Pet Peeves

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Consigliere said:
To answer your questions........

We have a pre-op clinic where every pt. (except cataracts) comes in for a pre-op visit and is seen by an anesthesiologist. That's where this magical bond that makes the pt. "comfortable for surgery" occurs. Most patients remember NOTHING about their anesthesia experience so your second question is irrelevant. Besides, I don't care what John Q Public thinks about what I do. Public perception of anesthesiologists is something I don't concern myself with (and neither does the ASA apparently).
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Wow. You're wrong on each one of these points. Other than the fact that your patients are seen in your clinic. I can't dispute that. And the ASA part maybe.
It's as if you've never spoken with someone who's had surgery before.
 
pgg said:
What about grammar critics who misuse apostrophes? 😉
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Never realized I did that. However, I do know the difference as had I spelled it out (anesthetists) that mistake would have been avoided. I know the difference between plural and possessive. When abbreviated (CRNAs) or (CRNAS) it looks funny to my eye.

I think that there are some people on here though who do not know the differences in the words I wrote about and how they are used in sentences.

This was about pet peeves. You are trying to prove a point. Point taken. Let's move on.
 
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Pooh & Annie said:
Wow. You're wrong on each one of these points. Other than the fact that your patients are seen in your clinic. I can't dispute that. And the ASA part maybe.
It's as if you've never spoken with someone who's had surgery before.
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I agree. Seeing someone weeks before surgery and the day of surgery, can be like night and day in their emotional affect.
I like to see the same patients that I will be taking care of intra-operatively ( I know, ideal world) and not patients who will be taken care of by my partners. I don't think we are interchangeable but my partners don't care either way. Even if there are two of us seeing patients, they don't care to see their own or let me see my own. They say it's the nature of anesthesia. They are older than me and have been doing this a while longer.

I am territorial, take a little time with my patients pre-op in order to make them feel comfortable and don't like them to have to meet yet another anesthesia doc right before they are asleep (I let them know about the CRNA and/or CRNA meets them pre-op). It's confusing,unnecessary and I don't think it helps any anxiety they may have.
 
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Hawaiian Bruin said:
Hyperchloremic acidosis after going bananas with liters of NS.
Bonus peeve: when that iatrogenic acidosis is misinterpreted as something intrinsically wrong with the patient.
Super bonus peeve: giving bicarb to "correct" said hyperchloremic acidosis.
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Dear gods. You got me started about an ICU case where I wouldn't trust the ICU as far as I could throw Mount Everest. Run by a bunch of ICU people who either really need to be put out to pasture permanently or shot.

Guy comes in for bowel resection for complete obstruction with active carcinoid. Too unstable to finish and closed night before, attending on that case ran through several sticks of vasopressin. Sent to ICU overnight. Comes down to me next day with no less than THREE liter bags of normal saline. Heard he got FIVE liters of the stuff overnight. NO BICARB correction bag.

Saline bags were on pumps, piggyback on piggyback to the Cordis the attending anesthesiologist put in the night before. Hypotensive/unstable. Where does the ICU put the pressors that weren't hitting him hard, and the octreotide?

In the bloody 18g PERIPHERAL IV >.<

Chloride was 117, BTW, as well as a pH lower than what I would like as a human. No wonder the pressors were doing squat.

Attending let me run the show. Stayed to sign him back into ICU because 1) we were short staffed for room help that day, and 2) I wanted to get this poor man optimized as I could. Reward: going home just after lunch the next day.

I switch all but one bag out for PlasmaLyte, hoping the acetate would buy me a stronger buffer system, switch lines to appropriately put the central line stuff central. Had to push bicarb to try to get the pressors to work. By the end and on arrival to the ICU, he was off pressors (used only a 2 units of vasopressin push throughout the case,) and was stable under GA, and a somewhat normalized physiology.

Attending, Attending surgeon, the senior surgical resident, and I all went to the ICU. All of us said to keep him on PlasmaLyte or LR if not available. No normal saline. Documented in post-op check notes by all of us.

Come in the next day? HALF NORMAL saline. By the closed (minded) ICU attendings orders. Surgical resident and I were infuriated. Documented our previous recommendations in notes.

I have never wanted to channel Alec Balwin from Malice while I was working in the hospital until that moment. I would love to have had immunity from punishment just to go off on those ancient SOBs and read 5 Big Blues worth of the Riot Act.

