Pet peeves

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drmwvr said:
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...
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The best is when they come back as the support person for a c/s.

Had some amazing conversations about eating placentas.

She was surprised how nice a birth could be in a c/s. I think we shook the foundation of her beliefs.
 
drsamzie said:
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.
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LOL - we don't accept "clearance" notes from non-physicians. Problem solved.
 
secretasianman said:
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.”
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We don’t call centipedes “sontipedes “

Heroin is the drug, every time I see it spelled heroine, I die a little.
 
HemeOncHopeful19 said:
Ok come on you can’t just drop that and not tell the story!
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Older female patient came to pre-op before her procedure. Supposedly a driver was verified but said they'd come back when we called. She was carrying a little basket with her. Got her IV, anesthesia saw her, got her versed, all ready to go. When we came to do the handoff and go to surgery, she asks "who's going to watch my pet possum while I'm in surgery?". We all look at each other and laugh, thinking it's a joke. Oh no - she opened the basket, and sure enough, there's a small live possum in there which she takes out and shows us. OMG!!! Her surgery was canceled, and she was told not to bring her possum with her if she came back.

True story - you can't make this crap up.
 
jwk said:
Older female patient came to pre-op before her procedure. Supposedly a driver was verified but said they'd come back when we called. She was carrying a little basket with her. Got her IV, anesthesia saw her, got her versed, all ready to go. When we came to do the handoff and go to surgery, she asks "who's going to watch my pet possum while I'm in surgery?". We all look at each other and laugh, thinking it's a joke. Oh no - she opened the basket, and sure enough, there's a small live possum in there which she takes out and shows us. OMG!!! Her surgery was canceled, and she was told not to bring her possum with her if she came back.

True story - you can't make this crap up.
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That’s literally a pet peeve.
 
jwk said:
Older female patient came to pre-op before her procedure. Supposedly a driver was verified but said they'd come back when we called. She was carrying a little basket with her. Got her IV, anesthesia saw her, got her versed, all ready to go. When we came to do the handoff and go to surgery, she asks "who's going to watch my pet possum while I'm in surgery?". We all look at each other and laugh, thinking it's a joke. Oh no - she opened the basket, and sure enough, there's a small live possum in there which she takes out and shows us. OMG!!! Her surgery was canceled, and she was told not to bring her possum with her if she came back.

True story - you can't make this crap up.
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Gold, Jerry! Pure gold!!
 
Love this thread. Just today’s peeves:

Patients being in the hospital for a week and coming to the OR with no IV access.

Patients being in the ICU on pressors and coming to the OR with no a-line.

Patient with hct of 12 from CBC drawn yesterday and no one did anything about. Surgeon annoyed about delaying non-emergent case for transfusion.
 
When your first simple questions to a patient, any questions, what's your name, how are you, what are we doing today... are met with at least a 5 second pause before a very slow movement of the mouth begins forming words. I die a little inside each time knowing this is going to be a really long painful preop.
 
We'llBeDoneIn15Minutes said:
When your first simple questions to a patient, any questions, what's your name, how are you, what are we doing today... are met with at least a 5 second pause before a very slow movement of the mouth begins forming words. I die a little inside each time knowing this is going to be a really long painful preop.
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The opposite is painful too…

Me: “How are you today?”
Patient: “I’m good! *Transitions into unrelated, never ending story”
 
We'llBeDoneIn15Minutes said:
When your first simple questions to a patient, any questions, what's your name, how are you, what are we doing today... are met with at least a 5 second pause before a very slow movement of the mouth begins forming words. I die a little inside each time knowing this is going to be a really long painful preop.
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I am always amazed how a family member of someone with severe dementia and aphasia from a stroke can claim to somehow have long drawn out conversations. It drives me crazy. I’m like “you had a conservation about X, Y and Z despite the fact your father has severe dementia, is AOx0 and had a massive left MCA stroke? Really?”
 
