How many think the ASA should stick to anesthesia?

[Outrigger]

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Trying to invoke JFK, the ASA Monitor has declared that "We are all Ukrainians". While I am not a Russian (who may vigorously deny being a Ukrainian) nor am I in favor of this war, I don't see what any of this has to do with anesthesia or why it has to be front page on the ASA Monitor. The tiny link mentioned is that since we are doctors we should care about the suffering. I do deeply care about those suffering in this war but such a flimsy excuse to put it in the ASA Monitor could equally apply to a million other causes under which people suffer. Nowhere does it mention how anesthesiologists are coping under the conditions or the state of anesthesia care because of the war - two reasons I could see for this editorial's inclusion. It is instead a purely political piece about the war.

There are a million other news sources reporting if we want a commentary on the war.

Am I off base here? I don't mean to sound callous at all but am simply tired of the ASA delving into political matters that do not have a direct connection to the practice of anesthesiology.

 

[Mman]

corporate (or in this case professional) virtue signaling

 

[coffeebythelake]

If the article isn't about sending medical supplies or help to Ukraine or neighboring countries for their refugees... can't quite see the professional relevance.

 

[nimbus]

#IstandwithTigray

We are all Tigrayan.

 

[LaryngoSpazz]

OP - couldn’t agree more. It would be one thing if the ASA was doing a good job of tackling issues important to us such as declining reimbursement, CRNA encroachment, etc…. Instead they are ok with the term Physician Anesthesiologists and did not fight back when CRNAs used the pandemic to become independent practitioners.

The ASA should be laser focused on protecting our interests rather than wading into politics.

While we are on this subject how do you all feel about the ASA paying independent consultants ($$$) to create the Diversity, Equity, and Inclusion survey that was sent out last year. Or the article in the April 2022 ASA monitor on Health Equity curriculum that is now ongoing in our residency programs. Major buzzwords in the curriculum include structural racism, power & privilege, microaggressions, unconscious bias-mindfulness. I don’t see how this should be required learning in anesthesia.

I shouldn’t have to say this but I am all for inclusivity. I make a point to treat all my patients the same regardless of where they come from or what they look like. When I read the details of this curriculum it seems like they are suggesting we treat people differently based on their appearance and background, which to me seems quite counterproductive to equality.

Do any of you feel this way too or am I just a product of a structurally racist system and my power & privilege is getting the better of me?

 

[CHARLESTONMMM]

I’m afraid to comment out of fear of being cancelled.

 

[GassYous]

i'm not ukrainian

 

[coffeebythelake]

i'm not ukrainian

Hashtag that
#notukranian

 

[secretasianman]

they are so out of touch..

 

[ChiDO]

It's what our woke culture has become. Let's cater to the 0.1% of people who scream the loudest.

It's just like in medicine, 1% of your patients cause 99% of your problems/phone calls/etc

 

[GravelRider]

It's what our woke culture has become. Let's cater to the 0.1% of people who scream the loudest.

It's just like in medicine, 1% of your patients cause 99% of your problems/phone calls/etc

It’s not new, though. It’s more noticeable and easier to track in the days of hashtags and social media, but appealing to feelings of solidarity has always been an effective marketing tool. It makes me wonder how many millions (billions?) of dollars were made using 9/11 in ad campaigns.

Marketeers have no shame and the affluent corners of the world are pretty universally against this war, so might as well take advantage of that sweet solidarity. “Woke,” “wokeism,” and “virtue signaling” are new words, but the marketing itself has been with us for at least a half century.

 

[linkin06]

I stopped wasting cme money on them. Better to use it for a conference in a nice spot. ASA is a joke.

 

[Tony C anesthesia]

I stopped wasting cme money on them. Better to use it for a conference in a nice spot. ASA is a joke.

same here. Paying the ASA annual membership is so dumb.

 

[anesussy]

I’m afraid to comment out of fear of being cancelled.

