Increased sphincter tone

[Beck928]

For all you anesthesia experts out there, I have a question. Being an MSIV on my second anes rotation, I have seen much of the day-to-day grind. I took anes trauma call last night to get a different perspective and saw some of the scarier aspects of anesthesia. All the cases seemed to have some element of "oh my god", from a peritracheal hematoma to aspiration of gastric contents (thanks to the surgical resident who LET GO of cricoid pressure) to rapidly dropping sats. So my question is, when you finish residency, do you feel like you are adept at handling these things? Does it all depend on your training and what you've seen there? Also, how many times in the typical week/month does your sphincter tone increase like this?
I had a great time and was totally NOT bored, but I wonder how stressful this could be if you didn't feel capable of managing these complications.

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[Tenesma]

in order to be good at what you do you will always need a certain amount of rectal tone ....

by the end of residency - nothing should scare you anymore... You will have engrained in your mind certain steps, tricks and a better understanding of physiology that will get your butt out of trouble pretty quickly... But the biggest difference is that you will actually find yourself in far fewer pickles then during residency, since with experience you will be able to predict what can and might go wrong, and therefore pre-empt situations before they happen....

 

[militarymd]

in order to be good at what you do you will always need a certain amount of rectal tone ........

Or you could just wear Depends....works for me

by the end of residency - nothing should scare you anymore...

I don't know...I finished my residency in 1997....lots of things still scare me....I know how to handle them as well as the next guy, but they still scare the hell out of me.

 

[Tenesma]

your defnition of being scared must be different from mine then...

My perineum still forms a very tight knot at times - but i am not per se scared.... I think the word scared is more appropriate in the situation where you don't know how to manage a problem or you don't know the outcome of a situation. IE: i used to be scared of running down to the ER for difficult intubations when i was a resident.... I am no longer scared, but i definitely could make diamonds out of carbon w/ my anus

 

[jetproppilot]

Or you could just wear Depends....works for me




I don't know...I finished my residency in 1997....lots of things still scare me....I know how to handle them as well as the next guy, but they still scare the hell out of me.

Man, and I thought you wielded The Force. I'm taking The Force from you now.

I agree with Tenesma in that when you say you're "scared" its all in the definition of what you mean. You're more uptight than scared I'm sure.

Scared is being forced off the road in the french quarter by two pissed off bruthas on motorcycles while you sit in the back of a minivan taxi with your wife after dinner at the Foundation Room (and way too many bottles of cabernet), because they were pissed the taxi driver pulled out in front of them, and watching one of the dudes in a rage get off his bike, after he parked his bike in front of the cab so the driver couldnt leave, walk over to the driver's door while yelling "GET OUT MUTHAFU&&ER!!! GET OUT!!!!" He angrily flipped the lock door handle while continuing to yell obsenities. Driver calls 911....

Now THATS SCARED!!!

True story. Ya'll be careful in New Orleans if youre commin.

 

[UTSouthwestern]

Man, and I thought you wielded The Force. I'm taking The Force from you now.

I agree with Tenesma in that when you say you're "scared" its all in the definition of what you mean. You're more uptight than scared I'm sure.

Scared is being forced off the road in the french quarter by two pissed off bruthas on motorcycles while you sit in the back of a minivan taxi with your wife after dinner at the Foundation Room (and way too many bottles of cabernet), because they were pissed the taxi driver pulled out in front of them, and watching one of the dudes in a rage get off his bike, after he parked his bike in front of the cab so the driver couldnt leave, walk over to the driver's door while yelling "GET OUT MUTHAFU&&ER!!! GET OUT!!!!" He angrily flipped the lock door handle while continuing to yell obsenities. Driver calls 911....

Now THATS SCARED!!!

True story. Ya'll be careful in New Orleans if youre commin.

Jet, if I'm that cab driver, I don't give a rat's a$$ if that bike is parked in front of me. I'm peeling out and anything or anyone in front of me is about to become hamburger meat.

 

[Disse]

"Scared" vs. "Sphincter tone" sound, in this thread, like the same thing.

So.. I'd like to add another term of "panic."


Panic seemed to start on the first day you're left alone as a CA-1 and decreases (in a stock market up/down herky-jerky fashion) from then on.

Speaking as a resident, as you see and do more, you start appreciating (though never enjoying) those scared, sphincter-tightening moments--I tend to call them "educational experiences" as in "Oh, my call was interesting we had an emergency rebleed and rapidly forming neck hematoma in a 45 yo gentleman s/p thyroidectomy who was getting hoarse, ate a tuna sandwich an hour ago, and the senior surgeon didn't want to open the neck under local.. it was quite the educational experience."

