:So yeah, that's pretty much the gist of it, keeping it short and sweet

😂.....👍....

We usually only pull the trigger on relaxation when it’s absolutely necessary. By "necessary," I mean there are times when an anesthesiologist decides that, given the specific nature of the illness or injury, having a totally relaxed patient is actually better than just having someone who's sedated—even if they seem relatively calm to us.
As for Paracetamol, we use it in the ICU, specifically the IV version called Perfalgan (it comes in those 100ml vials). The reason you don't see it used more often is basically a headache with Medicare coverage; it's not on the standard formulary, so it has to be brought in through special emergency imports. At least from what I can tell, that creates a massive hassle for hospitals and medical suppliers who really don't feel like jumping through hoops for such a small amount.
I'm not entirely sure what you meant by NSAIDs, though I'm guessing you're talking about non-steroidal anti-inflammatories... regardless, we use pretty much everything when it comes to analgesics—Analgin, Paracetamol, Ketoral, Tramal, Dolantin, the Fentanyl I mentioned earlier, even the Tramal and Paracetamol combo known as Zaldiar, and I've even seen people handing out Ibuprofen... honestly, even in the ICU, we're starting to see PCA pumps (patient-controlled analgesia) being used, albeit very sparingly. Plus, if a epidural catheter was placed during the procedure, we usually keep using it for pain management in the recovery period. So yeah, there are plenty of methods available. The bigger issue is that pain management often lacks a personal touch; sometimes a patient is in pain simply because they aren't following a specific doctor's protocol regarding how much analgesia should be handed out... while another patient might not just be pain-free, but they'll be "troublesome" in a different way, sleeping like a baby all day and night...😁....but hey, that's a whole other conversation and I don't want to start a whole new thread here...

Man, Sam Hall15, what are you even talking about with this cellular oxidation stuff?😁...there’s just no room for those kinds of theories out here...you just work with whatever tools you've got and follow the protocol...if someone started throwing around talk about cellular oxidation and all that high-brow theory, the senior staff would probably kick them straight out of the OR...😁...

Back when I first started out, we mostly did bolus sedation and relaxation. In the real world, that meant every 45 minutes or so, someone was popping an ampule of Pavulon and Dormicum into a vein. We'd go like that until dawn if we had to, sometimes longer...and every now and then, someone would toss in a bit of Apaurin just to keep things steady.
Then infusion pumps finally showed up. That's when someone decided continuous sedation and analgesia was the way to go, adding Pavulon or later Norcuron for relaxation whenever needed.
After that, we moved to a continuous mix of Fentanyl and Dormicum (we'd take 3 ampules of 10ml Fentanyl plus 18ml of Dormicum—totaling 50ml in a syringe—and put it all on the pump).
Then Sufentanyl entered the picture, which we used in pretty much the same combinations with Dormicum.
Honestly, those Fentanyl combos are still being used today, and they seem totally fine to me.

Eventually, Propofol rolled in and slowly became the gold standard for continuous sedation.

Oh, I almost forgot to mention using Thiopental for continuous sedation too. It’s especially common in neurosurgery or when you need to induce a coma. Just load up the Nesdonal on the pump and let it rip!

I should also mention that we sometimes use Anacond. It's this clever method where you basically turn a ventilator into an anesthesia machine. You draw up Sevorane or Forane into a 50ml syringe, hook it to the pump, and connect it via a special applicator directly to the ET tube or cannula. Once you turn the pump on and adjust the flow, the ventilator delivers an inhalation anesthetic with every breath to keep the patient sedated. It’s not super common, though, and doesn't have a massive range of uses.

Alexander Wright said:When it comes to induction, what’s your go-to anesthetic? Personally, I’m a huge fan of Propofol if the patient’s hemodynamics are looking solid, mostly because I can always count on those antiemetic perks and how much it settles down the hypopharynx.

By the way... do you guys see people with heart failure getting Reglan or Peporan during premedication at your hospitals... even if they're already NPO?

If we're talking about a full arrest situation, you usually don't even need to worry about those kinds of drugs... Otherwise, depending on whatever an anesthesiologist prefers, you'll either see the old-school combo of Lepto and Nesdonal, or more modern approaches using Esmeron or Hypnomidate, or just a quick Propofol bolus. For me, Propofol just feels the most elegant—it's easy to dose, clears out fast, and leaves the fewest side effects behind.

To be honest, I haven't really run into that business with Reglan and Peporan before; it seems more like a case-by-case call from the anesthesiologist rather than some standard routine.

Michelle Cook83 said:Hey fellow anesthesiologists, how often do you guys actually run into cases involving a cholinesterase deficiency?

You don't see it all that often, but it definitely happens... honestly, just like someone else mentioned earlier, those patients usually end up stuck with the breathing tube and on the ventilator a bit longer while they wait for things to "kick in"... there isn't really anything crazy about managing them, it's just part of the job.

Honestly, I’m on the same page—I don't think any of that stuff is actually necessary. Your body has its own built-in healing process, and it’ll do its thing the best way it knows how. Unless you're looking for a psychological boost, scar creams and all those other products almost certainly won't do anything else... though they definitely have one guaranteed effect, which is making it way easier to deal with the discomfort when you're trying to get comfortable in bed at night.

I’m telling you guys again... for any kind of wound on your body, honestly, just cleaning it properly with a decent antiseptic is plenty... you don't need those antibiotic powders or sprays applied locally! They don't actually do anything to help the healing process at all... don't go throwing your money away for nothing...

I've got some stuff regarding the JIL... I'll shoot you the details via DM shortly...

I’m honestly taking this as some kind of weird joke, so I’ll just head out without reporting anything. Just a heads-up, maybe don't start these kinds of mindless threads on the main forum next time.

Gary Miller61 said:How does Octenisept actually work? I used it on a cut once and was honestly shocked by how much it didn't sting compared to stuff like rubbing alcohol.

So basically, it’s a disinfectant specifically formulated for mucous membranes, whereas Bivacyn is an antibiotic... I don't know the exact ingredients off the top of my head, though... maybe just give it a quick Google search...