Posts by Sam Hall15

Generally speaking, a lumbar puncture serves as the primary diagnostic tool for identifying meningitis rather than brain imaging, though complications arising from the condition can often be detected through imaging techniques.

This is actually the opposite of "pigeon chest," which is what you're describing. It’s essentially a natural malformation, but since yours is so subtle, it shouldn't cause any functional issues like reduced lung capacity. If you're looking for more specifics, you should definitely check in with your doctor, though you could also look up pectus excavatum online—just keep in mind that medical info can be easily misinterpreted...

Nora, you've been in anesthesia for five years now, which means you're essentially in the middle of standardizing your specialization across the entire US. Your shifts during residency, and even after you're finished, will depend entirely on the needs of whichever hospital system you join. In major medical centers, people can really steer their careers toward specific interests—and if they have the drive, they can tackle just about anything. However, in smaller facilities or places facing an anesthesiologist shortage, you won't have much choice; you'll end up doing a little bit of everything. Naturally, that brings the question of job quality into play. During your training, you'll rotate through various branches of anesthesia and intensive care. If that's your goal, you can certainly push yourself to cover all those bases, including resuscitation, which touches upon almost everything. You’ll also rotate through several internal medicine specialties and neurology, though I'm not entirely sure about pediatrics. In practice, it becomes quite an individual journey based on your own goals, as you'll likely dedicate more time to certain areas.
I hope this helps at least a little.

Rachel, don't worry about the surgery or the anesthesia. Dosing based on body weight is just one of many parameters considered when administering anesthetics, and even then, it's really just a rough guideline. Ultimately, dosing is highly individualized; it's actually part of an anesthesiologist's skill to balance various medications to achieve the best possible anesthesia. Even between two people of the exact same weight, medication dosages will typically vary quite a bit, as every case is unique.

James King9, the options for general anesthesia are actually quite broad, so you don't need to worry about your next procedure being ruined by nausea. Just be sure to let the anesthesiologist know you had a rough time after your last surgery; if you're healthy enough, they should be able to use agents that won't trigger vomiting, and even when using the same anesthetic, there are ways to prevent that nausea from happening.

It is possible that the vein is inflamed, so you really should see a doctor for an examination; in the meantime, you can apply cold compresses

Generally speaking, if I may just circle back to the beginning of this discussion, the minimum lethal dose for an average adult is roughly 40 mL—just providing some information for academic purposes 😉

Alexander Lewis said:In my view, what happened here was nothing short of irresponsible medical care. A total breakdown in communication that results in a lack of pain management—leaving a patient to suffer needlessly—is pure negligence and deserves consequences.

If we don't take action after incidents like this (whether through lawsuits, formal complaints, or protests), we aren't just telling lazy staff that they can prioritize their cigarette breaks over quality work; we're also increasing the likelihood that someone else will have to endure the same agonizing experience.

Maybe the staff isn't entirely to blame, and some of the fault lies with an institution that overburdens its employees (though under the Hippocratic Oath, doctors shouldn't accept substandard conditions that harm patients). However, until people start holding both the staff and the institutions accountable for poor performance, patients and overworked medical professionals alike will continue to suffer, as all these grievances are simply swept under the rug.

I agree that the general state of communication in our hospitals needs a major overhaul, along with a better understanding of the anesthesia process itself. Many surgeons, and by extension their nursing staff, don't fully grasp it, not to mention other physicians. There are plenty of reasons for this, but I won't dwell on them to avoid making insinuations. That said, had the doctor and nurse bothered to check the anesthesia report from the surgery, they would have seen that the child received absolutely no analgesia. At my hospital, being aware of these situations, we tend to take the path of least resistance and administer an analgesic ourselves right as the child leaves the operating room.

