Pet peeves

[leaverus]

"2% normal saline" and "3% normal saline" man this bugs me seeing it in the notes of seasoned physicians. seriously, how the heck does a doctor practicing for many years not know that if it's not 0.9%, it's no longer normal! note: this post is meant partly in jest; just poking fun at some of our colleagues

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[GassYous]

Can you explain how 154 meq of na and cl is normal?

 

[repititionition]

“don’t give K+ containing fluids in hyperkalemia” I mean I could fill a page with fluid management stuff alone, that’s before we get to airway or hemodynamic stuff, or giving Benadryl for neuraxial puritis, wait I’m starting already...

 

[vector2]

Pts who are so goddamned fat that simply moving themselves from one bed to another is beyond the limits of their physical capabilities.

 

[Guillemot]

So many things were ****ed up at my old job…. But Ill just list one thing that all can relate to: The old anesthesiologists would leave their sharps and other trash all over the anesthesia work area constantly for the next anesthesiologist to work there to deal with.

 

[Simba1711]

Nurses and other staff talking during induction.

Patients complaining about the blood pressure cuff being too tight.

 

[Justanesguy]

CRNA “professionals” bitching about not getting full breaks, or “tough” assignments.
even worse is bitching that they are staying 10 extra minutes to finish a case, while being paid overtime rates of 150+ an hour.
You are making >200k a year for 40 hours a week, suck it up.

 

[thinkorswim]

Nurses or surgeons strapping down the patients arms during induction. It’s not a crucifixion and doesn’t save any significant amount of time.

 

[narcotics999]

So many things were ****ed up at my old job…. But Ill just list one thing that all can relate to: The old anesthesiologists would leave their sharps and other trash all over the anesthesia work area constantly for the next anesthesiologist to work there to deal with.

At my place, if any anesthesiologist does this, other OR staff will write you up immediately. They clean the anesthesia working space too.

 

[secretasianman]

When I tell the nurse to take the intubating stylet and they ask me “all the way out?” I get what they mean but come on out is out.

Another one is when people say “sontimeter.” Wtf is that. “Just pull the stylet out a sontimeter.”

 

[Dawkter]

“don’t give K+ containing fluids in hyperkalemia” I mean I could fill a page with fluid management stuff alone, that’s before we get to airway or hemodynamic stuff, or giving Benadryl for neuraxial puritis, wait I’m starting already...

What do you use first line to treat neuraxial pruritus, our formulary has nalbuphine only in the neuraxial order sets but naloxone seems to work best.

 

[drmwvr]

Pts who are so goddamned fat that simply moving themselves from one bed to another is beyond the limits of their physical capabilities.

Prolly their pet peeve too...

 

[Katheudontas parateroumen]

First choice fluid is NS (gah do I hate iatrogenic NAGMAs). People satting 100% in the ICU on 100% FiO2 and no one adjusts the FiO2. Not using a PEEP valve for bagging. Taking off HFNC or Bipap peri-intubation (I believe in apnea oxygenation). When people say "that's just what we do" without any other explanation or give circular answers instead of just saying "I don't know".

 

[JOHNBROCHILL]

PACU nurses who shop around for the orders they want after being told no.
When I have a first start block and due to pre op delays I can't start it until 7:28, now it's "we're not in the room yet anesthesia is still doing the block."
Patients who refuse to take their dentures out.
Glide-uh-scope.

 

[icecoldstar]

Attendings give residents 1 stick for art and central line, but CRNA can stick until they give up

 

[repititionition]

What do you use first line to treat neuraxial pruritus, our formulary has nalbuphine only in the neuraxial order sets but naloxone seems to work best.

8mg zofran

Ondansetron Is Effective to Treat Spinal or Epidural Morphine-induced Pruritus

Background. Spinally and epidurally administered morphine is frequently associated with pruritus. Isolated case reports indicate that ondansetron may be effective in this context. This study aims to investigate the effectiveness of ondansetron to treat this side effect.Methods. In a prospective...

pubs.asahq.org

Prophylactic administration of ondansetron in prevention of intrathecal morphine-induced pruritus and post-operative nausea and vomiting in patients undergoing caesarean section - BMC Anesthesiology

Background Intrathecal morphine is commonly used for post caesarean analgesia. However, their use is frequently associated with the incidence of troublesome side effects such as nausea, vomiting and pruritus. Various mechanisms have been postulated for the opioid-induced pruritus, with a variety...

bmcanesthesiol.biomedcentral.com

 

[deleted875186]

250 mcg fentanyl given because that’s how much is in the vial …. Followed by no long acting opioid.

