Talking during induction

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Simba1711

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What do you guys tell nurses , techs, and surgeons who talk while you’re inducing patient. It’s my pet peeve when people aren’t quiet while you’re putting the patient to sleep. Today on call , it happens twice. the resident and surgical attending were gossiping on non medical related stuff and I got their attention and told them I’m inducing. After I started pushing meds they started talking again. I had to tell them to stop talking. Wondering if there’s a better way to do this. Both instances were emergency cases with rsi. I usually let it slide if it’s an elective case or easy airway.

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People are usually pretty good about paying attention during induction but I find it annoying when they talk loudly and casually during emergence.
 
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What’s wrong with people talking. I don’t need complete silent during induction. It’s weird af when room is completely silent during induction. I myself am shooting the **** with the nurses and surgeons during induction
 
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What’s wrong with people talking. I don’t need complete silent during induction. It’s weird af when room is completely silent during induction. I myself am shooting the **** with the nurses and surgeons during induction


I’m usually talking quietly to the patient during induction.
 
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What do you guys tell nurses , techs, and surgeons who talk while you’re inducing patient. It’s my pet peeve when people aren’t quiet while you’re putting the patient to sleep. Today on call , the resident and surgical attending were gossiping on non medical related stuff and I got their attention and told them I’m inducing. After I started pushing meds they started talking again. I had to tell them to stop talking. Wondering if there’s a better way to do this. Both instances were emergency cases with rsi. I usually let it slide if it’s an elective case or easy airway.
Two options here:
1. You can tell them to leave the room prior to induction. If they dont leave, just stare at them and dont induce. Eventually, they will step out so they can get started.
2. You can take the passive aggressive route and start chatting really loudly about non medically related stuff and gossip with the nurses while they are operating.

What’s wrong with people talking. I don’t need complete silent during induction. It’s weird af when room is completely silent during induction. I myself am shooting the **** with the nurses and surgeons during induction
I would disagree here. If I am concerned about something, I prefer to focus on the patient and nothing else. We know that communication becomes the weakest link during urgent/emergent situations and its harder to recognize when that is occurring if you are distracted from the noise. The EU has separate induction rooms specifically build to reduce errors due to this.

It also shows a lack of respect from your colleagues if they believe its okay to talk during one of the two most critical parts of your anesthetic.
 
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I’m usually talking quietly to the patient during induction.
Same. The other little pet peeve is when everyone and their mother has to hold and stroke the patient, and ask them to “pick out a vacation spot” while I’m inducing. It’s like, for love of God, shut up!
 
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What do you guys tell nurses , techs, and surgeons who talk while you’re inducing patient. It’s my pet peeve when people aren’t quiet while you’re putting the patient to sleep. Today on call , the resident and surgical attending were gossiping on non medical related stuff and I got their attention and told them I’m inducing. After I started pushing meds they started talking again. I had to tell them to stop talking. Wondering if there’s a better way to do this. Both instances were emergency cases with rsi. I usually let it slide if it’s an elective case or easy airway.
I invite you to where I am, you will get wide variety of knowledge, gossip while inducing the patient. I sometime shout and yell. I have zero tolerance to clucking of the staff around. It happens often.
To be honest, I thought guys you have special room for induction !
 
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QUOTE="DrAmir0078, post: 23999250, member: 949974"]
I invite you to where I am, you will get wide variety of knowledge, gossip while inducing the patient. I sometime shout and yell. I have zero tolerance to clucking if the staff around. It happens often.
To be honest, I thought guys you have special room for induction !
[/QUOTE]

That sucks. My previous job was like that. Nurses would leave while I’m inducing the patient. Tech and nurses would think that surgery is over once dressing is off and start talking on their cell phone or leave the room while the patient is still waiting to be extubated. I once was helping a colleague with a difficult airway. The nurse and anesthesia tech are gossiping while I’m yelling at them to get the glidescope ready and the nurse got pissed at me for raising my voice and yelling at her. My new job is much better but once in a while it still happens. Like someone said earlier it’s a respect thing. The same people that talk during induction would go nuts if you don’t pay attention or talk during time out yet induction and emergence is the most important part of our anesthesia care. Also , if they are taking and it’s non medical related. If I’m anticipating difficulty with the airway I want to be able to communicate with other people what I need and what to grab.
 
