Pet Peeves

[anes]

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I can't say I have a problem with that. I would do the same thing if it were my family member or friend. If you were providing anesthesia for a family member or friend (the ethical aspect of that aside), wouldn't you maybe do a little something different (e.g., double up on the anti-emetics, LTA if you don't routinely do that, etc.)? Even if not, it's just a reminder that that patient is someone's daughter/friend/mother/etc. I think it's ok to be reminded of that occasionally.

No. What that means is that you are treating non- family at a lower level of care. I do my best to treat everyone as I would want a family member to be treated.

 

[Triple AAA]

(when dropping off a post-op to the ICU)

ICU RN: Gee, thanks ALOT for these messy, tangled lines!!
Me: Right, because your lines are always PERFECT when I pick up patients from you...

(from back in residency)
Attending: This is YOUR case! What do you want to do?
Me: I want to do _______
Attending: That's great. Let's do it my way anyway. (proceeds to push me out of the way and change around my setup).

ICU RN: Doctor, the pt's urine output has dropped. Do you want to give a fluid bolus?
Me: Ok, are they tachycardic?
ICU RN: No.
Me: Is their creatinine elevated?
ICU RN: No.
Me: Are they hypotensive?
ICU RN: No.
Me: Any electrolyte distubances?
ICU RN: No.
Me: How much fluid have they gotten in the last shift?
ICU RN: +10 L... so, how about that fluid bolus?
Me: ... facepalm

 

[pgg]

I do the same thing for everyone.

Well, that's not strictly true. I'll do LESS for people that trip my "unreliable" flag, ie I am less likely to offer/pitch blocks to them. But I don't do MORE for VIPs. Maybe I smile or chat more.

 

[Random Anesthesiologist]

(when dropping off a post-op to the ICU)

ICU RN: Gee, thanks ALOT for these messy, tangled lines!!
Me: Right, because your lines are always PERFECT when I pick up patients from you...

(from back in residency)
Attending: This is YOUR case! What do you want to do?
Me: I want to do _______
Attending: That's great. Let's do it my way anyway. (proceeds to push me out of the way and change around my setup).

ICU RN: Doctor, the pt's urine output has dropped. Do you want to give a fluid bolus?
Me: Ok, are they tachycardic?
ICU RN: No.
Me: Is their creatinine elevated?
ICU RN: No.
Me: Are they hypotensive?
ICU RN: No.
Me: Any electrolyte distubances?
ICU RN: No.
Me: How much fluid have they gotten in the last shift?
ICU RN: +10 L... so, how about that fluid bolus?
Me: ... facepalm

And they're probably 90 years old too! Lol

 

[circulus vitios]

This just happened to me...again. Biggest pet peeve.

As I roll patient to OR from holding, patient says that they have a brother/cousin/friend who is an attorney. What do they honestly think saying this will accomplish? Same goes for entitled VIPs that flaunt their VIPness at me. Puts me in a bad mood for the case.

Ask them how they plan on spending the malpractice payoff when they're rotting in the ground.

 

[gclax30]

More peeves:

1- Surgical resident/intern asking for case fluid totals right when I'm about to extubate. Their lack of situational awareness in the OR is truly amazing to me.

2- Subsequently having to repeat the totals to both the ICU nurses and the MD/PA/NP team once they mosey on into the patient's room.

 

[deleted171991]

One of my big pet peeves: at my hospital, only anesthesiologists can see the intraop anesthesia records in Epic. In the patient's chart, I can only see my preop and postop notes.

Not only that, but I am not a "physician", I am an "anesthesiologist". That means that if I filter the notes by physician-only, mine disappear. Same goes for the residents' notes.

 

[anes]

One of my big pet peeves: at my hospital, only anesthesiologists can see the intraop anesthesia records in Epic. In the patient's chart, I can only see my preop and postop notes.

Not only that, but I am not a "physician", I am an "anesthesiologist". That means that if I filter the notes by physician-only, mine disappear. Same goes for the residents' notes.

At my hospital all other doctors have "physician" on their name badge next to their name. All except for us... We have "anesthesia/anesthesiologist" next to our names. We are an MD only anesthesiology practice. So no CRNA or AA's.

 

[pgg]

At my hospital all other doctors have "physician" on their name badge next to their name. All except for us... We have "anesthesia/anesthesiologist" next to our names. We are an MD only anesthesiology practice. So no CRNA or AA's.

So, maybe walk on over to the ID office, and get a new badge with "physician" on it?