 

[coffeebythelake]

Our hospital has a policy that one of the attendings have to be present during sign in. My biggest pet peave is when the Attending surgeons are too lazy to show up for sign in, meanwhile I'm running between 3 rooms to do it.

 

[abolt18]

Our hospital has a policy that one of the attendings have to be present during sign in. My biggest pet peave is when the Attending surgeons are too lazy to show up for sign in, meanwhile I'm running between 3 rooms to do it.

Sign-in? Timeout ?

 

[CodeBlu]

Can you explain how 154 meq of na and cl is normal?

Ringers FTW.

Plasmalyte for kidney transplants.

 

[Radetzky]

Can you explain how 154 meq of na and cl is normal?

Interestingly normal saline got its name because 150 mmol is the sodium concentration of plasma water (ie 93% of plasma)

 

[MirrorTodd]

Ringers FTW.

Plasmalyte for kidney transplants.

We ONLY have plasmalyte at my current hospital. Like LR is nowhere to be found!

 

[deleted697535]

250 mcg fentanyl given because that’s how much is in the vial …. Followed by no long acting opioid.

What?
Thats the dose.
1 vial

 

[PainDrain]

How about giving benzos to 75+ year olds “because they were nervous on the bipap” then calling for a code/intubation when they are blue. Or not using adequate sedation in the ICU so a patient requires multiple reintubations.

Surgeons who want to do the case prone on 300lbs plus patients and then conveniently go missing when we turn.

 

[soorg]

Nurse/tech talks loud as they want during intubation/extubation, yet they insist on whisper-quiet during their precious time out.

People who wear shoe covers over their clogs.

Pt's who claim they have gastritis, but only with "really spicy foods."

People who spell it "parasthesias."

😑

 

[deleted875186]

Nurse/tech talks loud as they want during intubation/extubation, yet they insist on whisper-quiet during their precious time out.

People who wear shoe covers over their clogs.

Pt's who claim they have gastritis, but only with "really spicy foods."

People who spell it "parasthesias."

😑

I just had to google to see how to spell parasthesias

 

[Straight2eight]

When the resident/CRNA leaves the APL valve at 30-70 after doing their circuit test and doesn’t bother checking before slamming the mask onto a patient, especially when the patient is a 3 year old kid you’re trying to smoothly induce without versed.

Also the word dilatation. It’s a gratingly unnecessary word and if you use it I will immediately stop paying attention to anything you say thereafter while I perseverate in my head about what a dumb word it is lol.

 

[Beeftenderloin]

Plastic surgeons telling you to avoid pressers for flap cases and in stead just iatrogenically drown them and their new flap (which has no lymphatic drainage to assist in clearance of interstitial edema). Pressers don’t kill flaps, too much fluid does.

Also, just plastic surgeons in general. No one knows less about what we do but tries to dictate more.

 

[soorg]

“Pressers.”

 

[leaverus]

When I tell the nurse to take the intubating stylet and they ask me “all the way out?” I get what they mean but come on out is out.

Another one is when people say “sontimeter.” Wtf is that. “Just pull the stylet out a sontimeter.”

i think that's a canadian thing? i've heard canadians pronounce it that way.

 

[Beeftenderloin]

“Pressers.”

Guilty as charged.

 

[vector2]

People who write "ggt" instead of "gtt"

Also, "nare" isn't the singular of "nares"

 

[leaverus]

How about giving benzos to 75+ year olds “because they were nervous on the bipap” then calling for a code/intubation when they are blue. Or not using adequate sedation in the ICU so a patient requires multiple reintubations.

Surgeons who want to do the case prone on 300lbs plus patients and then conveniently go missing when we turn.