Straight2eight said:
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.
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I've done this to myself. Two likes if you purposely used perseverererate.
drsamzie said:
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.
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Wow. You whine like my child. How old are you? 🤣
drsamzie said:
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.
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25 hour work week stretched over 45 hours and brag like they have worked soooo hard.
dabears505 said:
How about actual pet in the room during labor epidural placement for support.
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Had a lady throw a fit for this but I shot her down. She said she couldn't be without her dog no matter what..... but had the nerve to show up at her next appointment without her pet, Brown Sugar.
nimbus said:
I bet he was no ordinary possum..
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It's a possumbility
 
BobLoblaw78 said:
RN's asking for help with a difficult IV. And being so helpful that they "didn't make any attempts because they wanted to leave me the good sites"
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Annoying as this may be, I prefer it to showing up and seeing a patient that has been turned into a pincushion with gauze taped all over both hands, both ACs, etc… Or only realizing after coming into the OR that the preop nurse placed a subcutaneous “IV”
 
Hork Bajir said:
Annoying as this may be, I prefer it to showing up and seeing a patient that has been turned into a pincushion with gauze taped all over both hands, both ACs, etc… Or only realizing after coming into the OR that the preop nurse placed a subcutaneous “IV”
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Step 1 - pre-op nurse, who now starts exponentially more IVs than I do in a given year tries first.
Step 2 - call IV team, since they do IVs with ultrasound guidance every day and we don't.
Step 3 - call anesthesia, have everything ready to go, and then if we see nothing worth sticking we'll do a central line. 🙂
 
jwk said:
Step 1 - pre-op nurse, who now starts exponentially more IVs than I do in a given year tries first.
Step 2 - call IV team, since they do IVs with ultrasound guidance every day and we don't.
Step 3 - call anesthesia, have everything ready to go, and then if we see nothing worth sticking we'll do a central line. 🙂
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I trained at a place where the pre-op nurses didn’t start IVs. As a resident, I was placing the IV for every patient. Doing IVs on awake patients is definitely a slightly different skill than asleep IVs, and I worry that the residents at my current job (where preop nurses do all of the IVs) are missing out.

Also FWIW anesthesiologists who came out of training in the last 5 years or so tend to be very facile with US for vascular access. There are definitely things I am below average of doing, but starting IVs is not one of them- give me an US, and if I can’t get an IV then I bet very few can. Much faster for me to do it than to wait for an IV nurse.

Also putting in a plug for the basilic vein IV- will usually stick with an 18g angiocath under US, then exchange over a wire for a longer (10cm) catheter like the ones Arrow makes for fem lines. Basically a poor-mans midline. Has bailed me out in numerous difficult IV situations, and just about everyone has a decent basilic (unless it’s clotted or something). Only thing to be careful about is not spearing the median nerve.
 
Gator7 said:
Love this thread. Just today’s peeves:

Patients being in the hospital for a week and coming to the OR with no IV access.

Patients being in the ICU on pressors and coming to the OR with no a-line.

Patient with hct of 12 from CBC drawn yesterday and no one did anything about. Surgeon annoyed about delaying non-emergent case for transfusion.
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I used to think this about vasopressors, but honestly I’d be fine if it’s low dose, one pressor. Obviously patient dependent, but I do think we underestimate the risks of arterial lines because we do them so frequently.
 
Hork Bajir said:
I trained at a place where the pre-op nurses didn’t start IVs. As a resident, I was placing the IV for every patient. Doing IVs on awake patients is definitely a slightly different skill than asleep IVs, and I worry that the residents at my current job (where preop nurses do all of the IVs) are missing out.

Also FWIW anesthesiologists who came out of training in the last 5 years or so tend to be very facile with US for vascular access. There are definitely things I am below average of doing, but starting IVs is not one of them- give me an US, and if I can’t get an IV then I bet very few can. Much faster for me to do it than to wait for an IV nurse.

Also putting in a plug for the basilic vein IV- will usually stick with an 18g angiocath under US, then exchange over a wire for a longer (10cm) catheter like the ones Arrow makes for fem lines. Basically a poor-mans midline. Has bailed me out in numerous difficult IV situations, and just about everyone has a decent basilic (unless it’s clotted or something). Only thing to be careful about is not spearing the median nerve.
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Share your thoughts exactly. When there is absolutely nothing superficial on a whale I don't hesitate to use the brachial. There's no reason to think you'll hit the brachial artery is you are proficient with ultrasound.
 
Gator7 said:
Love this thread. Just today’s peeves:

Patients being in the hospital for a week and coming to the OR with no IV access.

Patients being in the ICU on pressors and coming to the OR with no a-line.

