Pet peeves

[DrOwnage]

When I’m doing cataracts on non-English speaking demented patients who do exactly the opposite of what you say.

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[caligas]

"He's still alive"

“He’s been dead for an hour, but y’all seemed to be having such a good time”

 

[IMGASMD]

“If the patient is a good candidate for spinal, then yes…..”

What’s your ****ing definition for a good spinal anesthesia, dear bone doctor?! The ones that I can get without “wasting” your precious OR time?!

 

[abolt18]

"He's a fighter!"

Alright lady, now you just jinxed him. Thanks a lot.

 

[Robotic Wis-Hipple]

"He's a fighter!"

Alright lady, now you just jinxed him. Thanks a lot.

Better if they say he’s a jerk.

 

[zizzer]

Paramedics bringing a patient into a busy trauma bay and mumbling the presentation so nobody outside a five foot radius can hear it

 

[nimbus]

Paramedics bringing a patient into a busy trauma bay and mumbling the presentation so nobody outside a five foot radius can hear it

Mumbling surgeons too….

Surgeon: “abli-babli-boo”

me: “sure…..table up”

 

[We'llBeDoneIn15Minutes]

"Anesthesia,......."

 

[coffeebythelake]

Mumbling surgeons too….

Surgeon: “abli-babli-boo”

me: “sure…..table up”

We have a few mumblers at my workplace, and they always get mad when the circulator or the assistant or the anesthesia staff doesn't hear what he is saying and he has to repeat himself 🤣🤣

 

[deleted697127]

Nurses throwing blankets over lines at the beginning and end of cases. When a patient has multiple lines and someone tries to help place monitors, bair hugger, or tie down the patients arms but manages to tangle everything up and actually creates more work.

 

[BobLoblaw78]

This thread tangentially reminds me of this meme…

View attachment 343366

Best one I have heard this year! I am definitely stealing this one and using it. (just have to make sure and pick the right patients)

Friend gave me this patient questionnaire gem,
Has a Hart doctor for his In large hart.
I'm guessing questions regarding his most recent echo wouldn't yield much information.

Had one guy today with "bank pain" instead of back pain. Lol

One of my fav lines is the older skeevy guys that for some reason like to tell their spouse/family about the attractive nurse they had (or some other inappropriate comment). I always like to interject, "His name was Kevin."

 

[Beeftenderloin]

“Dobs”

There never was, nor will there ever be a letter S in dobutamine.

I’m a CV fellow so you can imagine the daily hellscape this creates for me.

 

[GassYous]

“Dobs”

There never was, nor will there ever be a letter S in dobutamine.

I’m a CV fellow so you can imagine the daily hellscape this creates for me.

Never heard of this before

 

[MirrorTodd]

“Dobs”

There never was, nor will there ever be a letter S in dobutamine.

I’m a CV fellow so you can imagine the daily hellscape this creates for me.

 

[GravelRider]

My pet peeve is the OR circulator, surgeon, or anyone else moving the OR lights in such a way that I’m guaranteed to smash my head. I’ll come into the OR and move the lights so they are out of my way and then I’ll turn around or stand up and smash my head on a light that was moved. I’ve hit my head so hard that I’ve wondered if I have a case against the hospital.

 

[pgg]

My pet peeve is the OR circulator, surgeon, or anyone else moving the OR lights in such a way that I’m guaranteed to smash my head. I’ll come into the OR and move the lights so they are out of my way and then I’ll turn around or stand up and smash my head on a light that was moved. I’ve hit my head so hard that I’ve wondered if I have a case against the hospital.

I'm 6'6"

I just accept daily head trauma as the natural state of things.

 

[D P356]

One of my fav lines is the older skeevy guys that for some reason like to tell their spouse/family about the attractive nurse they had (or some other inappropriate comment). I always like to interject, "His name was Kevin."

Whenever I hear any staff member ask a patient “do you know where you are?”
I follow in a high pitched voice so they can hear, “you’re in the jungle, baby.”

Learned that one in residency.

 

[Airway]

Whenever I hear any staff member ask a patient “do you know where you are?”
I follow in a high pitched voice so they can hear, “you’re in the jungle, baby.”

Learned that one in residency.