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As long as it's not super loud or unprofessional I don't really care. Just turn off the loud inappropriate music for a few minutes when Grandma's rolling in the room please. Also, stop messing with the arms and **** during emergence with ETT.
 
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I don't care as long as they are paying close attention to what I am doing and they quiet down if it looks like I need assistance.
 
I just tune it out and focus. If it’s too distracting I might ask to keep it down for a minute. That’s uncommon.

The only thing I really don’t like is when neuromonitoring starts placing needles prior to me placing the tube.
 
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Same. The other little pet peeve is when everyone and their mother has to hold and stroke the patient, and ask them to “pick out a vacation spot” while I’m inducing. It’s like, for love of God, shut up!
Just push the propofol faster.
 
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Same. The other little pet peeve is when everyone and their mother has to hold and stroke the patient, and ask them to “pick out a vacation spot” while I’m inducing. It’s like, for love of God, shut up!

Lol I don’t mind cause that means at least they’re at bedside and paying attention. Also less talking I have to do to the patient.
 
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What do you guys tell nurses , techs, and surgeons who talk while you’re inducing patient. It’s my pet peeve when people aren’t quiet while you’re putting the patient to sleep. Today on call , it happens twice. the resident and surgical attending were gossiping on non medical related stuff and I got their attention and told them I’m inducing. After I started pushing meds they started talking again. I had to tell them to stop talking. Wondering if there’s a better way to do this. Both instances were emergency cases with rsi. I usually let it slide if it’s an elective case or easy airway.
It does not matter if they talk. Never understand why people care.
 
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If I’m concerned about the induction I will tell them to please be quiet. If they persist, I will say it again in a louder and not as friendly way. I’m not sure what round 3 would be, but probably memorable. I have had occasion to give a handful of people both barrels in the past for other clearly unacceptable stuff.
One of my partners had to ask a proceduralist to step away for a moment for a quiet comment to remind him that the patient was critically ill and actively trying to die, right now, while they were f’ing around distracted and talking about their recent vacation with their fellow and nurse during critical parts of the case. Get your head in the game or get the F out comes to mind. And he pretty much said just that.
 
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If it is a complicated induction / sick patient, then I tell them to be quiet. Their noise and chatter could drown out important communication between members of the anesthesia team.

If I’m concerned about the induction I will tell them to please be quiet. If they persist, I will say it again in a louder and not as friendly way. I’m not sure what round 3 would be, but probably memorable. I have had occasion to give a handful of people both barrels in the past for other clearly unacceptable stuff.
One of my partners had to ask a proceduralist to step away for a moment for a quiet comment to remind him that the patient was critically ill and actively trying to die, right now, while they were f’ing around distracted and talking about their recent vacation with their fellow and nurse during critical parts of the case. Get your head in the game or get the F out comes to mind. And he pretty much said just that.

I do a mini-time out before inducing a critically ill patient (emergent ECMO initiation, hemorrhagic shock, trauma, etc.). In so few words, I essentially tell everyone to STFU, define clear roles for those in the immediate vicinity of the patient, dictate the steps for plan A and tell them about plans B, C, and D if we crash and burn. I do this for emergent intubations in the ICU as well. The noise pollution prior to induction especially for an "exciting" emergent case can be ridiculous.
 
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For routine inductions I’m a big fan of keeping it light. I like music. I’ll chat with the patient, techs, circulator. As long as one of them is paying attention to what I’m doing and assisting me, I’m good. If I’m actually concerned I induce with one of my anesthesia techs, who are amazing. If I’m quiet and focused, the staff that aren’t brand new know that means they probably should be too, I rarely have to say anything. Several of my colleagues are huge ducks about that stuff, so I don’t have to be. But even in sick/complicated patients, I still like music.
 
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Loud talking during induction or emergence is a sign that you work at a toxic place that doesn’t care about patients. When staff speak loudly during these clearly critical periods, it’s a top down cultural problem that honestly you will have problems fixing individually.

When it’s happened before I’ve told them something like “For patient safety, you need to go outside the OR if you’re talking loudly during induction.” It works in the instant sense, but it’ll keep happening.
 