 

[Spinach Dip]

Ask them how they plan on spending the malpractice payoff when they're rotting in the ground.

passive aggressive much?

 

[anes]

So, maybe walk on over to the ID office, and get a new badge with "physician" on it?

If it only was that easy.

 

[imfrankie]

What about grammar critics who misuse apostrophes? 😉

Sweet P

 

[pgg]

If it only was that easy.

Why isn't it? Who would say no?

 

[Ignatius J]

I can't say I have a problem with that. I would do the same thing if it were my family member or friend. If you were providing anesthesia for a family member or friend (the ethical aspect of that aside), wouldn't you maybe do a little something different (e.g., double up on the anti-emetics, LTA if you don't routinely do that, etc.)? Even if not, it's just a reminder that that patient is someone's daughter/friend/mother/etc. I think it's ok to be reminded of that occasionally.

I would not. I would like to think that I treat every anesthetic with much respect to every patient. LTA doesn't do **** and I am a big proponent of anti-emetics already.

 

[Triple AAA]

I would not. I would like to think that I treat every anesthetic with much respect to every patient. LTA doesn't do **** and I am a big proponent of anti-emetics already.

Additionally, some would argue that the pressure of taking care of a 'VIP' might make some physicians more inclined to make mistakes that could have otherwise been avoided. I will never make my physician status known if me or my loved ones ended up in the hospital.

 

[Lurch]

Additionally, some would argue that the pressure of taking care of a 'VIP' might make some physicians more inclined to make mistakes that could have otherwise been avoided. I will never make my physician status known if me or my loved ones ended up in the hospital.

This is my thinking. Demanding special treatment effectively forcing people to work outside of their and their institution's comfort zone is asking for trouble. As a physician patient, I turned away a special blanket marking VIP status for fear of the label and the pressure it might apply to my caregivers. A seasoned CA-2 did my wife's epidural as opposed to an attending who was covering who did maybe an epidural per year. Did it make a difference? Probably not but it made me feel better that I was operating within the comfort zone of the hospital and its providers.

 

[Depakote]

After explaining to the very sick patient that I'm going to provide some MILD sedation (appropriate for the procedure) for their MAC , having the circulator chime in and "reassure" the patient that they're going to be completely out, completely unaware of what's going on and sleeping the entire time. Bonus-points for doing an exaggerated Q-face and making snoring sounds to make sure the patient knew she'd be sleeping.

 

[Spinach Dip]

After explaining to the very sick patient that I'm going to provide some MILD sedation (appropriate for the procedure) for their MAC , having the circulator chime in and "reassure" the patient that they're going to be completely out, completely unaware of what's going on and sleeping the entire time. Bonus-points for doing an exaggerated Q-face and making snoring sounds to make sure the patient knew she'd be sleeping.

Reminds me of a conversation I had with an elderly relative recently...

Her: Oh, you're going in for [minor procedure]? Make sure you get a good doctor! I woke up during my surgery last month and it was HORRIBLE.
Me: Oh? I didn't know you went in for surgery. What was it for?
Her: A colonoscopy.
Me:

 

[deleted547339]

I love reading y'all's forum (EM resident).

 

[anes]

After explaining to the very sick patient that I'm going to provide some MILD sedation (appropriate for the procedure) for their MAC , having the circulator chime in and "reassure" the patient that they're going to be completely out, completely unaware of what's going on and sleeping the entire time. Bonus-points for doing an exaggerated Q-face and making snoring sounds to make sure the patient knew she'd be sleeping.

That always bothered me. I would correct them and tell the patient that they will be more awake then asleep, but comfortable.

 

[Vaporized]

Poor IV access. I have taken over many cases where I am caught with insufficient access. Now unjust routinely put in a good IV when I take over. EVAR with an 18 and 20 gauge. Come in and put in a 16. 30m later 1L EBL. open prostate surgery, 18 only, put 16, same story. Plus I use this as good practice on getting easy IVs when someone is asleep and vasodilated

 

[Triple AAA]

I once walked into a preop holding area to meet a patient who was coming in for a revision hip arthroplasty for an infected prosthesis. The patient expected an epidural because the junior ortho resident told them that they could have one. Unbelievable. I swear, I would just love to walk up to a patient on the floor and tell them what type of surgery is appropriate for them, without knowing anything about surgery and without consulting with the surgeon.