Will definitely start doing this. Thanks

 

[TheLoneWolf]

Pediatric surgeon claimed they "get all day nausea when exposed to any of the gas". This is not a new surgeon and has been working in a pediatric hospital for years. Nearly everytime I saw her, she would say "now I'm gonna be sick all day because I can smell your sevo".

Working at the same facility for years, with near universal mask inductions, and giving the same talk to each anesthesiologist or resident.

Wanted to roll my eyes each time or say "ok, maybe reconsider the job if you can't stand the unavoidable ppm residual VA inherent in the pediatric OR environment".

 

[VisionaryTics]

Pediatric surgeon claimed they "get all day nausea when exposed to any of the gas". This is not a new surgeon and has been working in a pediatric hospital for years. Nearly everytime I saw her, she would say "now I'm gonna be sick all day because I can smell your sevo".

Working at the same facility for years, with near universal mask inductions, and giving the same talk to each anesthesiologist or resident.

Wanted to roll my eyes each time or say "ok, maybe reconsider the job if you can't stand the unavoidable ppm residual VA inherent in the pediatric OR environment".

Question: how obnoxious is it for me to ask for gas to be off during laryngectomy? As a surgeon, I'm not normally in the business of specifying anesthetic plans, but I do ask for gas to be off when I'm sewing the trachea during laryngectomy (tube popping in and out of the stoma for maybe 10 minutes with intermittent apnea). I can't stand the smell of a full blast of gas when the tube comes out (plus headache), and I'm wondering how onerous of a task this is in the middle of a case.

 

[abolt18]

Question: how obnoxious is it for me to ask for gas to be off during laryngectomy? As a surgeon, I'm not normally in the business of specifying anesthetic plans, but I do ask for gas to be off when I'm sewing the trachea during laryngectomy (tube popping in and out of the stoma for maybe 10 minutes with intermittent apnea). I can't stand the smell of a full blast of gas when the tube comes out (plus headache), and I'm wondering how onerous of a task this is in the middle of a case.

I think not that big of deal if approached prior to case with simple "hey, would you be willing to do straight TIVA for a while during "x" time during the case since the tube will be coming in and out for like 10&15 minutes."

If they agree you just say "cool, thanks, I'll give you a heads up when we're getting to that part."

If they refuse, you accept and move on. I think most would be amenable if you approach it in a collegial fashion. At least I'd think so. Have to go through it every time you work with someone new, but eventually most will know it and be amenable to it.

That's just my opinion.

 

[Airway]

Question: how obnoxious is it for me to ask for gas to be off during laryngectomy? As a surgeon, I'm not normally in the business of specifying anesthetic plans, but I do ask for gas to be off when I'm sewing the trachea during laryngectomy (tube popping in and out of the stoma for maybe 10 minutes with intermittent apnea). I can't stand the smell of a full blast of gas when the tube comes out (plus headache), and I'm wondering how onerous of a task this is in the middle of a case.

I'd be more then willing - but as always need my CRNA to buy in. I don't think it's an elegant way to anesthetize a patient, questionable uptake, and expose the whole room to volatile anesthetics

 

[TheLoneWolf]

Question: how obnoxious is it for me to ask for gas to be off during laryngectomy? As a surgeon, I'm not normally in the business of specifying anesthetic plans, but I do ask for gas to be off when I'm sewing the trachea during laryngectomy (tube popping in and out of the stoma for maybe 10 minutes with intermittent apnea). I can't stand the smell of a full blast of gas when the tube comes out (plus headache), and I'm wondering how onerous of a task this is in the middle of a case.

That is totally reasonable, and is arguably best practice. If you are instrumenting an open airway, the VA will contaminate the room and the anesthetic depth will vary with an open trachea. Once the airway is secured with endotracheal intubation, trachea opened, I would convert to TIVA for the above reasons.

Adults rarely get a mask induction, they have an IV preop and get an IV induction. In general, kids get a mask induction with VA then plus minus an IV.

 

[Guillemot]

Question: how obnoxious is it for me to ask for gas to be off during laryngectomy? As a surgeon, I'm not normally in the business of specifying anesthetic plans, but I do ask for gas to be off when I'm sewing the trachea during laryngectomy (tube popping in and out of the stoma for maybe 10 minutes with intermittent apnea). I can't stand the smell of a full blast of gas when the tube comes out (plus headache), and I'm wondering how onerous of a task this is in the middle of a case.