Hawaiian Bruin said:
Tylenol #3. Seriously, can we just outlaw codeine already?
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Not as long as it is considered a Schedule III drug in mixes, I would think. Makes it easier for the addicts to get.

Hawaiian Bruin said:
In a similar vein, dopamine.
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Either that or have written justification why other pressors won't do, backed by clinical data that is LESS than 5 years old.

Sorry HB. Got me ranting hard.

Edited to for obvious lethal dose of chloride. But yes, one hundred seventeen by wet lab read
 
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1117 of Cl. How is that even humanly possible? Is this a typo? Thats like > 10 normal. I would think he'd be dead at that level, but maybe I am not that smart. Something about NA/K ATP pump. And blah, blah, blah.
 
It IS a typo.

And, btw, 1/2 NS is maintenance fluid, with 77 mEq/L of chloride. I don't really see the reason for hysteria from that, unless the patient was still acidotic from the hyperchloremia. A chloride-free fluid would have been better, yes, but I find it hilarious that any of you expected an intensivist to give a crap about your "recommendations".

I don't get the part with the "NO BICARB correction bag" either.
 
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Ronin2258 said:
Too unstable to finish and closed night before, attending on that case ran through several sticks of vasopressin.
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I'm sorry, I stopped being able to focus after the "several sticks of vasopressin" comment. Say what? "Sticks"? What's a stick of vasopressin? My assumption is the 20 mg vial diluted into a 10 or 20 ml syringe. But surely nobody with a brain gave that much vasopressin.
 
Beginning with "this had better not...", in an arrogant tone, will push one of my buttons, and make me tell them the whole list of risks and complications. If they still want the procedure after that, fine.

In my experience, these people are the most high-maintenance and ungrateful anyway.
 
Ooooohh I got one...
This little sukah has happened to me a couple of times in my career.

Imagine this: It’s 16:30 and you’re on call. You’re finally done with your gazillion supah fast ninja style ENT cases. You’ve heard of a 20 y/o lap appy that is going to be coming your way. You think to yourself: Bamm! I finally got me some chill time. :heckyeah:

Excited for your lap appy chill time, you turn the corner that ultimately reveals the omnipotent board. In excitement you glance up at the add-ons. You look up and down and left and right. Hmmm....No sign of the lap appy. Instead, your eyes stumble upon this afternoons first case d’jour… a trach a la ICU. 🙁🙁

So you head to ICU to scope it out. After navigating the winding hallways of the unit you come to your patients room. You gaze upon one of those really large BMI type patients lying on one of those fancy wide-load, air-fillled, anti- bed-sore hospital beds. Todays ICU player is also hooked up to every drip known to mankind. Too boot, we are looking at bad respiratory failure -a lot of which is restrictive in nature 🙄. But it’s also one of those respiratory failures where you kinda think to yourself: "with a peep of 18 I should prolly bring the ICU vent with me to the OR… Ughhh… one more thing to lug out there… and darn it…where is my 20 y/o lap appy?" :yeahright:

So you’ve done this a million times before… you head back to the OR, hook up to the vent, dial in some stuff, lower your O2, pull the ETT, hook up the trach and chit chat w/ your ENT dude for a while. The case goes smooth.

After transferring the monitor, the one thousand cables and the gtts you finally get enough hospital staff to help you move the patient over to the inflatable air filled anti-sore bed thingy. Just then... you get a text: 20 y/o Lap appy to follow… and just like that… you’re smiling again. :smug:
With a smile from ear to ear and in great anticipation of your chill lap appy, you head out of the OR. You wave to the pacu nurses and head into the corridor that leads to the ICU’s.

Then… suddenly and without warning you notice your patient is starting to sink into the bed. You quickly realize that the inflatable bed thingy is loosing pressure and the rate of pressure loss is ummm… fairly significant. You also realize you are located in no-mans-land (That’s the place between pacu and the ICU). Your patient then starts sinking deeper and deeper and deeper into the bed. The patient is literally being sucked into a black hole. As the patient is sucked past the event horizon the perimeter of the bed starts caving in engulfing the patient prisoner in a cocoon of deflated bed material. 😱
So you think to yourself what do I do?… and dang it, I could really use 500mg of lap appy right about now. You do the only thing you can do. Since the backup battery to the bed has apparently failed, you mobilize the troops to increase their pace to make a crash landing in the ICU. Once you get there, you hook up to the nearest outlet and give the bed some electron juice... and like magic, the patient suddenly begins to levitate out of the depths of the black hole… a few moments later the anti bed sore-pain in my ass- hospital bed is back to normal and I’m on my way to my beloved lap appy. :whistle:


So yeah… One of my pet peeves is having one of those wide load, inflatable-bed-sore-preventing beds loose pressure while in transit.