Just use the uno reverse on them. Caring so strongly about Ukraine is racist bc white people don't care about black/brown people with the exact same issues. Literally there are news articles of countries welcoming Ukrainian refugees with open arms when just a few years back they were saying "F off, we're full" to black/brown refugees.

 

[pgg]

Useless organization does something useless to draw attention to itself. News at 11.

 

[Planktonmd]

I tried to find the link for donating money to Syrian refugees on the ASA web page but it's not there surprisingly!
Maybe they forgot to react to that humanitarian crisis???

 

[dabears505]

Haha love the hypocrisy. The outrage! Yet do people not remember we just recently invaded a country over false pretenses. And we have the galls to try and charge putin for war crimes.

The only war the ASA should be concerned about is ours against the crnas.

 

[aafisahar]

Haha love the hypocrisy. The outrage! Yet do people not remember we just recently invaded a country over false pretenses. And we have the galls to try and charge putin for war crimes.

The only war the ASA should be concerned about is ours against the crnas.

war crimes is victor's justice. if we lost WWII, it would have Allied officers hanging at Nuremberg. Likewise, what we did in Iraq and Afghanistan dwarfs what's going on in Ukraine. Suspect it's two things, one is that there is relatively little sympathy for muslim populations (eg see the uyghur mess) and obviously, the US is the strongest power able to wipe out the Hague if anyone attempted to charge American officers. I don't disagree that Putin deserves to be put on trial at the Hague, I also know the nuclear weapons he possesses are a great deterrent against any war crime prosecution.

 

[D P356]

It's what our woke culture has become. Let's cater to the 0.1% of people who scream the loudest.

#Disney#DeSantis

 

[nimbus]

Just use the uno reverse on them. Caring so strongly about Ukraine is racist bc white people don't care about black/brown people with the exact same issues. Literally there are news articles of countries welcoming Ukrainian refugees with open arms when just a few years back they were saying "F off, we're full" to black/brown refugees.

At our own southern border, Ukrainians are currently getting a pass while Mexicans, Haitians, Hondurans, Salvadorans, who are in as much risk of death are turned back. About 500/day are waved through at one port of entry.

 

[anesussy]

At our southern border, Ukrainians are currently getting a pass while Mexicans, Haitians, Hondurans, Salvadorans, who are in as much risk of death are turned back.

Yeesh. Sadly, though, not surprised.

 

[nimbus]

war crimes is victor's justice. if we lost WWII, it would have Allied officers hanging at Nuremberg. Likewise, what we did in Iraq and Afghanistan dwarfs what's going on in Ukraine. Suspect it's two things, one is that there is relatively little sympathy for muslim populations (eg see the uyghur mess) and obviously, the US is the strongest power able to wipe out the Hague if anyone attempted to charge American officers. I don't disagree that Putin deserves to be put on trial at the Hague, I also know the nuclear weapons he possesses are a great deterrent against any war crime prosecution.

“No one knows with certainty how many people have been killed and wounded in Iraq since the 2003 United States invasion. However, we know that between 184,382 and 207,156 civilianshave died from direct war related violence caused by the U.S., its allies, the Iraqi military and police, and opposition forces from the time of the invasion through October 2019. The violent deaths of Iraqi civilians have occurred through aerial bombing, shelling, gunshots, suicide attacks, and fires started by bombing. Many civilians have also been injured.”

Iraqi Civilians | Costs of War

The Costs of War Project is a team of 35 scholars, legal experts, human rights practitioners, and physicians, which began its work in 2011. We use research and a public website to facilitate debate about the costs of the post-9/11 wars in Iraq, Afghanistan, and Pakistan.

watson.brown.edu

 

[deleted1130227]

“No one knows with certainty how many people have been killed and wounded in Iraq since the 2003 United States invasion. However, we know that between 184,382 and 207,156 civilianshave died from direct war related violence caused by the U.S., its allies, the Iraqi military and police, and opposition forces from the time of the invasion through October 2019. The violent deaths of Iraqi civilians have occurred through aerial bombing, shelling, gunshots, suicide attacks, and fires started by bombing. Many civilians have also been injured.”