Increased hair growth certainly has its underlying causes and requires proper diagnosis; however, in this particular instance, we aren't actually dealing with hirsutism 😁

fadeddrifter262 said:My child is 1 year and 11 months old and was hospitalized at the local children's hospital two weeks ago due to a fractured forearm. They performed a reduction under general anesthesia and applied a cast up to the shoulder. I don't know exactly what kind of anesthesia was used since it was an emergency, but based on the IV line she had in her hand, I assume it was intravenous. The procedure and recovery went well, and she was discharged after four days. At the first follow-up, they found that the bones had shifted, so she was hospitalized again for another reduction. Again, I wasn't informed about the specific type of anesthesia, but this time she didn't have an IV in her hand. After the procedure and a 15-minute sleep, the child woke up and cried in pain for the next five hours. I asked for some pain relief, but the nurses told me she had already received pain medication along with the anesthesia. After five hours, she was given a suppository and fell asleep within fifteen minutes. She was discharged the same day, and as we were leaving, the nurses seemed surprised that she didn't have an IV line.

I am asking for your help and advice!

What kinds of anesthesia could have been used? Did she actually receive any pain medication during the second procedure, or was that just an oversight by the nursing staff?
And finally, I read somewhere that children who undergo general anesthesia more than once might face learning difficulties later on. Does anyone have any information regarding this?

In the case of a second procedure, it was likely inhalation anesthesia. This is incredibly convenient for kids, but the catch is that they don't always get post-operative analgesia during the anesthesia itself. The staff taking over the little one at the ward really should have been warned about that. It seems the nurses made a mistake by not checking what kind of anesthesia was administered, wrongly assuming the child had already been given pain relief. Personally, I wouldn't worry about any potential impact on cognitive function.

Angela Wright said:It’s because it feels easier to just wait for "someone else" to fix things.
I agree with someone earlier who mentioned that people aren't just unaware of their rights, but their responsibilities too.
I work for a cancer support nonprofit. We started out as volunteers, but eventually, things required a much more serious and professional approach—largely due to the exact reasons being discussed in this thread.
The truth is, the system is broken, but that system is built by everyone in this society: the medical staff, the patients, and every citizen. When both sides stay silent about the issues and irregularities they encounter, then in the eyes of the government, the problem doesn't even exist.
Here is a very real example from the daily grind of oncology:
waiting three months for radiation treatment isn't just an anomaly; it’s essentially a death sentence for people who actually have a very high chance of surviving and going into remission. Rarely does a doctor tell their patient that this delay isn't normal. Likewise, many patients who realize how wrong this is choose not to speak up publicly and say: I've been waiting three months for my tumor radiation!
Some are afraid of offending "the doctor," while others just don't want their diagnosis made public, and so on. But clearly, they aren't afraid of the fact that the tumor will kill them if the treatment protocol isn't followed.

Let’s talk about individual responsibility. I’ll focus on oncology since that's my area, but it ties back to the original post.
In the US, we still see far too many deaths from types of cancer that could be prevented or caught early through responsible behavior—things like regular checkups, early screening, and maintaining a healthy lifestyle and diet. If we look at it pragmatically, catching these early minimizes both the physical toll and the cost to the taxpayers.
Specifically, colorectal cancer is one of the most common malignancies. Through screening and early detection, it can be cured in 90% of cases! Our flawed system has launched screening initiatives where free occult blood tests are mailed directly to the homes of people over 50, which is the most at-risk group. The tests are incredibly simple: you collect samples for three days, put them in the kits, and mail them back using the prepaid postage provided. The response rate is only 30%. In some areas, it’s practically negligible.
Then, once the disease takes hold—often after it has already metastasized to the liver—people rush to the doctor, panic sets in, and it becomes a cycle of chemotherapy, different lines of treatment, varying results, and incredibly expensive medications costing upwards of $0.00$30,000 per month, all while facing total uncertainty.
We also have young children suffering from rare tumors that cannot be easily detected or prevented. Their treatments can cost as much as $0.00$100,000 per month. The government is strapped for cash. That money was essentially wasted by those over 50 who felt that their health screenings were none of anyone else's business.

