Hey everyone!

Before I start, this question has probably been asked to death, so I'm actually really sorry, but it's been on my mind a lot lately.

I'm an RN who's currently working in the ED that's having dreams working in the OR, more specifically being a CRNA or an anesthesiologist.

CRNA argument: I already chose the nursing path, and it would be much quicker than starting over and going into med school. CRNAs where I live make from 300k up to 500k depending on their employment status. From what I've read, you clock in and clock out and take no work home with you. While having more responsibilities, the job doesn't seem overwhelming difficult once you are probably trained. Additionally, if I ever have any difficulties, I can rely on an anesthesiologist. School cost is about 120 to 160k. CRNAs, while not as respected as anesthesiologists, are probably the most sought-after and respected job in the nursing field.

Anesthesiologist argument: This is probably fucking stupid but it's party true, I feel that as I get older (I'm still in my mid 20s) I realize that I'm going to keep getting older and I have one life, and so I want to make it count. I'm still going to become 40, might as well become a doctor, and have pride and accomplishment in my life. Talking with doctors, you can tell they have great pride in their work, and I envy their knowledge. However, probably because im young, this might be a stupid thing to think. From the doctors or other healthcare professionals I've talked to, they say becoming a doctor is not worth it. Additionally, while i might be passionate about medicine now, I'll probably have different priorities in the future. Anyways, anesthesiologists make about 500k to 700k in my area from what I've read and seen. However, 8 years of additional school is a hard pill to swallow. If I didn't want to start a family and enjoy my youth, I would do it instantly. But the idea of me truly starting my life in my early to mid thirties and losing all of my twenties to books is scary. The cost of med school is insane from 200 to 400k. I know that anesthesiology is one of the more relaxed specializations in medicine, but I'm going to assume you work more hours than a CRNA. Obviously, as a doctor with long training, you are highly respected for your career.

So I'm at this crossroads and would love some advice or just your thoughts.

Attending said patieny need more paralysis, and to repeat atracurium. I think its something else. Guidance pls

Can patients still show signs of tourniquet pain during procedures when they receive a spinal block? Was doing a total knee and the patients hr, rr, and BP all steadily increased about 70 min after tourniquet inflation and somebody had mentioned it being related to tourniquet pain.

Our group got new chairs for us to use. 10/10 and makes a huge difference in efficiency. Just wanted to brag a little.

MS3 here - enjoying my anesthesia rotation a lot so far and trying to decide on specialty choice. I can live without most parts of surgery but the one part I love is suturing. Do yal throw in sutures ever? What about critical care docs in the ICU?

So I had 20 year old female primi, with 24 weeks who had presented with renal stones , urologist said it would take 5 minutes top 10 minutes and he is fast, of course. bP=100/60, HR=88 otherwise she is goodball work up is fine. Emergency DJ insertion. How would you deal with such case, what would be your anesthesia decision. Type and preparation and all , thanks in advance. P.S i would go spinal but did think of doing TIVA.

Hey, do you guys use the predictors for difficult intubation also to predict a diffulty of LMA insertion? Or do you perhaps have your own list of risk factors? One attending told me that not everyone is suitable for LMA anatomically but I have not figured out what she meant exactly. Thank you for your advice in advance:)

Hello! Anyone have any insight about working at Jersey Shore Medical Center in Neptune NJ? Thank you!

I am having series of partial/incompete spinal anesthesia and I don't know where I'm going wrong. There is usually good csf flow and patient does not complain of pain or move legs. But surgeons keep saying the abdominal muscles are not relaxed and they can't work. I do mostly obstetric surgeries in a 3rd world country.

I keep hearing mixed opinions on where to train. Some people say that academic programs, where residents are often more coddled, might leave you less prepared for the fast pace and independence required in private practice.

For those of you who’ve gone down this path, what’s your take? Is there truth to the idea that certain programs leave you better prepared for private practice?

Also, how important is it to complete residency near where you’d like to practice long-term? Does this help with job prospects or networking?

As someone new to the game coming out of training in such a hot but volatile anesthesia market, I’m curious what others would recommend when it comes to evaluating different PP groups? Comparing them apples to apples.

Obviously there’s the salary, weeks of vacation (and how that process is structured), potential buy-in’s, call schedule, support and mentorship structure, but I’m wondering more about what a new hire can and should glean about the health of a practice; how to judge the stability of a practice with respect to hospital stipends and relationships, potential changes that could alter the partnership stake, etc. what’s taboo to ask and what’s fair game with respect to “the books”?

Thanks in advance.

Just figured I'd shoot the heads up as I didnt get an email

Wondered where's the optimal balance re documentation. Heard writing more can potentially leave you exposed medico-legally in the event of an incident etc.

What do you guys think about this? Which things do you feel should be included, and which should not - to avoid medico-legal issues or otherwise?

What are some of your go to studies to quote or show to learners?

Basic retake is this weekend for those of us who failed

Retakers, how are we feeling? Everyone else; last minute advice, words of wisdom? Anything ??

Very nervous rn

It seems to have a very low warming effect compared to no Bair hugger, despite the patient being warmer at 36-37 degrees.

I suppose 32 degrees is warmer than a room temp of 70 which is 21 degrees C.

I had a patient call me a “piece of sh!t” in preop during a prolonged profanity-laden rant after they had a bad experience with one of my partners during a previous encounter. I was professional and empathetic (as best as I could be) and they eventually calmed down, but I was pretty close to refusing to care for the patient considering their belligerence and the fact that it was a 100% elective procedure.