Gotta watch out for those beds once you are running on back up power.
 
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LOL, that's awesome.

They opened a new hospital here a couple years ago. Someone apparently used an imperial ruler instead of metric or something when installing the elevators, so there was a gap at the front of the door juuuust wide enough for hospital bed wheels to turn sideways and get stuck in. Transporting a large patient between the OR and ICU one day we got stuck. So there I am, in the elevator ventilating the patient, the RN is trying to deadlift/squat the bed up, and of course the elevator doors are making that obnoxious alarm sound as they try to close because they've been open more than 10 seconds.

Where's a strong-like-bull orthopod when you need one?
 
FFP said:
I don't get the part with the "NO BICARB correction bag" either.
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AM Cl was 112 on post op check at midnight. Last ABG was the one *I* ran before bringing him up to the ICU at 6pm. Yep. ICU did not include an ABG with morning labs. On a vented patient. -.-

By some old ICU attending, for every two bags of normal saline given, a "correction bag" of 1/2NS with 50-150Meq of bicarbonate in it, to stay ahead of the iatrogenic hyperchloremic acidosis. This patient had no such thing added to his fluid regimen by MAR review.
" An ideal strategy reduces plasma Cl- while preserving plasma Na+. This may be achieved by prescribing D5W plus a variable amount of NaHCO3 as the maintenance fluid, with the amount of NaHCO3 dependent on the desired amount of Cl- and pH change. This prescription provides a strong cation (Na+) without a strong anion, resulting in an expected increase in SID as Na+ is maintained but Cl- falls; the increased SID drives proton consumption and produces an increased pH."
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Article quoted: http://ccforum.com/content/9/2/198

Article that originally thought hyperchloremia was insignificant: Gunnerson KJ, Saul M, He S, Kellum JA: Lactate versus non lactate metabolic acidosis: a retrospective outcome evaluation of critically ill patients. Crit Care 2006, 10:R22.
Rebuttal saying Gunnerson was full of it, their references at the end: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1550953/pdf/cc4963.pdf

Oh, one more thing about this ICU: They don't believe in goal-directed therapy. I had to remove the FloTrac I was using and patch in a standard transducer. -.-

Mman said:
I'm sorry, I stopped being able to focus after the "several sticks of vasopressin" comment. Say what? "Sticks"? What's a stick of vasopressin? My assumption is the 20 mg vial diluted into a 10 or 20 ml syringe. But surely nobody with a brain gave that much vasopressin.
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I got signout from the attending about the impeding doom I was getting that day (young cardiac fellowship-trained anesthesiologist.) 20ml of 1 unit/ml vasopressin. It's a last ditch when we encounter ACE-I and ARB hypotension under anesthesia where I trained, and of course, carcinoid. At least one of those syringes, if not more while they were waiting for the octreotide to work. Guy had to go, he was septic and crashing. Per my sign out, vasopressin was the thing his body liked, after trials of epi/norepi failed.

I only used 2units.
 
Chicks with butterfly tattos on their back, who can't sit still for a subq wheal as you prepare for an epidural.
 
Ronin2258 said:
AM Cl was 112 on post op check at midnight. Last ABG was the one *I* ran before bringing him up to the ICU at 6pm. Yep. ICU did not include an ABG with morning labs. On a vented patient. -.-

By some old ICU attending, for every two bags of normal saline given, a "correction bag" of 1/2NS with 50-150Meq of bicarbonate in it, to stay ahead of the iatrogenic hyperchloremic acidosis. This patient had no such thing added to his fluid regimen by MAR review.

Article quoted: http://ccforum.com/content/9/2/198

Article that originally thought hyperchloremia was insignificant: Gunnerson KJ, Saul M, He S, Kellum JA: Lactate versus non lactate metabolic acidosis: a retrospective outcome evaluation of critically ill patients. Crit Care 2006, 10:R22.
Rebuttal saying Gunnerson was full of it, their references at the end: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1550953/pdf/cc4963.pdf
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Of course I don't believe hyperchloremia is something insignificant. There is bicarbonate loss in the urine 2/2 hyperchloremia, hence the acidosis. I just find it crazy to give bicarb to "prevent" it, instead of just giving LR in the first place.
 
chocomorsel said:
Never realized I did that. However, I do know the difference as had I spelled it out (anesthetists) that mistake would have been avoided. I know the difference between plural and possessive. When abbreviated (CRNAs) or (CRNAS) it looks funny to my eye.