 

[Ignatius J]

Poor IV access. I have taken over many cases where I am caught with insufficient access. Now unjust routinely put in a good IV when I take over. EVAR with an 18 and 20 gauge. Come in and put in a 16. 30m later 1L EBL. open prostate surgery, 18 only, put 16, same story. Plus I use this as good practice on getting easy IVs when someone is asleep and vasodilated

Not trying to single out, but I do not get why people get caught up as much on an 18 to 16 or a 20 to 18. I've never done a case where I thought upgrading one IV size would have changed the outcome. I have, however, seen people blow good veins with 16s when an 18 would have sufficed.

 

[anes]

Not trying to single out, but I do not get why people get caught up as much on an 18 to 16 or a 20 to 18. I've never done a case where I thought upgrading one IV size would have changed the outcome. I have, however, seen people blow good veins with 16s when an 18 would have sufficed.

One example.

50 y/o trauma patient with multiple fractures,hypotensive to 50s, tachycardic, profusely bleeding. Had a 22 gauge antecube hooked up to a Belmont. The person I was taking over for was more concerned about getting an arterial line in the patient than getting better iv access. First hct that came back was 15.

 

[Ignatius J]

One example.

50 y/o trauma patient with multiple fractures,hypotensive to 50s, tachycardic, profusely bleeding. Had a 22 gauge antecube hooked up to a Belmont. The person I was taking over for was more concerned about getting an arterial line in the patient than getting better iv access. First hct that came back was 15.

Sounds like the patient should have a cordis. That is an entirely different issue. PIV versus central line I get. 20G vs 18G I do not.

 

[pgg]

Not trying to single out, but I do not get why people get caught up as much on an 18 to 16 or a 20 to 18. I've never done a case where I thought upgrading one IV size would have changed the outcome. I have, however, seen people blow good veins with 16s when an 18 would have sufficed.

That bugs me too. Some people have this silly sense of pride putting 18 or 16 g IVs in everyone, even if they're getting colonoscopies or other barely-MAC-worthy procedures.

A 20g in a big vein will run faster than an 18g in a small vein. The IV catheter is short. The vein is long. They're not getting that much better flow cramming an 18 or 16 in that fragile little vein, even if they don't blow it. Another case where better is the enemy of good enough.



The ER-special 22g in an AC vein is a recurring favorite of mine. You can't even get the RIC kit wire through that ... Bonus points when it comes with the microbore pigtail flow restrictor tubing directly connected (and under a maze of criss-crossed foam tape and other cute right-brain-nursey IV securing tricks).

 

[Ronin2258]

Give me at least a 20g in an adult if it's placed in the ED. You're an emergency department. You should be expecting trouble. I can put more later when I can get more volume in.

If the fecal matter is hitting the air turbine, go either femoral, IJ, or IO. If femoral or IJ go with a 9fr sheath, not a 15cm TLC with three long, narrow channels. And get rid of those damned claves/restrictors safety caps. If I need to put pressure behind what I'm giving, you just cut the flow rate by 30-50% with those accursed things.

 

[imfrankie]

People standing around watching with their clipboards

 

[Vaporized]

I can't figure out how to quote from my phone, but to answerabout IVs . In a case with high expected blood loss I like to have an iv for rapid infusion and blood. So if I need to pump blood the other IV can be wide open. So if I have a 20 and 18 I have seen 20 back up and mess up the warmer with pumping so that means I hook it up to the 18. So while I am pumping blood I have the other one wide open but a 20 wide open is slow. So I would rather have 2 18s one I can raise to the ceiling and open up with my hands are busy pumping and drawing up meds with the other IV. I started 16 because their veins were easy to get. So 18 pumping blood and 16 as high as possible wide open while my hands are busy.
Probably a little overkill but we have had in the last few weeks a few evar complications from the femoral venous access where they bleed like stink. This is not for cases like arthroscopy or lap chole where I haven't seen major fluid changes.

 

[pgg]

An hour ago:

I'm pushing the propofol to induce a patient. Surgeon pipes up, oh by the way, I'll need her paralyzed for this.

Patient's wide eyes flip back and forth between him and me.



Now it's a race between my hasty yet soothing words of reassurance about relaxation not paralysis and the propofol to see which hits her brain first ...

 

[BobBarker]

I can't figure out how to quote from my phone, but to answerabout IVs . In a case with high expected blood loss I like to have an iv for rapid infusion and blood. So if I need to pump blood the other IV can be wide open. So if I have a 20 and 18 I have seen 20 back up and mess up the warmer with pumping so that means I hook it up to the 18. So while I am pumping blood I have the other one wide open but a 20 wide open is slow. So I would rather have 2 18s one I can raise to the ceiling and open up with my hands are busy pumping and drawing up meds with the other IV. I started 16 because their veins were easy to get. So 18 pumping blood and 16 as high as possible wide open while my hands are busy.
Probably a little overkill but we have had in the last few weeks a few evar complications from the femoral venous access where they bleed like stink. This is not for cases like arthroscopy or lap chole where I haven't seen major fluid changes.

