Posts by Sam Hall15

Dilatation is just one possibility; there are plenty of other factors in the game, not strictly limited to myocardial issues, that could lead to an X-ray showing cardiomegaly or an enlarged heart.

Has anyone actually encountered students who truly impressed them with their insight or dedication? It seems like some folks on this board could use a little work on their own biases, acting as if students are nothing more than an inconvenience...

Oh, and just to clarify, we aren't doing full-head electrode monitoring here. Since the goal isn't to map out specific brain regions but rather to track alertness levels, we only need a few electrodes on the head—usually just four.

Because, generally speaking, teaching hospitals are designed as primary learning environments rather than general facilities. That said, students do occasionally rotate through for specific practical training required by their curriculum, though those instances are far less frequent than regular rotations.

Technically, a patient can't be fully conscious in the literal sense. However, it is possible for anesthesia to be shallow enough that certain senses, typically hearing, remain active. Alternatively, they might just be slowly emerging from a deeper state. If you combine that with effective analgesia and muscle relaxation, it becomes nearly impossible to detect without neurological monitoring like an EEG, which isn't standard practice in most American hospitals.

If you choose to go to a teaching hospital, you have to accept that there will be residents and interns on staff, which means you might receive care from someone still finishing their training... That's just how the system works, and if that doesn't sit right with you, then a private clinic or a standard community hospital is probably a better fit for you.

As I’ve mentioned before, it’s quite common for anesthesiologists to staff the clinic because they aren't heading into the OR as often, or due to various staffing shifts. Consequently, the chances of the same specialist performing both the initial assessment and the actual anesthesia are slim. That said, the clinician administering the anesthesia usually has plenty of context from the report provided by the assessing doctor. The real issue arises if a patient has specific requests or if circumstances change unexpectedly, as communication between the patient and the anesthesiologist once they are in the operating room is often limited...

😁 I agree regarding the choice of physician for Jackson. Americans can be quite reckless sometimes, handing out prescriptions to just about anyone—not to mention those mid-level anesthesia providers, though even they would be a better pick than a cardiologist... I'm just not a fan of using propofol as an induction agent, but it works wonders for maintenance and TIVA.

I am not Dr. Miller, but I will certainly try to help you out.
Paralytics aren't used for every single procedure; it really depends on a few variables. If the surgery is quick and the surgeon doesn't need the patient fully relaxed, they might just use total intravenous anesthesia—usually a short burst of Propofol lasting only a few minutes. However, if the procedure involves opening body cavities or an ENT surgery where consciousness isn't an option, they’ll opt for general anesthesia. Pain management is standard with any type of anesthesia, but muscle relaxants aren't always necessary. I haven't covered every single possibility here, just providing some basic insight... if there is a specific question, we are happy to try and assist...

Just wanted to jump in here...
Most eye surgeries are performed under local anesthesia, just as Dr. Miller mentioned, which means the anesthesiologist doesn't carry much direct responsibility in those cases. As for the pre-op assessments in outpatient clinics, it isn't a strict rule, but it’s quite common for these to be handled by anesthesiologists who don't actually work in the operating rooms for various reasons; consequently, you won't have that same doctor guiding you through the actual procedure.
Regarding the risk of "waking up" during surgery, most American operating rooms don't use continuous neurological monitoring to track anesthetic depth at every second. Instead, anesthesiologists monitor the patient manually, and seasoned doctors are often more intuitive than machines when it comes to tracking these levels. However, if an unexpected complication arises during surgery, there might be a slight delay in administering analgesics or anesthetics for a few minutes, which can lead to what's known as "light anesthesia." Lately, certain drugs like Propofol have become very popular, which can sometimes result in lighter anesthesia because patients are frequently under-dosed. There are many variables to consider during administration, and occasionally, physicians—particularly younger ones—might under-dose a patient out of caution regarding drug risks, leading to these unfortunate incidents.

Why Advil? There isn't really any causal treatment involved; it all just boils down to managing symptoms. What kind of issues is he dealing with?

If the appendix isn't filling up, there is a strong suspicion of inflammation likely caused by an obstruction—perhaps a fecalith or something else entirely... I am not sure why everyone is making such a fuss when dealing with a young patient where non-invasive or semi-invasive methods simply aren't yielding a clear diagnosis of the pathology. They should just explore the abdomen and get to work...

Could you clarify this pathology report, or better yet, transcribe it—specifically the diagnosis? It’s a bit confusing and feels incomplete, so I’m unclear on what kind of lesion we're actually looking at. Gallstones are certainly the most common cause of pancreatitis in women. That hardening of the duodenum is somewhat concerning, though, as it could potentially indicate tumor infiltration. It would definitely be helpful if you could share the full pathology findings for a more meaningful response; feel free to send a private message if you'd prefer not to post here. In any case, wishing you the best moving forward...

While an epidural can be used during a C-section, a spinal block is typically preferred because it provides superior anesthesia. Regarding the choice of method, several people here have incorrectly assumed that the patient always gets the final say. That isn't how it works; just like any other medical procedure, there are specific indications and contraindications. Doctors offer what is clinically recommended, and if a patient refuses the recommended path, they may be left without viable options. General anesthesia is a serious matter and remains a life-threatening procedure regardless of the surgery involved. This is why regional anesthesia is strongly advised whenever it is appropriate based on the patient's medical profile. Following a spinal block, we administer plenty of fluids because the procedure can cause a significant drop in blood pressure. Combined with proper positioning, this helps prevent post-procedure headaches and protects against the risk of cerebellar herniation into the spinal canal.
ps. The clinician does not decide when to attempt or cease spinal anesthesia efforts 😁

Hmm... anesthesiologists... now that is interesting...

All those tests should really be handled by a primary care physician first. If they determine that specialized follow-up is necessary, they can then refer the patient to a specialist—someone who undergoes nine years of training specifically to manage things like essential hypertension. In most cases, this falls under the scope of primary care; while there are rare instances where an internist's expertise is required, that doesn't seem to be the case here...

First of all, there isn't much room for personal opinion here; the laws and regulations are clear. Under these guidelines, a primary care physician or family doctor is not just permitted, but actually required to prescribe antihypertensive therapy...
Regarding this lady's situation, the wisest course of action for now is to stick to the twice-daily medication schedule. If her symptoms become too severe, she should consult her physician to adjust the treatment. However, the readings you mentioned are nowhere near causing hypotension, let alone any kind of symptomatic low blood pressure, as such a condition essentially doesn't exist in cases like this
The worst thing you could do right now—aside from completely stopping the medication—would be to constantly change the treatment protocol or allow for massive fluctuations in blood pressure, which, I must emphasize, is extremely hard on the body...

Potassium Chloride is primarily excreted through the kidneys, though some is lost via stool; it serves mainly to maintain intracellular gradients, among other functions. I wouldn't advise bypassing your primary care physician, though it is quite likely you'll need a consultation with a nephrologist. As for Aldactone—spironolactone—its use here seems strictly intended to conserve potassium rather than treating a renal issue that necessitates diuretic therapy.

I am not entirely sure of the underlying cause for a permanent tracheostomy, but provided there is no central pathology or remaining tonsillar muscle tissue, patients should theoretically be able to clear secretions from the oral and nasal cavities... However, the more critical point is the necessity of clearing the lower airways, which requires using suction machines to clean the trachea and bronchi...

It’s likely just a combination of an insufficient bladder outlet and some irritation in the urethral lining, so things should settle down within a few days... however, if you notice any blood in your urine, you really ought to see a doctor, and the same goes for significant pain or intense burning during urination.