It isnt unreasonable to request this at all. It is a matter of personal safety and patient safety that you dictate volatile not be used during this portion of the case.

 

[GassYous]

Question: how obnoxious is it for me to ask for gas to be off during laryngectomy? As a surgeon, I'm not normally in the business of specifying anesthetic plans, but I do ask for gas to be off when I'm sewing the trachea during laryngectomy (tube popping in and out of the stoma for maybe 10 minutes with intermittent apnea). I can't stand the smell of a full blast of gas when the tube comes out (plus headache), and I'm wondering how onerous of a task this is in the middle of a case.

Very reasonable request and I can't see why anyone would say no especially if you ask nicely

 

[Toothpickwars]

Question: how obnoxious is it for me to ask for gas to be off during laryngectomy? As a surgeon, I'm not normally in the business of specifying anesthetic plans, but I do ask for gas to be off when I'm sewing the trachea during laryngectomy (tube popping in and out of the stoma for maybe 10 minutes with intermittent apnea). I can't stand the smell of a full blast of gas when the tube comes out (plus headache), and I'm wondering how onerous of a task this is in the middle of a case.

In addition to this very reasonable request, operative suction right next to your incision might get some of it out of your face.

 

[IMGASMD]

Here are a few….
“You have done this before, right?”
“Am I your first patient?”
“Did you have a good night sleep?”
“You’ll do a good job right?”
“I don’t wanna feel anything….”
“I want to be asleep, and don’t want to know anything…”

 

[Iso4ane]

Here are a few….
“You have done this before, right?”
“Am I your first patient?”
“Did you have a good night sleep?”
“You’ll do a good job right?”
“I don’t wanna feel anything….”
“I want to be asleep, and don’t want to know anything…”

Not yet. I watched a YouTube video though.
Yep. (Of The Day)
Nope. But, I feel the coffee kicking in.
Well, I haven't been fired yet.
Neither do I, and I make sure it doesn't hurt me.
Same here, same here, but I'll get you to sleep first.

 

[Iso4ane]

A buddy of mine sent me this. Has this happened to anyone...



For me it wasn't a hernia, but a lap chole.

 

[Hoya11]

Question: how obnoxious is it for me to ask for gas to be off during laryngectomy? As a surgeon, I'm not normally in the business of specifying anesthetic plans, but I do ask for gas to be off when I'm sewing the trachea during laryngectomy (tube popping in and out of the stoma for maybe 10 minutes with intermittent apnea). I can't stand the smell of a full blast of gas when the tube comes out (plus headache), and I'm wondering how onerous of a task this is in the middle of a case.

dont you trach them distal to the operative site before doing the laryngectomy? why is the tube coming in and out?

 

[VisionaryTics]

dont you trach them distal to the operative site before doing the laryngectomy? why is the tube coming in and out?

During laryngectomy, there may or may not be a trach placed at the start of the case (or patient coming in with a trach). During the tumor ablation, the inferior laryngectomy cut is made (fully releasing the entire trachea). Then the laryngectomy is completed (releasing larynx from pharynx). Part of the closure is the trachea being matured to the skin to create an end-stoma. This usually requires popping the tube in and out a couple of times to place sutures without risk of rupturing the balloon.

 

[Toothpickwars]

“We gave 15 of local” as pacu report without anyone knowing specifically what they gave. Big difference whether that was 1% lido with epi or 0.5% plain bupi….

 

[DocVapor]

“We gave 15 of local” as pacu report without anyone knowing specifically what they gave. Big difference whether that was 1% lido with epi or 0.5% plain bupi….

Is it though, really?

 

[GassYous]

“We gave 15 of local” as pacu report without anyone knowing specifically what they gave. Big difference whether that was 1% lido with epi or 0.5% plain bupi….

Why does it matter

 

[jwk]

Pediatric surgeon claimed they "get all day nausea when exposed to any of the gas". This is not a new surgeon and has been working in a pediatric hospital for years. Nearly everytime I saw her, she would say "now I'm gonna be sick all day because I can smell your sevo".

Working at the same facility for years, with near universal mask inductions, and giving the same talk to each anesthesiologist or resident.

Wanted to roll my eyes each time or say "ok, maybe reconsider the job if you can't stand the unavoidable ppm residual VA inherent in the pediatric OR environment".