None of us can point fingers at anyone else. We have a healthcare system and hospitals that are exactly what we deserve.😳

👍

casualcobra Asks:
Hello, I have a quick question regarding septoplasty surgery. What type of anesthesia is typically used, and how is ventilation handled—is endotracheal intubation required? I’m scheduled for this procedure soon, but I am honestly terrified of the anesthesia part... 😢

General endotracheal anesthesia will be used; the patient will be intubated orotracheally, just like 99% of other general anesthesia cases, meaning the nose remains clear. As for the anesthetic itself, the approach depends more on the individual patient than on the fact that it’s a septoplasty. They will almost certainly start with IV induction followed by balanced anesthesia—a combination of IV and inhalation agents. Don't worry, everything should go smoothly... Good luck.

copperraven53 said:Thanks for the advice. 🙂

Just wanted to give a quick update. The doctor decided my cold wasn't severe enough to delay things, so they went ahead with the procedure. It was a cyst puncture with sclerotherapy. The whole thing took about 25 minutes; they gave me anesthesia through a mask (I can't recall the technical term 😁) instead of intubation, though I did get an injection beforehand that made me feel incredibly dizzy. Everything went fine, even though I was pretty anxious about it.

That lovely Propofol.....

It isn't standard practice to ask for blood donations for a specific patient—that's usually a request made when there's a shortage of a certain type—but that doesn't guarantee they'll receive the exact amount needed just because someone found a donor to "offset" their requirements.
I believe you might be under the misconception that this is somehow mandatory.

crimsonnomad61 said:A question for Dr. Pella or Anthony Dubledore.

My five-year-old son is scheduled to have his third wisdom tooth removed this Tuesday. For the last two days, he’s been complaining of headaches, and I'm getting nervous about the anesthesia since we aren't sure what's causing the pain. What should I do?
Thanks in advance for any advice.

If these headaches have been going on for a little while, you really ought to run some basic tests. It could just be a simple upper respiratory infection, but it might also be psychosomatic—essentially him projecting his fear of the surgery through physical symptoms. Either way, take him to see his pediatrician first. Once you have those results, bring them to the anesthesiologist. If the pediatrician doesn't find anything major, the anesthesiologist will make the final call based on the labs and their own exam. I know that sounds a bit vague, but without more info, there isn't much else I can say. If you have more details, let us know and we'll try to be more specific. Good luck!

Do you think waking up would feel any different if we didn't use Lepto during induction? I'd say yes. While deep inhalation anesthesia alone can provide enough relaxation, you'd have to hit a significantly higher MAC to achieve that same level of muscle relaxation provided by a relaxant—which, let's face it, isn't usually necessary. It would likely be lower than what's required during an inhalation-based induction, but certainly higher than maintenance levels (though I haven't actually tried that myself yet).

Are you certain you're looking for type O blood? You haven't specified the Rh factor either, which seems suspicious given how common those types are... at least in American hospitals.

Alexander Wright said:khm... for a myasthenia patient, the best bet would be to ditch non-depolarizing relaxants entirely... you could induce with succinylcholine for intubation, then switch to high-dose Sevoflurane, and you'd likely hit adequate relaxation for pretty much any surgery.
If you're dealing with a Whipple procedure or some neurosurgery, maybe throw in 2 milligrams of Pavulon and you'll be fine... besides, they're heading into shock anyway, so it doesn't really matter when their strength returns.

Of course... it all depends on how severe the myasthenia is. If someone has a decent quality of life just on Mestinon monotherapy, then underdosing Norcuron might work, but if they need steroids or even plasma exchange, stay far away from non-depolarizing agents like the plague.

I'm curious about your personal experience, or anyone else's who has worked with patients like this. Why avoid relaxants if they respond well to antagonists? There isn't any actual long-term risk of worsening the disease itself by using them.
They get Neostigmine, spend a little time in the PACU, and if everything looks good, they head back to the floor.

Anonymous said:Look, feralharbor89,
before you drown us out with all that applause, take a second to actually read what these "on-call doctors" have been posting. You'll see just how much advice and genuine support they've provided to people in need right here on this forum. They do all of this pro bono, in their own free time, too. It’s a shame you aren't checking the private messages, because that's where even more questions get answered.
At the end of the day, we're just trying to fight against medical stereotypes and stop people from playing doctor without any training.🙂

😉 👍 🙂

I understand why people find it easier to relate to laypeople, especially those who have walked a similar path, but that doesn't make them competent to give advice—certainly not the specialized kind, right...

It looks like you really took quite a beating today 😁
I believe the main point here was simply to highlight that kidney surgery isn't exactly a walk in the park. Even if some might perceive certain procedures as straightforward, there are always a million underlying complexities that aren't common knowledge...