Iraqi Civilians | Costs of War

The Costs of War Project is a team of 35 scholars, legal experts, human rights practitioners, and physicians, which began its work in 2011. We use research and a public website to facilitate debate about the costs of the post-9/11 wars in Iraq, Afghanistan, and Pakistan.

watson.brown.edu

All true. The Iraq war was probably the single greatest foreign policy mistake in the last 50 years. But the overwhelming amount of deaths was caused by Iraqis killing other Iraqis. Saddam Hussein was a barbarian who kept the other barbarians in check…until we removed him.

 

[nimbus]

All true. The Iraq war was probably the single greatest foreign policy mistake in the last 50 years. But the overwhelming amount of deaths was caused by Iraqis killing other Iraqis. Saddam Hussein was a barbarian who kept the other barbarians in check…until we removed him.

If you go beyond 50 years, then we get into Vietnam.

Was My Lai just one of many massacres in Vietnam War?

US atrocities were far greater in the Vietnam War than is normally acknowledged, writes investigative journalist Nick Turse

www.bbc.com

“While the US suffered more than 58,000 dead in the war, an estimated two million Vietnamese civilians were killed, another 5.3 million injured and about 11 million, by US government figures, became refugees in their own country.”

Some of our actions there make Putin look restrained.

 

[Drwine]

OP - couldn’t agree more. It would be one thing if the ASA was doing a good job of tackling issues important to us such as declining reimbursement, CRNA encroachment, etc…. Instead they are ok with the term Physician Anesthesiologists and did not fight back when CRNAs used the pandemic to become independent practitioners.

The ASA should be laser focused on protecting our interests rather than wading into politics.

While we are on this subject how do you all feel about the ASA paying independent consultants ($$$) to create the Diversity, Equity, and Inclusion survey that was sent out last year. Or the article in the April 2022 ASA monitor on Health Equity curriculum that is now ongoing in our residency programs. Major buzzwords in the curriculum include structural racism, power & privilege, microaggressions, unconscious bias-mindfulness. I don’t see how this should be required learning in anesthesia.

I shouldn’t have to say this but I am all for inclusivity. I make a point to treat all my patients the same regardless of where they come from or what they look like. When I read the details of this curriculum it seems like they are suggesting we treat people differently based on their appearance and background, which to me seems quite counterproductive to equality.

Do any of you feel this way too or am I just a product of a structurally racist system and my power & privilege is getting the better of me?

Anesthesiology has been a leader in diversity for over 50 years. We have a black male CRNA working for us and he shared some chilling statistics of the lack of diversity in the CRNA profession. If black nurses that emigrated directly from Africa and the Caribbean and went to CRNA school in the US were counted separately the statistics would be much worse.

Increasing Diversity—One CRNA at a Time | Campaign for Action

When Wallena Gould began studying to become a CRNA, it did not take long for her to notice that very few of the students around her were people of color. There were no professors of color either.

campaignforaction.org

 

[coffeebythelake]

If you go beyond 50 years, then we get into Vietnam.

Was My Lai just one of many massacres in Vietnam War?

US atrocities were far greater in the Vietnam War than is normally acknowledged, writes investigative journalist Nick Turse

www.bbc.com

“While the US suffered more than 58,000 dead in the war, an estimated two million Vietnamese civilians were killed, another 5.3 million injured and about 11 million, by US government figures, became refugees in their own country.”

Some of our actions there make Putin look restrained.

Of course! And when you look back 100 to 200 years at colonization of Africa, many more millions died.

 

[anesussy]

Anesthesiology has been a leader in diversity for over 50 years. We have a black male CRNA working for us and he shared some chilling statistics of the lack of diversity in the CRNA profession. If black nurses that emigrated directly from Africa and the Caribbean and went to CRNA school in the US were counted separately the statistics would be much worse.

