Still deciding whether PIEB is better than CEI for labor analgesia. I still mainly use CEI with PCEA. Great overview and summary from Dr. Ana Sjaus #ASRASPRING25#ASRA50
Dr. Lawrence Tsen makes the case for DPE with the advantages of CSE of faster onset and sacral spread and fewer of the downsides of fetal bradycardia or the untested catheter #ASRASPRING25#ASRA50
A pragmatic approach to evaluating new techniques in regional anesthesia and acute pain medicine #ASRASPRING25
➡️ improving outcomes?
➡️ enhancing efficiency?
➡️ increasing access?
➡️ decreasing disparities?
@EMARIANOMD@ASRA_Society@commonwealthfnd
https://t.co/ryjhzxPGna
@MSharifpourMD I trained at a facility that didn’t carry sugammadex until my 4th year, and even then restricted its use. I worry about residents now that are so reliant on sugammadex they don’t know how to dose neostigmine/glyco or redose NMBs to intentionally have 0 twitches at end of case.
When the next cardiologist tries to argue that the PAUSE trial only says to hold for two days instead of three, remind them that the trial defined “two days” as 68 hours #ASRASPRING25@SLKoppMD#ASRA50
58 measles cases on Tuesday is now more than 90.
Measles is THE most contagious illness.
A infected person can infect 18 others with one exposure.
Virus can survive for hours in air.
The vaccine is 99% effective, but low vaccine rates allow viral spread.
This was preventable.
My heart is broken💔: As friends & family know, my wife was pregnant with our 2nd child, & about to begin her 2nd trimester. A few days ago she had severe pains, & bleeding, and had to go to the emergency room. There, it was discovered that our baby no longer had a heartbeat. Devastated doesn't come close to what that feels like.
Unfortunately for people like us, because of the current laws in the state of Texas, that was only the beginning of this nightmare. Jess (my wife) had an "incomplete miscarriage", and what needed to happen, what was best for HER, and her health, was to terminate the pregnancy, and get the baby out.
The doctor gave her a medication that would move this process along, and sent her home. Where, apparently we would be handling it ourselves. We were told it might take a couple of attempts before it worked.
I'll let you decide how you feel about that.
After a long, painful night of the equivalent of early labor, the baby was still with her. So, we went back to the Emergency Center to get the 2nd dose. A new doctor was on call. He was an older man. You could hear him in the hallway as he said, "I'm not giving her a pill so she can go home and have an ab*rtion!". Being well aware that our baby no longer had a heartbeat. Then, he came into the room to say, and I quote: "Considering the current stance. I'm not going to prescribe you this pill". Then, just sent us on our way.
The "CURRENT STANCE"?! Did he really just say that?!
No one should ever have to hear their wife say: "Get this dead baby out of me!".
Can you even imagine how that must feel?
The pain, and the bleeding continued. So, we decided to go to another hospital, about an hour away. There was a female doctor on call there, and we thought we might have better luck.
I should probably mention, the procedure to get the baby out is called a D & C. It's scary, & traumatizing, but sometimes necessary in situations like ours. Especially in emergency circumstances.
So we get to the next hospital. They take Jess in, ask her a bunch of questions, do a new scan... confirm that the baby is still there, with no heartbeat, and then disappear... for hours. Only to come back in and keep asking the same questions over and over. It's becoming clear that they're primary concern is NOT my wife's health. Instead, they seem to be worried about the legalities involved.
So, they decide it is not "enough of an emergency" to perform the D & C.
They do, however, prescribe another, stronger, final dose of the medication for us to try again... at home.
So, we go home to try again. Another long day/night of early labor pains. Only to discover my wife UNCONSCIOUS in the bathroom. Having to pick my wife's cold, limp body off of that bathroom floor, not sure if I was about to lose her, is something I will NEVER forget.
She had to be rushed to the hospital.
By this point she had lost so much blood, and bodily fluid, her body gave out.
They were able to stabilize her, give her the fluids she needed, and we came back home yesterday afternoon. We were also able to confirm that our baby was no longer with her.
Now, not only do we have to live with the loss of our baby... we have to live with the nightmare of what we just experienced because of political and religious beliefs. MY WIFE'S HEALTH SHOULD HAVE COME FIRST. PERIOD!
God knows what mental and emotional damage this has done.
If you consider yourself a staunch "pro-lifer" ... 1) You've never been through what we just went through, and 2) You should take a long, hard look in the mirror and reevaluate your reasons for supporting such a cold, barbaric, ignorant point of view.
It's not that black & white, and it's never going to be.
If you think your "Pray To End Ab*rtion" sign in your yard is "Christian", I suggest you revisit the teachings of Jesus and try again. If you support these laws that make ab*rtion illegal, and result in people being put through what we just were, you should be ashamed of yourself. I've never been so angry, or heartbroken... and the devastation I'm feeling must pale in comparison to what my poor wife is feeling.
Everyone in academic medicine says, "Ooh get ready for July"
Yeah, get ready to welcome a group of enthusiastic new physicians with an untainted love of medicine 😁 This is the energy boost that our profession needs!
When you see them, give a warm "Welcome, Doctor!"