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There's one anesthesiologist who wants complete silence in the room during induction out of the 60 I work with across 4 hospitals. It's super weird. Like literally no one is allowed to talk at all about anything. He's also the slowest of all of them. Refuses to draw up meds, prep spinal stuff, until the patient is literally on the OR table.

Most everyone else wants music off or low. Quiet chatter is OK, which is what I think is normal and respectful. Very rarely are people standing at the head of the bed loudly talking about random stuff.

Obviously, not an anesthesiologist, but don't be like that first guy I described, no one wants to work with him. Everytime I get him in my room every few months, I ask the anesthetics coordinator why I'm being punished.. Usually they chuckle and saw everyone needs a turn with him. 🤣

As a surgeon, I don't care if you talk while I'm operating. We play music, tell jokes, talk about anything. Now if it's a an emergent critical step, or something is going wrong, yes everyone shut up and focus so staff cam hear steps and requests. I find that very very rare that someone is talking when things aren't going well in either induction or surgery.
 
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The opening paragraph rings so true. Attendings that die on the hill about talking are insufferable. Being absolutely quiet and the room completely akinetic is the purpose of the timeout. Not induction.
 
Now if it's a an emergent critical step, or something is going wrong, yes everyone shut up and focus so staff cam hear steps and requests.
Induction and emergence are critical steps. Just FYI.
 
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There's one anesthesiologist who wants complete silence in the room during induction out of the 60 I work with across 4 hospitals. It's super weird. Like literally no one is allowed to talk at all about anything. He's also the slowest of all of them. Refuses to draw up meds, prep spinal stuff, until the patient is literally on the OR table.

Most everyone else wants music off or low. Quiet chatter is OK, which is what I think is normal and respectful. Very rarely are people standing at the head of the bed loudly talking about random stuff.

Obviously, not an anesthesiologist, but don't be like that first guy I described, no one wants to work with him. Everytime I get him in my room every few months, I ask the anesthetics coordinator why I'm being punished.. Usually they chuckle and saw everyone needs a turn with him. 🤣

As a surgeon, I don't care if you talk while I'm operating. We play music, tell jokes, talk about anything. Now if it's a an emergent critical step, or something is going wrong, yes everyone shut up and focus so staff cam hear steps and requests. I find that very very rare that someone is talking when things aren't going well in either induction or surgery.

He needs silence because he’s doing all that prepping 😂.


Surgeon present for induction? We have one surg onc and a few gyns who are routinely present at induction. I appreciate it because it helps move things along but >90% of our surgeons arrive when we call them for positioning or when the patient is being prepped.

Are most people doing both a preinduction time out and a preincision time out? We usually do only a preincision time out. Our Kaiser surgeons tell us they need to be present for a preinduction time out when they are working at Kaiser.
 
What do you guys tell nurses , techs, and surgeons who talk while you’re inducing patient. It’s my pet peeve when people aren’t quiet while you’re putting the patient to sleep. Today on call , it happens twice. the resident and surgical attending were gossiping on non medical related stuff and I got their attention and told them I’m inducing. After I started pushing meds they started talking again. I had to tell them to stop talking. Wondering if there’s a better way to do this. Both instances were emergency cases with rsi. I usually let it slide if it’s an elective case or easy airway.
I had an attending during residency who would belligerently demand absolute silence during inductions. Everyone thought he was a jerk off. I'm sure people are having similar feelings about you. It shouldn't be so noisy that you're yelling but demanding absolute silence makes you a hard on.
 
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This reminds me of one of the ASA's online simulator courses where there's an emergency ortho case, and the surgeon's playing loud thrashing metal music in the OR. It would fail you if you didn't tell him to turn it off.

I can't remember the last time it was so noisy in an OR that I was distracted or had to ask people to quiet down.

People who demand absolute silence are weird. It's awkward and unnatural and I suspect it's sort of disturbing to the patients also.
 
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This reminds me of one of the ASA's online simulator courses where there's an emergency ortho case, and the surgeon's playing loud thrashing metal music in the OR. It would fail you if you didn't tell him to turn it off.

I can't remember the last time it was so noisy in an OR that I was distracted or had to ask people to quiet down.

People who demand absolute silence are weird. It's awkward and unnatural and I suspect it's sort of disturbing to the patients also.
Agree that demanding complete silence is a bit weird, but having the OR turn into a nightclub the moment the final suture goes in (and before pt wakes up), or prior to induction, is even weirder.
 