I remember my first beer, too.

 

[OB1🤙]

When I've sold the 30g lido local prior to an IV or a-line, which I give very slow and gentle, as "a little pinch," in front of the circulator mind you, why does the circulator then feel compelled to scream "OK HERE COMES A BEE STING OH YEAH IT'S GONNA BURN."

Dude. Nobody is comforted by the idea they're about to get stung by a bee. Shut the f up.

 

[anes]

How about the nurse saying "doc, did u give the patient versed so that they don't remember anything" as you're wheeling the patient to the OR.

On a patient that you were not planning on giving versed.

 

[Depakote]

Da Vinci I&D of a ****ing external wound. You can't make this up.

 

[Ignatius J]

I can't figure out how to quote from my phone, but to answerabout IVs . In a case with high expected blood loss I like to have an iv for rapid infusion and blood. So if I need to pump blood the other IV can be wide open. So if I have a 20 and 18 I have seen 20 back up and mess up the warmer with pumping so that means I hook it up to the 18. So while I am pumping blood I have the other one wide open but a 20 wide open is slow. So I would rather have 2 18s one I can raise to the ceiling and open up with my hands are busy pumping and drawing up meds with the other IV. I started 16 because their veins were easy to get. So 18 pumping blood and 16 as high as possible wide open while my hands are busy.
Probably a little overkill but we have had in the last few weeks a few evar complications from the femoral venous access where they bleed like stink. This is not for cases like arthroscopy or lap chole where I haven't seen major fluid changes.

That is cool. If you have conundrums like that, cool. I have done a lot of cases and never run into this issue. Frankly, if a rapid infuser is involved, central access should be being obtained while it is getting set up. Just my opinion. Ever seen an IV blow during rapid infusion? Ain't pretty.

 

[Spinach Dip]

How about the nurse saying "doc, did u give the patient versed so that they don't remember anything" as you're wheeling the patient to the OR.

On a patient that you were not planning on giving versed.

What... I don't... WHY EVEN ASK THAT???

 

[Vaporized]

That is cool. If you have conundrums like that, cool. I have done a lot of cases and never run into this issue. Frankly, if a rapid infuser is involved, central access should be being obtained while it is getting set up. Just my opinion. Ever seen an IV blow during rapid infusion? Ain't pretty.

I have only ever used Belmont in trauma to a cordis. Anyways, I just an issue recently when we had a EVAR go bad with an iliac artery rupture losing blood volumes and one go bad where the patient ended up in abdominal compartment syndrome. Both requiered many prbc, ffp, and IVF. Also had an open prostate when they got into bleeding and couldn't figure out how to stop it until the chair came down. As a ca2 I over think these things so when I am where you guys are it is cake.

 

[epidural man]

When I've sold the 30g lido local prior to an IV or a-line, which I give very slow and gentle, as "a little pinch," in front of the circulator mind you, why does the circulator then feel compelled to scream "OK HERE COMES A BEE STING OH YEAH IT'S GONNA BURN."

Dude. Nobody is comforted by the idea they're about to get stung by a bee. Shut the f up.

Did ya' all see that article that showed that when you say - this is gonna hurt - it hurts way more...vs when you say - this will make the procedure go much easier. cool article.

 

[k12balla]

After quickly gaining favor and reassuring your anxious primigravid getting her first epidural, the nurse feels the need to announce as you prepare the subq wheal "this is the worse part"....

 

[Triple AAA]

OR nurses, anesthesia techs, etc. who throw away clean supplies between cases because they're 'exposed'. Then we go to induce and there's no suction...

 

[risnwb]

The ER-special 22g in an AC vein is a recurring favorite of mine. You can't even get the RIC kit wire through that ... Bonus points when it comes with the microbore pigtail flow restrictor tubing directly connected (and under a maze of criss-crossed foam tape and other cute right-brain-nursey IV securing tricks).

I too hate the 22g ac from the er..
Had a few crashing patients with this as their 2nd iv... You can put one of the small (peds I think) arrow wires for a-lines through the 22... And although it's JUST long enough, you can thread a RIC over that... Or thread a 20g angiocath over it and then use the RIC kit wire... (Probably only worth it in a pinch!)


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