I think that there are some people on here though who do not know the differences in the words I wrote about and how they are used in sentences.

This was about pet peeves. You are trying to prove a point. Point taken. Let's move on.
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There seems to be some variability in what is considered acceptable on this. Different sources give different answers, but at least one agrees with the way you (and I) write it.

Practical English Usage, 2nd Edition (Michael Swan, 1995) says this:
Apostrophes are used in the plurals of letters, and often of numbers and abbreviations.

  • He writes b's instead of d's.
  • It was in the early 1960's. (OR ... 1960s.)
  • I know two MP's personally. (OR ... MPs.)
 
Ronin2258 said:
I got signout from the attending about the impeding doom I was getting that day (young cardiac fellowship-trained anesthesiologist.) 20ml of 1 unit/ml vasopressin. It's a last ditch when we encounter ACE-I and ARB hypotension under anesthesia where I trained, and of course, carcinoid. At least one of those syringes, if not more while they were waiting for the octreotide to work. Guy had to go, he was septic and crashing. Per my sign out, vasopressin was the thing his body liked, after trials of epi/norepi failed.

I only used 2units.
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I also use it for refractory hypotension from vasodilation. But never that much. If you haven't gotten the effect you are looking for after 1 or 2 (or maybe 3-4 units), time to switch to something else. Vasopressin drips for shock run in the neighborhood of 0.03 units/min, or 1.8 units per hour. I've actually reviewed a case from a patient that was probably killed from under resuscication that was masked by getting vasopressin 30 units (over 2-3 hours). If I was thinking I needed to be going through 10 or 20 units of vasopressin during a case, I'd probably want a PA cath (which I never use) to track their SVR. Because at those doses you just end up in low output states with a HR and BP that look good on the monitor.
 
k12balla said:
Chicks with butterfly tattos on their back, who can't sit still for a subq wheal as you prepare for an epidural.
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Glad I'm not the only one that had that problem. One nearly jumped off the bed just by me touching over this huge, intricate back tattoo that had to have taken 3-4 sittings to finish.

Though I did have a couple who were piercing/tattoo artists who wanted to watch, gauges in the ears (all metal out on the wife,) and the whole nine. Both looked at the 18g Touhy afterwards and ask, "That's it?! Pregnant women are p****s!"

FFP said:
Of course I don't believe hyperchloremia is something insignificant. There is bicarbonate loss in the urine 2/2 hyperchloremia, hence the acidosis. I just find it crazy to give bicarb to "prevent" it, instead of just giving LR in the first place.
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Welcome to my most hated ICU.

The new chair of surgery of that hospital, critical care trained, was also livid at that.

Preaching to the choir on LR/PlasmaLyte vs NS. This ICU practiced true cookbook medicine: "I have done it this way, I've always done it this way, and we will stay going this way."
 
Consigliere said:
Quick question: Have you ever seen a surgeon bring a patient to the OR or help move the patient from the OR table to the stretcher after the surgery? I've been doing this for 15 years and haven't.
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Yes and yes. And not just trainees.
Ask for help and they will help. It only takes one button push to pause a dictation and one more to restart it.
 
Ronin2258 said:
Preaching to the choir on LR/PlasmaLyte vs NS. This ICU practiced true cookbook medicine: "I have done it this way, I've always done it this way, and we will stay going this way."
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Oh, man. Don't even get me started on this. When I hear this I usually respond, "Well you've always done it wrong."

Listen, I respect our medicine-trained colleagues but they acquire their medical knowledge a far different way than we do. Each day our OR experience is like a little physiology lab. They, instead, often write orders, walk away, and then come back hours later only to wonder why their treatment didn't work. They make the diagnosis then treat. It is often see one, do one, teach one. With the emphasis usually being on "one". Monkey-see, monkey-do. Once they acquire a skill, they stop questioning whether or not it makes sense or is the best way.