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This reminds me of one of the ASA's online simulator courses where there's an emergency ortho case, and the surgeon's playing loud thrashing metal music in the OR. It would fail you if you didn't tell him to turn it off.

I can't remember the last time it was so noisy in an OR that I was distracted or had to ask people to quiet down.

People who demand absolute silence are weird. It's awkward and unnatural and I suspect it's sort of disturbing to the patients also.
It’s always ortho

Had one memorable emergence that the ortho-bros had Pearl Jam’s “Jeremy” cranked up to 11, patient waking up “angry”, so after politely asking them more than once, I got loud enough to get them to shut it off/volume down/change to a calmer song. Immediately, as the volume cut down, the patient also calmed down too, and then the ortho-bros were in awe. They are such a caricature of themselves.

I like some background music, but at a reasonable volume that people can still talk and be heard.
 
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It’s always ortho

Had one memorable emergence that the ortho-bros had Pearl Jam’s “Jeremy” cranked up to 11, patient waking up “angry”, so after politely asking them more than once, I got loud enough to get them to shut it off/volume down/change to a calmer song. Immediately, as the volume cut down, the patient also calmed down too, and then the ortho-bros were in awe. They are such a caricature of themselves.

I like some background music, but at a reasonable volume that people can still talk and be heard.
Not always ortho. In residency there was an OB-GYN that would turn on Britney Spears (and her contemporaries), turn the volume up to 11, and boogie during a whole case. Terrible surgeon. I was tearing my ears off one time during an open hyster when she lost control of a uterine artery. Only reason I knew about it is because her back got stiff and she froze in place while this woman's belly filled up with blood. Circulator I think realized what was happening and turned the music off; surgeon snapped out of it and we managed to get the patient through it.

I never worked with her again.
 
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There's one anesthesiologist who wants complete silence in the room during induction out of the 60 I work with across 4 hospitals. It's super weird. Like literally no one is allowed to talk at all about anything. He's also the slowest of all of them. Refuses to draw up meds, prep spinal stuff, until the patient is literally on the OR table.

Most everyone else wants music off or low. Quiet chatter is OK, which is what I think is normal and respectful. Very rarely are people standing at the head of the bed loudly talking about random stuff.

Obviously, not an anesthesiologist, but don't be like that first guy I described, no one wants to work with him. Everytime I get him in my room every few months, I ask the anesthetics coordinator why I'm being punished.. Usually they chuckle and saw everyone needs a turn with him. 🤣

As a surgeon, I don't care if you talk while I'm operating. We play music, tell jokes, talk about anything. Now if it's a an emergent critical step, or something is going wrong, yes everyone shut up and focus so staff cam hear steps and requests. I find that very very rare that someone is talking when things aren't going well in either induction or surgery.
As another poster mentioned. Induction and emergence are critical steps. The fact that you do not understand that and believe its okay to shoot the sh1t during these times just reinforces the idea that you do not respect your colleagues role and the patient's safety.
That said, yes pin-drop silence is weird.
 
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Same. The other little pet peeve is when everyone and their mother has to hold and stroke the patient, and ask them to “pick out a vacation spot” while I’m inducing. It’s like, for love of God, shut up!
This bothers me much more when I'm placing an epidural. I feel like I am annoyed with 90% of the things the RN tells the patient about the epidural.

Example: "This first numbing medicine is the WORST part!! It will be like a big bee sting and hurt a lot, but it's SOOO worth it!"

I feel like that makes them so much more jumpy and dramatic, but when I say, "This is going to feel like a little mosquito bite," they usually don't even flinch or anything.

Also, "You'll feel so much in 5 minutes" on the patient whose BMI is >50, setting the patient up to be frustrated if it's difficult at all.
 
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This bothers me much more when I'm placing an epidural. I feel like I am annoyed with 90% of the things the RN tells the patient about the epidural.

Example: "This first numbing medicine is the WORST part!! It will be like a big bee sting and hurt a lot, but it's SOOO worth it!"

I feel like that makes them so much more jumpy and dramatic, but when I say, "This is going to feel like a little mosquito bite," they usually don't even flinch or anything.