So my question: have you guys ever refused to care for patients who are belligerent assuming the procedure is elective? Do you try to find a replacement, give them a cool off period and come back, etc? How have you handled situations like this?

https://forums.studentdoctor.net/threads/usap-texas-suit-still-on.1499582/

Anyone interested in any USAP Texas site-Austin, Houston, Dallas should read this forum. One USAP partner who’s leaving comments and another USAP partner jumps on trying to justify their major problems.

Fair warning…danger signs around all of these USAP Texas sites

Studying for primaries and have a quick question.

I have always been taught that fentanyl has a short plasma half-life due to rapid redistribution to the peripheral compartment due to high lipid solubility.

However, currently reading and see that Vd for fentanyl is 4L/kg (3-8L/kg). Isn’t this range quite a small Vd?

Thanks,

I’m impatiently awaiting ABA CCM exam results and wondering if people who have taken them in the past got the results right at 4 weeks after or had to wait the full 6 weeks before getting them. I just want to know if I’m done with board exams forever or not so waiting for this one seems so much harder than waiting for the other 50 exam results I’ve had to wait for.

I'm not well versed in business or contract law but I have been looking up job postings online and found many 1099 positions that seem like they should be W2. These include salary, schedule, vacation time off, some benefits etc. which makes me think they should be W2 positions. Am I missing something? I thought as an independent contractor, you control when and how you do your work and you aren't scheduled as a regular employee.

Mods, feel free to delete if this post is inappropriate. I got some serious shade on the nursing sub in my DMs for posting. I am a former NTICU nurse from a level 1 trauma center and current PACU nurse at a small facility (handful of ORs, 20 beds, nurse anesthetist only) that does a substantial amount of surgery for our size. (3 full time one part time neurosurgeons, 2 full time orthos doing total joints, smattering of generals, ENT, eyes.) Spine cases include usual surgicsl center stuff plus multi level TLIFs, LLIFs, ALIFs etc and the multilevels of all types always come to me in a very high level of pain with not much I can do to get back ahead of it. My standing PACU orders allow for up to 250mcg of fentanyl and 2mg dilaudid. I'll typically give about half of that before reaching out to the anesthetist. They'll get 1g of IV tylenol if they're due, maybe some more IV methocarbamol, but then I have to send them to the floor because we're out of options or I'm just snowing them with no stated improvement in pain.

I believe our current preop and operative practice is preoperative tylenol and gabapentin/lyrica, followed by low dose ketamine/versed for the patient's pre op cervical plexus or ESP block depending on surgery. At induction the patient receives loading dose fentanyl and they all have McLott running the whole case (lately receiving the full bag as we've halved the size from 100ml to 50ml with the fluid shortage, which makes wake ups much longer obviously) 500-1000mg IV Robaxin, and if they remember--0.5mg to 1mg dilaudid prior to extubation. The other issue is the floor we admit to has nurses with very little post op experience with major surgery like this and they've somehow managed to absolutely snow some of these patients leading to rapids and strokes being called despite floor orders being the usual 5-10mg PO Oxy q4h PRN and 0.5mg IV Dilaudid q2h PRN. A few have gotten PCA pumps or epidural which apparently were managed fine.

Unfortunately none of the surgeons will allow the use of Toradol or methadone (though I question how seriously the head CRNA has pushed the issue.) I've provided studies showing the efficacy of both in managing post op pain, but in your experience is the juice worth the squeeze to continue pushing for their use?

And yes I know its odd for an RN to be asking these questions and pushing these proposals, but like I said it's a very small facility, I'm in and out of ORs helping the anesthetists all the time, and I'm very interested in anesthesia myself.

For my neuro folks: which brain tumor types (not location) tend to bleed the most? I've had mixed answers from attendings when asking about meningiomas, gliomas, astrocytomas, and craniopharyngiomas. Would love reddit's opinion as I can't find it in Miller, Barash, or Cottrell & Patel.

I am a current fellow looking for jobs now. I am interested in the Cleveland area, but can't find many prior threads talking bout it the local market. I know it's going to be mostly Cleveland Clinic, UH, and Metro, but does anyone have any information on what it's like to work for any of these organizations?

I appreciate any information!

Been using prilocaine 1% 40 ml (+4ml 8% NaBic) for IVRAs (upper extremities) for quite awhile. Duration of tourniquets 28-30 min. anything less we have side effects like nausea vertigo RR down.

Would like to switch to chloroprocaine (Ivracain 0.5%). Dosage recommenddation? Time to release tourniquets no less than 20 min, but not as long as prilocain. anybody?

I’ll kick it off: Apparently high degree of overlap between Pass Machine qbank and the actual test, tho I can’t personally attest to that.

Ready, go.

Sorry for the basic question. I’m hospital employed, and we do sooo many cataracts each week, 30 cases by noon each day. I’m so sick of them, talking to that many patients a day, mostly giving 2mg Versed, I can’t stand them. Can’t the ophthalmologist just give their own meds and do conscious sedation like the GI docs do? Is the hospital even really reimbursed well for having us there?

We're all about 8 months out from the end, how is everyone feeling? I'm pretty burnt out, loathe going into work most days. It seems like the end is never getting closer even though the days are ticking by. Although I do realize the end is coming up so trying to do as much as possible as I can, it's hard to tell if I'm depressed from residency sometimes or what

Do they mean a decrease in contractility, causes bradycardia, causes arrhythmias, or a combo of these?

Stupid question I know, but people throw this term around and I want to know what you all think it means.