Increasing Diversity—One CRNA at a Time | Campaign for Action

When Wallena Gould began studying to become a CRNA, it did not take long for her to notice that very few of the students around her were people of color. There were no professors of color either.

campaignforaction.org

Fact is that the reason medical auxiliaries (PAs, NPs, CRNAs) have made so much headway is because they are primarily white. You think the northeast white elites would be ok with letting them gain this much headway if they were mostly black, hispanic, or Asian? Yeah, right.

Of course! And when you look back 100 to 200 years at colonization of Africa, many more millions died.

France is still colonizing Africa to this day, and yet they're one of our biggest allies. Funny how morals go out the window when you don't actually care about the people group that's in trouble.

 

[deleted1130227]

At our own southern border, Ukrainians are currently getting a pass while Mexicans, Haitians, Hondurans, Salvadorans, who are in as much risk of death are turned back. About 500/day are waved through at one port of entry.

Politics matters. For decades Cubans refugees/immigrants have been treated differently than others seeking to come here from Latin America.

Just use the uno reverse on them. Caring so strongly about Ukraine is racist bc white people don't care about black/brown people with the exact same issues. Literally there are news articles of countries welcoming Ukrainian refugees with open arms when just a few years back they were saying "F off, we're full" to black/brown refugees.

Culture matters too. The reality is that there are more difficulties integrating peoples with different religions and cultures into your society than peoples with similar cultures and values.

 

[anesussy]

Culture matters too. The reality is that there are more difficulties integrating peoples with different religions and cultures into your society than peoples with similar cultures and values.

Probably true, but "we stand with Ukraine (and all other countries with similar religions, cultures, and phenotypes to ours; the people outside of the Anglosphere can languish on their own)" doesn't really inspire me.

 

[deleted1130227]

The only war the ASA should be concerned about is ours against the crnas.

 

[We'llBeDoneIn15Minutes]

ASA and ABA are both awful with their authoritarian politics. A decade later I'm still in disbelief and angered that the ABA stated you will lose certification if you participate in a legal court ordered execution.

Maybe under fear of decertification they should tell us what religion, political party, and sexual orientation we MUST adhere to and whether or not we can own a firearm.

 

[nimbus]

Just use the uno reverse on them. Caring so strongly about Ukraine is racist bc white people don't care about black/brown people with the exact same issues. Literally there are news articles of countries welcoming Ukrainian refugees with open arms when just a few years back they were saying "F off, we're full" to black/brown refugees.

At the San Ysidro border, some Ukrainian dogs are getting across the border in days based on asylum claims….but if you’re a central or South American human, it takes at least months. The difference in treatment is nauseating.

And why are Ukrainians coming through Mexico?? Why don’t they come directly to the US or stay in Mexico?



Ukrainians Face New Hurdle at U.S. Border: No Dogs

 

[GravelRider]

ASA and ABA are both awful with their authoritarian politics. A decade later I'm still in disbelief and angered that the ABA stated you will lose certification if you participate in a legal court ordered execution.

Maybe under fear of decertification they should tell us what religion, political party, and sexual orientation we MUST adhere to and whether or not we can own a firearm.

I don’t think it’s unreasonable for an organization certifying physicians to not want its representatives to be executioners. Our states are already shoving religious beliefs down our throats, so maybe you should shun being a member of the United States? You can be brought up on criminal charges for treating a woman who needs to have a pregnancy terminated.

 

[We'llBeDoneIn15Minutes]

I don’t think it’s unreasonable for an organization certifying physicians to not want its representatives to be executioners. Our states are already shoving religious beliefs down our throats, so maybe you should shun being a member of the United States? You can be brought up on criminal charges for treating a woman who needs to have a pregnancy terminated.

I'm not saying I would be an executioner. I most likely wouldn't, and never had previously as well. It's just not their judgement to make, regardless of their personal beliefs.

 

[GravelRider]

I'm not saying I would be an executioner. I most likely wouldn't, and never had previously as well. It's just not their judgement to make, regardless of their personal beliefs.

I don’t know, a state seems to have no problem forcing their personal beliefs on me. That’s a government forcing religion into how I make a decision regarding the care of a patient. I guess I have less of a problem if a private organization that you can voluntarily be apart of saying that you can’t be an executioner if you want to be a member.