Also, "You'll feel so much in 5 minutes" on the patient whose BMI is >50, setting the patient up to be frustrated if it's difficult at all.
Exactly. Or “you’re gonna sleep so well after this.” How do you know?! Why would you promise that?! Or you start inserting the tuohy, and 1 cm in, as the pt might voice some discomfort, the nurse asks “Do feel it to the right or left??” Umm, we literally just started. And I’m more than capable of asking my own questions…
Rant over
 
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I realize that sometimes noise just happens a bit. It gets away from people and they just need a gentle reminder to re-orient.

I definitely ask the circulator on occasion to turn the music down a little if I feel it's louder than is reasonable at induction/emergence, but I definitely don't mind if the music is quiet enough that me and the OR staff can easily talk to each other without raising voices.

Also when people are getting a little too rowdy at induction/emergence, I'll tell them "reign it in people, until we're done with ___". It has always gone smoothly and I find it's not confrontational but makes it clear that it needs to change immediately.
 
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Our scrub nurses and circulators are well trained to stfu and stop unwrapping stuff when we utter the magic words "We're going to sleep now", and ask our permission even touching the patient during emergence. It's great.

The new ones take about a week before they're indoctrinated.

At this other place I do locums, it's a complete ****show. Scrub nurses and circulators never taking the quiet hint, so we usually have to use a loud voice.
 
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For some reason my wife always calls me on the phone during induction. It’s like she has some sixth sense…
 
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For some reason my wife always calls me on the phone during induction. It’s like she has some sixth sense…
Yes because the shape size and consistency of the dogs morning poop is my most pressing concern at 7:30 in the morning.
 
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Yes because the shape size and consistency of the dogs morning poop is my most pressing concern at 7:30 in the morning.
I hear that! My wife is fanatical about our dogs. One time I was filling up the dog's bowl with water from the faucet which my wife noticed. She screamed "what are you doing?!" like I was pouring poison in the bowl. I said "I'm giving the dogs water." To which she replied "from the sink ?(real incredulous like)...use the filtered water from the fridge." My retort: "Not for nothin' hon, but Rocky's in the backyard right now snacking on his own feces. I don't think he's got that discriminating a palate that he'll turn his nose up to tap water." Like the shi_t eating mutt's gonna come inside, go to his bowl, take a few laps and think "how gauche!" and walk away.
 
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Two options here:
1. You can tell them to leave the room prior to induction. If they dont leave, just stare at them and dont induce. Eventually, they will step out so they can get started.
2. You can take the passive aggressive route and start chatting really loudly about non medically related stuff and gossip with the nurses while they are operating.


I would disagree here. If I am concerned about something, I prefer to focus on the patient and nothing else. We know that communication becomes the weakest link during urgent/emergent situations and its harder to recognize when that is occurring if you are distracted from the noise. The EU has separate induction rooms specifically build to reduce errors due to this.

It also shows a lack of respect from your colleagues if they believe its okay to talk during one of the two most critical parts of your anesthetic.
I think these are both immature ways to handle the situation. If you prefer to induce the patient in a quiet room then confidently state that to the other personnel in the room. If you say it like you mean it then they will listen.

I mean it’s one of those weird things where not all attendings will want a pin drop quiet room during induction so if you have a room where no one knows your personal preference then just speak up and state that you would like a quiet room during induction. Nothing weird about this, but no one can read your mind. So if this is what you want let it be known.
 
I have no issues with small talk during induction. If it's a pretty sick patient or a difficult airway, people seem to sense that and be quiet/stay out of the way as needed. I'm usually shooting the **** with the patient or playing their favorite artist on spotify for them as they get off to sleep anyway. I could care less what the background people are doing within reason.
 
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As an ER doc who is usually intubating sick AF people, I hate it when people are talking during RSI.
 
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Talking during induction should be a violation like a joint commission violation when people talk during time outs. This happen at my previous hospital 4 years. The talking during time out.

So no one should talk or do other stuff besides the person doing the induction. I will write joint commission to include this
 
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Talking during induction should be a violation like a joint commission violation when people talk during time outs. This happen at my previous hospital 4 years. The talking during time out.

So no one should talk or do other stuff besides the person doing the induction. I will write joint commission to include this
Please don't add any fuel to their illegitimate fire!
 
