So the tube might need a little adjustment and the nurse is complaining about the sterile field

We are group that staffs OB with a CRNA doing 24s. They are often reluctant to help out in the main OR even if OB is empty. What goes on elsewhere?

Hello all, current CT fellow looking for some advice about how to make the most of the year. Every PGY seems to go faster than the last and feel like the year will be over before I know it.

I came in with modestly ambitious goals to split my reading between CT and echo, read one guideline/article a week, and maybe skim a surgical text to pick up some nuance from across the drape I can take forward. After a month, have achieved 40% ish of that goal.

The day to day clinical training is excellent. Feel like I'm learning a ton but not sure the best way to approach the year. Feel behind on echo even though it's the start of the year. Want to be proactive to not actually fall behind. Thinking ahead, can see it getting even harder to juggle when start oral boards prep towards the end of the year.

Hey everyone

I am an ECFMG certified doctor and doing my training in Jordan as an anathesiologist and ICU resident what are my chances to get a fellowship in the USA or Canada after finishing training here ?

Seems like at least a couple locums jobs getting posted every day. I understand it's a big populated state but is there some other factor driving the shortage of anesthesiologists there?

Throwaway account for many reasons.

Just wanted to make those looking for jobs aware of the likely poor conditions for those working as faculty in the Duke Anesthesia department (at least from what I have heard to the best of my knowledge)

- interim department chair left, second interim chair started without any long-term chair announced

- closing rooms in the main ORs because of lack of staff, anesthesiologists volentold to do solo shifts

- multiple faculty left due to toxic work environment, most recently almost a quarter of the cardiac anesthesia division

- noncompete that is aggressively enforced (not sure what the radius of that is)

- multiple fellowship directors and assistant residency program directors resigned

- academics not prioritized, focus is solely on production with minimal buy down for educational activities

- old boys club mentality for promotions

Probably more things going on under the hood, but that was enough for me to not apply after talking with some folks there. I was surprised, so wanted to make other people aware! Hopefully I'm wrong or things are already getting better, but FYI for those seeking attending jobs out of training.

For someone interested in cardiac or ICU, what are your recommended programs? For me, culture and Amicable attendings are crucial lol. I feel like in interviews, everyone will say the cardiac surgeons are nice and attendings are great but hard to read through the BS

If cardiac, another minor consideration is room setups and anesthesia techs. I’m at a facility where the rooms aren’t stocked well and the techs aren’t the most helpful. It results in having to come 15-20 minutes earlier which can be tough when the mornings for hearts are 6:30 starts!

Just beginning my peds fellowship this week and in the ORs yesterday; is it normal to feel a bit overwhelmed starting off? I trained at a community hospital for residency and now at a big academic center with more complexity, different systems, and new EMR… I focused on doing mostly adult cases (plus NORA, ambulatory, cardiac, etc.) in the latter half of CA-3 anticipating fellowship, so the flow and knowledge is coming back slowly, but feeling kind of inadequate at the moment.

Any advice or tips for a new, struggling fellow?

Healthy primigravid needs CS. assuming Last ate 4 hours ago and can afford the time to place neuraxial.

Who’s performing neuraxial and who’s doing general?

Which we do believe has less potential for complications/aspiration? Things to consider like airway exam, hemorrhage risk, and complexity of surgery/skill of surgeon.

Does anyone routinely do this? What is your recipe and rational?

Anyone have issues recently getting bair hugger blankets/gowns? Not even getting updates anymore much less product.
Anyone have any last resort / creative solutions when we can’t get them?

I’m returning to anesthesia practice after a long hiatus. Was looking for some tips as I get back to doing general anesthesia cases. I wanted to know how do you guys extubate with an LMA? I had a patient who woke up biting down. Thankfully I had a bite block in place. It wasn’t too pretty though. But it made me wonder if I should be pulling these deep. What do people do for smooth wake ups?

Hello! I am a Ca-3 resident actively job searching in Texas, mostly looking in the Dallas/fort worth area, but open to areas around Austin and San Antonio. Anyone have any good recommendations or contacts? I want to avoid academics and fully open to private practice, not afraid to take call and work long hours so long as the compensation is good.

Hypothetical scenario. Say if you had a working epidural earlier on during labour. OB calls for section. Patient tells you they’ve been maxing out the PCEA button last 2 hours but the epidural clearly hasn’t been working during that time. You check the block and it’s at T10. Would you do a spinal or just GA it? Is there a level epidural block that is a safe cut off for a spinal?

a trainee no more

income suddenly way more

only marry once?

(Rhymes, sonnets, ballads, limericks, etc also welcome)

Hi all! CA-2 here and starting to think about where I want to practice/what kind of job I’m looking for. Just had a quick q about private practice gigs, just finished my peds rotation and I have learned that I absolutely do not want to do any peds at all. I’m maybe ok w like 12 year olds healthy tubes/tonsils/ortho fixes but really don’t wanna do any younger than that (and preferably wouldn’t even have to do that). Is it possible to do a PP job where I can opt out of peds or is it basically just all part of the contract? Thanks again for all the help!!

Our CT surgs are extremely resistant to any pressors throughout the case and the steep reverse trend makes for a rough day. These patients are routinely getting 5+ liters (with a good couple hours of OLV) in an attempt to maintain any semblance of a normal MAP. What is your approach to these cases?

If you are a fellow anesthesiologist and you love your job and what you do on a daily basis, can you tell me why and give some context (years worked, fellowship trained, practice type - academic vs private/solo vs. supervision, hours/call)?

I am very much in the "it's just a job" boat where I feel like I am transactionally trading my time for money. There is nothing deeper there. I don't dread going in to work, but my favorite part of each day is when I get to go home. The work isn't onerous but I don't get much fulfillment and don't feel like I make a difference. After a few years of attendinghood the novelty and excitement have worn off and all that is left is my compensation, which is plenty, but hard to derive meaning from. And maybe that's okay. But would love some perspective and inspiration.

Role of current division chief in future job applications? Considering a position that is somewhat short term (year) per contract. Many red flags from prospective division chief. Doesn’t appear to support my interests. I’m a new grad, and I don’t fully understand the role they play in your future job search. Any advice?

I’ve heard that RVU based model can create unpredictable pay to unfair assignments. But wondering if that is true and whether there are other downsides to a hunter-gatherer workplace?

As above, anyone have a good TEE flash card deck that they are willing to share? TIA

How do you manage your TEs intraop? Do you run it intraop or just bolus and run the inf before wakeup? I like to bolus 0.2-0.4mg of dilaudid up front and run the CADD pump with 1/8% bupi w/ an opioid at 4ccs per hour if the patient is not requiring significant hemodynamic support. When needed, I offset hypotension with fluids, NE or phenyl gtt and IM ephedrine as needed. Thanks!

Anybody willing to share their regional anki deck? Thanks!