Good grief, it's a good thing they weren't around when we used halothane. We used modified Jackson-Rees circuits, and the 500cc reservoir bag had a hole in the side. You delivered positive pressure by placing your thumb over the hole and squeezing the bag. There was no scavenging back then. The excess vapor simply exhausted into the room.

 

[Mman]

Whenever I hear any staff member ask a patient “do you know where you are?”
I follow in a high pitched voice so they can hear, “you’re in the jungle, baby.”

Learned that one in residency.

but do you follow up with the next lyric? "you're gonna die"

Because I imagine that might get even more chuckles

 

[pastafan]

Here are a few….
“You have done this before, right?”
“Am I your first patient?”
“Did you have a good night sleep?”
“You’ll do a good job right?”
“I don’t wanna feel anything….”
“I want to be asleep, and don’t want to know anything…”

When asked how long have I been doing this I always replied since 7:30. "No, no doc, I meant how many years".

 

[Iso4ane]

When asked how long have I been doing this I always replied since 7:30. "No, no doc, I meant how many years".

Uh, yeah, they just grabbed me off the street at 7:30.

 

[Airway]

want to be asleep, and don’t want to know anything

I get really paranoid and annoyed when people say this and start rambling about recall.

My big annoyance is when people want to talk about brain health and the effect anesthesia has on brain. It is impossible to talk about this with any layperson in any useful fashion. There was a recommendation in A&A from some working group that one should talk to all geriatric patients...very frustrated when I read that.

 

[deleted875186]

I get really paranoid and annoyed when people say this and start rambling about recall.

My big annoyance is when people want to talk about brain health and the effect anesthesia has on brain. It is impossible to talk about this with any layperson in any useful fashion. There was a recommendation in A&A from some working group that one shot talk to all geriatric patients...very frustrated when I read that.

This is also a big annoyance to me. Probably a large part of the cognitive impact is surgery itself, but everything gets blamed on the anesthesia.

Besides, what is there really to do, other than the patient cancelling their surgery if they are really concerned about cognitive impairment.

 

[IMGASMD]

I get really paranoid and annoyed when people say this and start rambling about recall.

My big annoyance is when people want to talk about brain health and the effect anesthesia has on brain. It is impossible to talk about this with any layperson in any useful fashion. There was a recommendation in A&A from some working group that one shot talk to all geriatric patients...very frustrated when I read that.

Sounds like your patients are much more educated than mine. I don’t even want to talk about brain health, with surgeons (they don’t care I know) let alone the patients. I do almost if not all my GI cases with the disclaimer that it is not “general anesthesia”. But general anesthesia still has chance of recall. Not sure what to really say to cover all bases.

I am also tired of when patient says I am allergic to narcotics, so don’t give me any, when they’re about to go for a major surgery….
“I will throw the kitchen sink at you. That may not be enough, dear…”

 

[Airway]

Sounds like your patients are much more educated than mine.

No. I wish. I work with an underserved population now. But it doesn't matter educated or not - they still don't get it

I had a PhD something or other request 'me', spinal and no resident/crna for a case. I gave him a stack of literature (that disagreed w his reasoning for neuraxial, also the first time I did the case I did am epidural) and then went along with the silliness. Unfortunately, it was a case I had to do several times. I doubt he read/understood anything I handed him. I know I didn't.

 

[IMGASMD]

I know I didn't.

General public’s distrust of intellectuals.

 

[Toothpickwars]

Why does it matter

Local maximum for post op blocks.

 

[GassYous]

Local maximum for post op blocks.

Why does it matter

 

[Toothpickwars]

Why does it matter

Because bupivacaine is cardiotoxic and my attendings like dogma?

 

[DocVapor]

Because bupivacaine is cardiotoxic and my attendings like dogma?

Yeah, so in PP if a surgeon asks you how much local they can use, just respond with "A lot."

 

[Simba1711]

When hospital staff use the elevator to go up or go down one floor instead of using the stairs. Or try to get in without letting people exit the elevator

 

[Toothpickwars]

Yeah, so in PP if a surgeon asks you how much local they can use, just respond with "A lot."

👍 I’m going to keep working in the land of high BMIs anyway 😬

 

[ISoNitrous]

“The A line tracing is dampened.”

No, my friend, it is damped.