Patient with hct of 12 from CBC drawn yesterday and no one did anything about. Surgeon annoyed about delaying non-emergent case for transfusion.
Click to expand...
nimbus said:

Anesthesiology

pubs.asahq.org pubs.asahq.org
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There's what I call the transplant floor special, 22ga in the AC. For the kidney transplants patients I get it, they have **** for veins, but one of our kidney surgeons like to give a lot of fluid and mannitol prior to reperfusion; this is the only time i hate having a fast good surgeon.


But, dear good, our liver transplants come down with 22ga IVs in the AC too. Some of those guys are so congested, I could stick a central line in their forearm.
 
0kazak1 said:
There's what I call the transplant floor special, 22ga in the AC. For the kidney transplants patients I get it, they have **** for veins, but one of our kidney surgeons like to give a lot of fluid and mannitol prior to reperfusion; this is the only time i hate having a fast good surgeon.


But, dear good, our liver transplants come down with 22ga IVs in the AC too. Some of those guys are so congested, I could stick a central line in their forearm.
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I put in a ric in the ac once and the blood just poured out like I hit the aorta
 
Hork Bajir said:
Annoying as this may be, I prefer it to showing up and seeing a patient that has been turned into a pincushion with gauze taped all over both hands, both ACs, etc… Or only realizing after coming into the OR that the preop nurse placed a subcutaneous “IV”
Click to expand...

I agree. I want the nurses to try a couple times if they see some targets (but not excessively), but occasionally there isnt anything visible. So I just put in an IV with US which generally is not a big deal.
 
patriot6 said:
The opposite is painful too…

Me: “How are you today?”
Patient: “I’m good! *Transitions into unrelated, never ending story”
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Yes, similarly the patient that thinks they are helping you by greatly expanding their answer to every single yes/no question.

GERD? turns into a life long dietary history, years of OTC meds, and eventually solving the issue a decade ago by figuring out which foods were the trigger.

Diabetes? turns into a lesson in his complete family tree, lists all the relatives on his mom's side that have Diabetes, while nobody on his father's side, and he is the only of four siblings to not have Diabetes.

So you're saying you don't have Reflux or Diabetes. Great, got it (eyeroll).
 
pjl said:
The best is when they come back as the support person for a c/s.

Had some amazing conversations about eating placentas.

She was surprised how nice a birth could be in a c/s. I think we shook the foundation of her beliefs.
Click to expand...
I tried my hardest to convince one of our pregnant circulators to eat her placenta, even going so far as to saying, "Your colleague's eaten two." No dice...
patriot6 said:
When the vascular surgeon suggests which airway device I should use:

"Hey man, it's a short case... you can put in an LMA."

Morbidly obese, GERD, A1c of 15.
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Everytime the patient bleeds, point it out to the surgeon. "Hey, I think the patient's bleeding. You gonna bovie that? Or tie it off or what?"
 
Gator7 said:
Love this thread. Just today’s peeves:

Patients being in the hospital for a week and coming to the OR with no IV access.

Patients being in the ICU on pressors and coming to the OR with no a-line.

Patient with hct of 12 from CBC drawn yesterday and no one did anything about. Surgeon annoyed about delaying non-emergent case for transfusion.
Click to expand...
Hooboy, then you'll love the ICU line consults/coming to the OR patients we get from FP/IM hospitalists running levophed off a 22G in the hand sans CVP or A-line.
 
secretasianman said:
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.”
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Metric system comes from the French…
 
ICU systolic blood pressure ceilings on patients with only a NIBP cuff

Surgeons that request a MAC then get agitated when the pt moves a little or they then request a breath hold makes me want to sux dart them in the leg.

Surgeons that are always in a rush but aren’t there for positioning only to come in and complain about the positioning. Maybe if you were in the room to guide this…..
 
GassYous said:
I don't think anyone gives two ****s about what a midlevel has to say
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I was asked to look through a cardiology consult by hospital per-op nurse, for an anesthesia okay….

The recommendation at the end just didn’t make much sense. I was new to the system, so didn’t recognize the name. Called the per-op nurse back and asked who the person is. She just said, Oh, yes Jane Smith is a nurse practitioner.

I asked for additional work up and/or echo.

The nurses know. We know. The NPs know. Why are we all pretend it’s alright they’re doing garbage work and calling physicians names behind our back?!
 
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