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Tbh, if it's a straightforward case I don't mind if people are talking or going about their own business.
 
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There's one anesthesiologist who wants complete silence in the room during induction out of the 60 I work with across 4 hospitals. It's super weird. Like literally no one is allowed to talk at all about anything. He's also the slowest of all of them. Refuses to draw up meds, prep spinal stuff, until the patient is literally on the OR table.

Most everyone else wants music off or low. Quiet chatter is OK, which is what I think is normal and respectful. Very rarely are people standing at the head of the bed loudly talking about random stuff.

Obviously, not an anesthesiologist, but don't be like that first guy I described, no one wants to work with him. Everytime I get him in my room every few months, I ask the anesthetics coordinator why I'm being punished.. Usually they chuckle and saw everyone needs a turn with him. 🤣

As a surgeon, I don't care if you talk while I'm operating. We play music, tell jokes, talk about anything. Now if it's a an emergent critical step, or something is going wrong, yes everyone shut up and focus so staff cam hear steps and requests. I find that very very rare that someone is talking when things aren't going well in either induction or surgery.
I don't pre-draw meds or spinal kit either, I do it as the pt is being positioned by the RNs after the pt is in the room. I'm pretty quick so I multitask and get everything done efficiently. Plus the clipboard warrior RNs and inspectors don't like pre drawn syringes so I am totally compliant 😎
This bothers me much more when I'm placing an epidural. I feel like I am annoyed with 90% of the things the RN tells the patient about the epidural.

Example: "This first numbing medicine is the WORST part!! It will be like a big bee sting and hurt a lot, but it's SOOO worth it!"

I feel like that makes them so much more jumpy and dramatic, but when I say, "This is going to feel like a little mosquito bite," they usually don't even flinch or anything.

Also, "You'll feel so much in 5 minutes" on the patient whose BMI is >50, setting the patient up to be frustrated if it's difficult at all.
I just tune them out and get LOR. I realize some battles are just not meant to be fought, especially with LnD nurses, you go from hero to zero if you get on their wrong side. Thankfully most of the nurses are good at my place and are appropriately reassuring
 
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You know what I don’t like? A tight-gripped chin lift mask with a hand over the eyeballs while I push drug.
 
Perhaps. But I’ve had enough patients complain. Imagine you are about to lose control of your life. Imagine you may be having a tumor removed, or a leg amputated. Now imagine a stranger’s hand 3 inches from your face.

It’s not pleasant, relaxing or soothing. Quite the opposite.
 
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Perhaps. But I’ve had enough patients complain. Imagine you are about to lose control of your life. Imagine you may be having a tumor removed, or a leg amputated. Now imagine a stranger’s hand 3 inches from your face.

It’s not pleasant, relaxing or soothing. Quite the opposite.
Some of my trainees will do odd intense preoxygenation where they cover the patients whole face and the keep yelling at them about how to orient their chin and where they will go on vacation. They’re learning it from someone….

But nothing is as bad as the creepy black mask straps that all the crnas seem to want to use, which must be something that’s taught in “anesthesia school”.
 
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This bothers me much more when I'm placing an epidural. I feel like I am annoyed with 90% of the things the RN tells the patient about the epidural.

Example: "This first numbing medicine is the WORST part!! It will be like a big bee sting and hurt a lot, but it's SOOO worth it!"

I feel like that makes them so much more jumpy and dramatic, but when I say, "This is going to feel like a little mosquito bite," they usually don't even flinch or anything.

Also, "You'll feel so much in 5 minutes" on the patient whose BMI is >50, setting the patient up to be frustrated if it's difficult at all.
Sounds like you're a lightweight at epidurals. I put them in too fast to allow myself to be bothered by those dumb things.
 
Sounds like you're a lightweight at epidurals. I put them in too fast to allow myself to be bothered by those dumb things.

We get it. You’re bored.

I also want to vote this person off the island.
 
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Had the circulator who was helping me induce signout out to another RN while I was intubating. I wouldn’t have minded, except it was a tricky airway and I had failed DL twice and it was started to get slightly stressful especially since mask ventilation wasn’t that great. I usually don’t mind a little chit chat or whatnot, but felt this was pretty inappropriate for patient care and very disrespectful of my job.
 
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