We often are treating as we're making the diagnosis. That's the difference. And while I might consider it, I don't always care about what the latest publication in NEJM or JAMA says about some small hypothetical case series that was just published and we should change the way we've done everything that already has a mountain evidence base behind it. Also, if there is controversy in a particular area with a lot of conflicting data that doesn't make your way of doing something stronger and more definitive.

Despite being only mildly hypertonic, 0.9% NaCl is poison. No one should use it. Not even in end-stage renal failure patients. Plasmalyte 7.4 should be the "go-to" fluid of choice. For everyone.
 
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Plasmalyte 7.4 as the "go-to" for everyone? Really? What's it cost? Good old cheap LR is perfect for the vast majority of patients.

Also to be fair to our medicine colleagues, they are treating a different patient than we are. We are treating a surgical patient. A patient having a physical assault on their body causing a pro-inflammatory response and a cascade of issues arising from that. They are treating a medical patient that is quasi stable. They are also treating patients long term compared to us. They have studies that can show what the best cocktail of meds is to give someone a better outcome 5 years from now in a given situation. That isn't always applicable to the same patient having a surgical procedure.

So while I like to give them grief and roll my eyes, they treat different patients than we do.

I also don't like to use my little physiology lab in the OR with an N of 1 repeated a bunch of times to make anecdotal evidence to replace large scientific studies. It's bad science. If I can find strong evidence that using some medication for some patient will lead to some better outcome, I prefer to do that rather than rely on it not working the last 2 or 3 times I used it.
 
IlDestriero said:
Consigliere said:
Quick question: Have you ever seen a surgeon bring a patient to the OR or help move the patient from the OR table to the stretcher after the surgery? I've been doing this for 15 years and haven't.
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Yes and yes. And not just trainees.
Ask for help and they will help. It only takes one button push to pause a dictation and one more to restart it.
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Quite a few, actually. Most of the ones I worked with are willing to help.

BuzzPhreed said:
Oh, man. Don't even get me started on this. When I hear this I usually respond, "Well you've always done it wrong."
...
Despite being only mildly hypertonic, 0.9% NaCl is poison. No one should use it. Not even in end-stage renal failure patients. Plasmalyte 7.4 should be the "go-to" fluid of choice. For everyone.
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Sorry for the wind up. And I am forced by experience to concur with your sentiment. One of the reasons why I glad to heard the rumor before graduation that they were going to set up a surgical ICU to treat surgical patients in that hospital (finally.)
 
Mman said:
Plasmalyte 7.4 as the "go-to" for everyone? Really? What's it cost? Good old cheap LR is perfect for the vast majority of patients.
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Plasmalyte does not contain calcium. Calcium is completely unnecessary in IV fluid. The cost differential is irrelevant. Fart in a tornado with regards to overall cost of care. Also the pH of LR is 6.0 and it only has 130 mmol of Na+.

And, our medicine colleagues should continue to do chronic care and not be involved in dictating critical care, most of whom have (at best) a cursory knowledge on the subject. That was the point.
 
Ronin2258 said:
Sorry for the wind up. And I am forced by experience to concur with your sentiment. One of the reasons why I glad to heard the rumor before graduation that they were going to set up a surgical ICU to treat surgical patients in that hospital (finally.)
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My sentiments exactly. I've met very few medicine critical care docs who fully understand how to take care of a post-surgical patient.
 
BuzzPhreed said:
Plasmalyte does not contain calcium. Calcium is completely unnecessary in IV fluid. The cost differential is irrelevant. Fart in a tornado with regards to overall cost of care.
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Fart in a tornado? How many 1 liter bags of IV fluid are used in the OR every day in this country? 1 million?

What is the NNT for Plasmalyte 7.4 compared to LR to have a better outcome for a patient in any way? LR is just fine and dandy almost all the time.
 
Mman said:
What is the NNT for Plasmalyte 7.4 compared to LR to have a better outcome for a patient in any way? LR is just fine and dandy almost all the time.
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Why are you asking a question that hasn't formally been answered? How much does ondansetron cost? How much unnecessary prophylactic ondansetron is given every day and was is the NNTT to prevent PONV? We still do it.

Fart in a hurricane. LR is probably $3-4/bag. Plasmalyte is probably $11-12/bag. A hospital charge for a 2-level spinal decompressionis about $24,000. A TKA is about $18,000 on average. How many knees are done everyday? Plasmalyte ain't going to break the bank. And, if I'm hanging blood I'd rather already have Plasmalyte in the line. Probably doesn't matter in the short run with LR, but look at the filter in the blood infusion set after your second PRBC if you're running LR and tell me what you see.
 