Panic, though, is what residency is designed to get rid of. Panic implies lack of control. That you, for some reason, can't think clearly and can't anticipate what needs to be done next. You don't need to have done every single possible permutation of every case by the end of residency--what you need to know is how to think critically, evaluate possible decisions and act decisively when those permutations appear and not panic. I'm just a resident though so I'll let the salty old timers add more.

 

[jetproppilot]

Jet, if I'm that cab driver, I don't give a rat's a$$ if that bike is parked in front of me. I'm peeling out and anything or anyone in front of me is about to become hamburger meat.

I concur, dude. I concur. Fortunately the police showed up pretty quick and quelled the situation....

 

[jetproppilot]

"Scared" vs. "Sphincter tone" sound, in this thread, like the same thing.

So.. I'd like to add another term of "panic."


Panic seemed to start on the first day you're left alone as a CA-1 and decreases (in a stock market up/down herky-jerky fashion) from then on.

Speaking as a resident, as you see and do more, you start appreciating (though never enjoying) those scared, sphincter-tightening moments--I tend to call them "educational experiences" as in "Oh, my call was interesting we had an emergency rebleed and rapidly forming neck hematoma in a 45 yo gentleman s/p thyroidectomy who was getting hoarse, ate a tuna sandwich an hour ago, and the senior surgeon didn't want to open the neck under local.. it was quite the educational experience."

Panic, though, is what residency is designed to get rid of. Panic implies lack of control. That you, for some reason, can't think clearly and can't anticipate what needs to be done next. You don't need to have done every single possible permutation of every case by the end of residency--what you need to know is how to think critically, evaluate possible decisions and act decisively when those permutations appear and not panic. I'm just a resident though so I'll let the salty old timers add more.

No more to add. Well said.

 

[Tenesma]

i agree... panic is the word...

 

[Monty Python]

....one of the dudes in a rage get off his bike, after he parked his bike in front of the cab so the driver couldnt leave, walk over to the driver's door while yelling "GET OUT MUTHAFU&&ER!!! GET OUT!!!!" He angrily flipped the lock door handle while continuing to yell obsenities. Driver calls 911....

Now THATS SCARED!!!

True story. Ya'll be careful in New Orleans if youre commin.

JPP:

I highly recommend the following:

1. Glock model 27 (minicompact .40 cal S+W, almost fits completely in the palm of my hand, immune to rust).

2. A concealed carry permit. Louisiana state law says the State Police "will" (as compared to "may") issue a CCP to citizens who meet the eligibility criteria. Best $100/4 yrs you'll ever spend. Let me know if you need their phone number.

With apologies to those offended by gun postings on this forum.

 

[Willamette]

JPP:

I highly recommend the following:

1. Glock model 27 (minicompact .40 cal S+W, almost fits completely in the palm of my hand, immune to rust).

2. A concealed carry permit. Louisiana state law says the State Police "will" (as compared to "may") issue a CCP to citizens who meet the eligibility criteria. Best $100/4 yrs you'll ever spend. Let me know if you need their phone number.

With apologies to those offended by gun postings on this forum.

The 27 is a GREAT choice. And (minor point) I believe that it is "Shall" rather than "Will." Either way, it means that the county sheriff (or whoever issues the permit) has NO CHOICE but to grant your CCW if you meet certain requirements.

Willamette

 

[anesthesiadrew]

On a second note about CCW, it will put you in all cop's good graces at other times if you are extremely upfront about having a gun if you ever deal with them. Say you get pulled over for instance, my CCW is hanging out the window and I tell them up front a weapon is in the vech. Individual cop's response will always be different. One wanted me to hand him the gun from under my seat, I politely declined and requested to step out of vech, he can get the loaded gun himself. Momma didn't raise no fool.

Most are extremely at ease after they find out you are a law-abiding (speeding was my cause for being pulled over) and gun-respecting citizen. They deal with society's POS on a daily basis and I think it is almost refreshing to meet an honest person every now and then.

Can vouch for "baby" .40 Glock, put on left leg ankle holster and no one is the wiser. What is kewl about Glock is they are of absolute quality and the full size clips will fit the baby Glock. Now that Clinton's 10 round ban on clips is out, strap on a Glock with standard clip, then pocket one of the 15 round double stacks. Your golden. Spend the extra money on Tridium sights and you have a domestic peacekeeper that will last you a lifetime.

Of course, my CCW permit explicitly states that I will most certainly be illegal to carry "where alcohol is to be consumed on the premises". Perhaps that is a good thing for society in general. That's the great thing about an ankle holster, unless you got high water's on expecting Noah to come by, nobody's gonna know.