75+? heck, some of our crnas have no age limit; even the 90yr olds with severe dementia get 2mg iv.

 

[PainDrain]

How about sending patients from the ED or ICU emergently without an airway or adequate IV access simply because “well we figured you guys would do it.”

 

[TheLoneWolf]

Plastic surgeons telling you to avoid pressers for flap cases and in stead just iatrogenically drown them and their new flap (which has no lymphatic drainage to assist in clearance of interstitial edema). Pressers don’t kill flaps, too much fluid does.

Also, just plastic surgeons in general. No one knows less about what we do but tries to dictate more.

In residency, one of the head and neck surgeons famous for long flaps in a big name cancer center would tell you to all avoid pressors other than Norepi during his cases.

Same center, a hepatobiliary surgeon, severe OCD, wanted to talk to you every 5 mins for an update. Anytime hypotension was present, he would insist on nothing other than "100 ml of albumin".

For both I would just give what I felt the patient needed.

 

[Potatoman1800]

Patients in pre-op noticing and commenting how young I look (currently a year out from CT fellowship), then ask me “make sure you take care of me 🤨”. Then surgeon - the guy who’s about to chop them up - busts in and are welcomed like another one of the patients’ children.

 

[Potatoman1800]

Patient going for big abdominal surgery. Pre-op clearance note from primary care NP says something along the lines of “highly recommend light form of anesthesia due to history of head trauma in 1986.” Patient has no neuro issues.

Are you kidding me, when’s the last time you dealt with a patient in the hospital, let alone the OR? And since when are you an expert in anesthetic administration. Stay behind your laptop and enjoy your 25 hour work week.

 

[GassYous]

Patient going for big abdominal surgery. Pre-op clearance note from primary care NP says something along the lines of “highly recommend light form of anesthesia due to history of head trauma in 1986.” Patient has no neuro issues.

Are you kidding me, when’s the last time you dealt with a patient in the hospital, let alone the OR? And since when are you an expert in anesthetic administration. Stay behind your laptop and enjoy your 25 hour work week.

I don't think anyone gives two ****s about what a midlevel has to say

 

[dannyboy1]

Plastic surgeons telling you to avoid pressers for flap cases and in stead just iatrogenically drown them and their new flap (which has no lymphatic drainage to assist in clearance of interstitial edema). Pressers don’t kill flaps, too much fluid does.

Also, just plastic surgeons in general. No one knows less about what we do but tries to dictate more.

Just tell em what they want to hear. We have a particularly crazy one who will look over at your syringes so I just put a blank sticker on it….

 

[Potatoman1800]

Just tell em what they want to hear. We have a particularly crazy one who will look over at your syringes so I just put a blank sticker on it….

Tell him you’re giving Zofran in divided doses.

 

[deleted875186]

Tell him you’re giving Zofran in divided doses.

Tell him it’s anesthesia in a syringe

 

[Drangue]

Attendings give residents 1 stick for art and central line, but CRNA can stick until they give up

The best one.

 

[coffeebythelake]

How about sending patients from the ED or ICU emergently without an airway or adequate IV access simply because “well we figured you guys would do it.”

Ruptured, contained AAA transferred from OSH with 2x 20g PIVs and nothing else. No art line, no T&S. What a **** show.

 

[drmwvr]

Ruptured, contained AAA transferred from OSH with 2x 20g PIVs and nothing else. No art line, no T&S. What a **** show.

Well...the patient is coming to you for a reason....

 

[coffeebythelake]

The best one.

I give my residents 3 tries

 

[frosted2]

I give my residents 3 tries

The attending we all want and need!!!


O2 "stats"

 

[Justice4all]

Peds: 2 attempts depending on clinical situation. Sometimes need to just observe

 

[dabears505]

How about actual pet in the room during labor epidural placement for support.

 

[Toothpickwars]

How about actual pet in the room during labor epidural placement for support.

Honestly would prefer to some of the spouses/doulas we get.

 

[drmwvr]

Honestly would prefer to some of the spouses/doulas we get.

labor epidurals get pretty routine/boring after a while...having a doula in the room to troll during placement really makes my day....I'm kinda disappointed the times that they leave...