No, Plasmalyte is slightly more expensive. There's no contention there. Besides they are pass-through costs.
 
BuzzPhreed said:
Plasmalyte does not contain calcium. Calcium is completely unnecessary in IV fluid. The cost differential is irrelevant. Fart in a tornado with regards to overall cost of care. Also the pH of LR is 6.0 and it only has 130 mmol of Na+.
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What's wrong with calcium? There's 3 mEq of it in a liter of LR ... what is that, about 200 mg of CaCl?

You can give blood with LR, despite the dogma. (Though granted it's usually not worth the effort to convince the RNs that you're not going to kill the patient.)

We don't stock plasmalyte in easy reach. I haven't cared enough to ask for it in recent memory. LR is cheap and Just Fine.
 
Come on, I use LR everyday. Easier to get and no "rolling eyes" because most people don't know what Plasmalyte 7.4 even is.

Plasmalyte 7.4 is more physiologic. That's all I'm saying. This is basic (no pun intended) and is self-evident for reasons that don't need to (and never will) be 100% proven by a study. But... no one should be using 0.9% NS (and I will take-up that crystalloid vs. crystalloid fight).

http://www.ncbi.nlm.nih.gov/pubmed/23732264?access_num=23732264&link_type=MED&dopt=Abstract

Plasmalyte is really not that different than LR, but it buffers better than LR.

http://www.ncbi.nlm.nih.gov/pubmed/10155362

The current thinking overall is that less fluid, no matter what that fluid is, than we are used to giving is probably better. Now let the mental masturbation carry on.

pgg said:
Chili needs beans, by the way.
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On this we can agree. And cheese. And sour cream. Still with me?
 
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BuzzPhreed said:
Plasmalyte is really not that different than LR, but it buffers better than LR.

http://www.ncbi.nlm.nih.gov/pubmed/10155362

The current thinking overall is that less fluid, no matter what that fluid is, than we are used to giving is probably better. Now let the mental masturbation carry on.
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The buffer in LR is lactate, and in Plasmalyte is about 60% acetate+ 40% gluconate. The pKa of lactate is 3.8, of the acetate is 4.8, and of the gluconate is about 3.7. So the buffer in Plasmalyte has a pKa of around 4.3, while the one in LR is 3.8. Given that the physiologic pH is 7.4, very far away from both pKa's on a logarithmic scale, the difference in buffering at physiologic pH should be clinically insignificant (the buffer will be in 99% unprotonated form in both cases).

Except that Plasmalyte contains almost double the amount of total buffer compared to LR (50 mEq/L versus 28 mEq/L). Is that physiologically significant? I would say no. One drop in the ocean of the body's total buffering capacity, versus two.

The problem with the paper cited is that it ignores the huge amount of buffering capacity of the body. One would probably really need tens of liters of Plasmalyte and LR to see a clinically significant pH difference after infusion.

</1 hour mental masturbation>
 
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BuzzPhreed said:
Why are you asking a question that hasn't formally been answered? How much does ondansetron cost? How much unnecessary prophylactic ondansetron is given every day and was is the NNTT to prevent PONV? We still do it.
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Because if you want to claim that a product that might get used a billion times a year in the country should always be replaced with one that might cost double or triple what it costs, well then you aren't being very cost effective, especially when the change in intervention doesn't make a damn bit of difference to the patient. What's the NNT with prophylactic ondansetron? Oh I don't know, a million times better than plasmalyte 7.4 vs LR?
 
lar-NIX or phar-NIX

Especially hate hearing that from anyone with MD or DO behind their name.

The nurse thing annoys me too. It's happened more with dumb young surgery residents than anyone though. I don't get angry about it. I just let them say their spiel to me, then turn to the pt and introduce myself as the anesthesiology resident then turn back to the surgery resident and tell them they might want to tell the nurse what they just told me. Happened 3 times.

Another pet peeve, OB residents who get into my space to adjust the bed while I'm getting ready to intubate. GTFO. This happened.
 
Random Resident said:
Another pet peeve, OB residents who get into my space to adjust the bed while I'm getting ready to intubate. GTFO. This happened.
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Just wait till you meet surgeons who literally move the patient inches while you are securing the tube. These are usually the same mofos who hurry everybody, as if saving 5 minutes in a 2 hour-surgery is worth the high amounts of stress for the OR staff.
 
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