 

[coffeebythelake]

I don’t think it’s unreasonable for an organization certifying physicians to not want its representatives to be executioners. Our states are already shoving religious beliefs down our throats, so maybe you should shun being a member of the United States? You can be brought up on criminal charges for treating a woman who needs to have a pregnancy terminated.

Hearing about all these botched executions does make me want to chime in and say, hey we can do this easily and painlessly if someone who actually knows what they are doing is involved.

 

[deleted1130227]

Hearing about all these botched executions does make me want to chime in and say, hey we can do this easily and painlessly if someone who actually knows what they are doing is involved.

Anybody who has the ability to secure reliable IV access can be given a simple recipe that will be reliable, quick. and painless. That said, It has been fooked up lots of times.

 

[Mman]

Anybody who has the ability to secure reliable IV access can be given a simple recipe that will be reliable, quick. and painless. That said, It has been fooked up lots of times.

there are IM and inhaled meds that can accomplish the job just fine without IV access

 

[nimbus]

there are IM and inhaled meds that can accomplish the job just fine without IV access

Carfentanil?

 

[Mman]

Carfentanil?

sure but you could go simple and just give them some mixture of carbon monoxide and/or nitrous and just make them sleepy and then a complete hypoxic mixture and they would arrest in their sleep

 

[GassYous]

Carfentanil?

Are we anesthetizing elephants here

 

[BobLoblaw78]

sure but you could go simple and just give them some mixture of carbon monoxide and/or nitrous and just make them sleepy and then a complete hypoxic mixture and they would arrest in their sleep

This or inhalation with 100% nitrogen.

 

[coffeebythelake]

Are we anesthetizing elephants here

Just make sure you don't use the doses that Wes Ely would use.

 

[Mman]

This or inhalation with 100% nitrogen.

I really don't know why they haven't done this somewhere yet. Completely painless and 100% lethal and seems unlikely to be subject to manufacturing shortages/bans.

 

[deleted1130227]

I really don't know why they haven't done this somewhere yet. Completely painless and 100% lethal and seems unlikely to be subject to manufacturing shortages/bans.

History. Some states did execute convicted criminals with gas. Usually cyanide which was reportedly not quick and not painless. Also the allusions to Nazi gas chambers.

I agree that 100% nitrogen or helium or something kin is most likely quick, painless and unlikely to be distressing to witnesses.

 

[GravelRider]

I really don't know why they haven't done this somewhere yet. Completely painless and 100% lethal and seems unlikely to be subject to manufacturing shortages/bans.

Wouldn’t the person develop tachypnea and be awake for a significant period of time while the hypoxia sets in? While not particularly painful, I can’t imagine it’s pleasant.

Why does it have to be drugs at all? What is wrong with the guillotine? As long as the blade is kept sharp, seems pretty quick and effective to me. As a matter of fact, I remember reading that the guillotine was actually developed as a more humane form of execution. Is executing someone with drugs somehow more civilized than the guillotine?

 

[Mman]

Wouldn’t the person develop tachypnea and be awake for a significant period of time while the hypoxia sets in? While not particularly painful, I can’t imagine it’s pleasant.

if you inhaled 100% nitrous oxide you would be at nearly a MAC of gas and would not have any distress whatsoever. You could even ramp it up slowly.

 

[GravelRider]

if you inhaled 100% nitrous oxide you would be at nearly a MAC of gas and would not have any distress whatsoever. You could even ramp it up slowly.

The original post said nitrogen, not nitrous oxide.

 

[nimbus]

Are we anesthetizing elephants here

It’s not certain but there is a theory that Russia used aerosolized carfentanyl to end the hostage standoff when Chechen rebels took over a theater in Moscow. At the time, doctors treating the victims complained that the state would not tell them what agent was used hindering their efforts to save them and many of the people in the theater died.

 

[DirtDocMD]

All this talk of “difficult IV access”. What about an IO catheter??