My son just became a anesthesiology Doctor, I love watching your video's, so i can see everything he went through to archive his dream of been a Doctor.
Currently reviewing for our country's physician licensure exam and watching this during my coffee break. It's kind of inspiring for sure to hear about residency training. Stay safe, doc! 😃
Thanks Max for sharing your experiences so flawlessly! I'm also 3 months into my anesthesia training in HK, and its reassurring to know that we all go through similar experiences and steep learning curves 😂
Hi Annie, thanks for the feedback! Yes, I can assure you that you, me, my co-residents, and I'm sure many anesthesia residents all feel like the learning curve can be very steep.
Reggaeton? Cool dude!! Thanks for the look around the OR, the explanations, stories and concrete examples and details. Very, very helpful!!! And your compassionate and open minded persona is great man!! :)
Thank you so much for your videos. I'm a lay person from the UK but I do understand a little bit and enjoy geeking out or falling asleep to your videos. I've had a really tough time this week and watching you and/or your interviews have really helped me.
You do a very good job with these videos. One of your best qualities is that you aren't acting like a big shot, you are very easy to relate to. It sounds like you are speaking sincerely, you explain procedures or terms that most of us don't know. You are much more likeable than Dr.'s that act like they are God and we should worship them! Your pleasant attitude means so much to your patients, trust me! Surgery is a scary thing, having caring people around you makes a world of difference! I thank you on behalf of all your patients, they all appreciate you whether they know it or not! Great video and channel, keep up the great work and I wish you all the best in your career, life!
hey Max! Greetings from Turkey:) You have such an amazing content. They are great tools to get an insider look into anesthesia. I'll also start off my residency program in anesthesiology next month. Watching this video made me feel so proud for choosing this unique specialty! Pls keep on sharing your story with us:)
Hey Max, great video! Thanks for your hard work uploading these videos. I'm just about to start medical school and am very interested in anaesthesia; I find your videos both entertaining and informative.
Very interesting max I have 4 stents , no thyroid , and a few others you people have all my respect and the perfusion people too in my eyes you people are really in charge of the surgeries I hold up my glass to you all
Hey Juanita, thanks for the nice feedback! My two favorite Spotify playlists to put on in the OR are Mood Booster and Operating Room Mix. But I've been known to put on Bad Bunny radio :)
I have a fear of the or due to waking from surgery while still in there surgery was over but I freaked out a bit, recently I had to have surgery again, and there fear was there, my obgyn who is amazing, came in with me which made it easier, I don't remember much I recall her holding some leads in her hand, and pulling my arm out of the gown, some meds going in my iv, that's the last I recall, I woke with a male voice saying here's your little friend, which was my simba stuffy as it helps keep me grounded. good experience this time
Sorry you had that experience the first time around, it sounds really scary. It's very very rare for people to wake up during surgery, and is incredibly unlikely it would ever happen again to you.
Max deserves 7 million subs....I am scared to death for what's coming but I find a weird comfort in listening to him describe his job...god I'm scared tho
This was a great video! I plan on applying to Anesthesia this year in the Match and this video gives me life. Might need to apply to Mount Sinai if I can afford the cost of living lol
Here in India,we have 2nd highest population in the world...n during our 1st year of residency,we end up working nearly 12 hrs a day for routine surgery in govt college n on emergency day,it's straight 24 hrs... during routine surgery days we do nearly 9,10 cases per day..so nearly after 1st year,junior most become very much expert...yet in govt setup,we don't have all the monitors but have all the drugs available there..it's pleasure to see your setup...
@@MaxFeinsteinMD yes...but in operation theatre we have 2nd year n 3rd yr resident available along with assistant professor during the surgery..m doing freelance since last 7 yrs...but here we anaesthesiologists get 30% of surgeons charges in Pvt practice...(sad part) so we do 4,5 cases per day..take care
Wow I'm so impressed. You seem to all ready so calm. I need to find all your videos. So interesting. I'm sure your helping allot of residents thinking about your field. Thanks for shareing. So interesting.Thanks. oh how long does it take to get use to the OR smell.
Thank you for the nice feedback on this and the other video you commented on! Exuding calmness is definitely a goal, even if I don't feel calm inside, it's important for the patient, surgeon, and OR staff for the anesthesiologist to remain calm especially when problems arise. I've found that different ORs have different smells. In rooms where there's a lot of electrocautery (essentially a small, controlled burn that cuts through skin and other tissue) it tends to smell like burnt flesh, which I find very unpleasant and haven't gotten used to. A lot of the ORs where I work just have a sort-of sterile smell which doesn't bother me.
thanks for the update! will be following through your journey through CA-1 to CA-3. hopefully one day i can be in your shoes (?) fingers crossed. am a FMG from the UK, worried about cancelled electives and lack of UCSE for applications :x. any idea how the situation is like?
Hi Brandon, thanks for following along on my journey through residency! As far as elective cancellations, what I've seen is that many programs have been opening anesthesia rotations back up to their own students over the last 1-2 months. I suspect it will be a bit longer before rotations are opened up to students that aren't at the affiliated medical school. One of the other complicating factors is that many hospitals require 14-day quarantine periods before their own employees can return to work after travel to many parts of the US (as well as outside the US, depending on where exactly). I'm sure outside rotators will be subject to the same requirement. What do you mean by UCSE? Not sure I understand.
@@MaxFeinsteinMD sorry for using abbreviations! I meant United States clinical experience! Fair! Must be really hard for even their own employees to get around covid. Haha! Anyway appreciate the reply. Lookin forward to mee vids! Funny content BTW!
12:26 when things are wrapped like that, does that mean the entire thing gets thrown away when it's used? Is it just basically plastic housing, or is that actually like a camera inside that gets thrown away as well?
Still would love to do this but haven't had the right situation yet! I'm waiting for the right patient to come along who potentially would be comfortable with me filming them. Hopefully can do this soon- I'll let you know.
This is a good question. Muscle relaxants generally shouldn't be used with LMAs because with an LMA, you're depending on a patient to breath spontaneously (ie. on their own with very little ventilatory support) for the entire case. The reason for that is since an LMA doesn't actually go past the vocal cords, you can't deliver much positive pressure through one (you risk a leak that would lead to filling up the stomach with air, and more importantly not getting adequate oxygenation and ventilation of the lungs), which ultimately means that using a ventilator through one isn't a good idea. Let me know if I didn't explain it well.
that little skit you did was funny, surprised you didn't scream corona and call for back up....drs here did, was funny as heck...have surgery tomorrow, I hope my anesthesia Dr. has a good sense of humor like you, last one I think sat on a thumb tack, mr, crabby pants
Hi Dr Feinstein just wanted to say how I appreciate your videos, they are so informative and I love your great sense of humour. I have a question for you (I will just give you a long background story to go with it) I have a child multiple disabilities Autism primarily being the biggest challenge, he has required quite a few surgeries- we have done 4 general anaesthetics this year with another one to go. I have had pretty much a different anaesthesiologist each time for my son, some anaesthetics have been really easy and relaxed (one of the drs came to the ward chatted to my son gave him her swipe card so he could open all the doors on the way to theatre and made him really relaxed which helped me as a parent) another was quite abrupt and what I thought was rude about not having notes ready etc and made the room really tense and stressful) my question is do you get training in dealing with children/individuals with disabilities/challenging behaviours? I really feel for staff when they maybe put into these situations with children like mine who require extra support. I really hope staff get support and appropriate training Thanks so much Katrina from Australia 🇦🇺
I know you're only in your 1st year and haven't gotten into a pediatric anesthesiology rotation, have you thought about doing pediatrics? I think you would do well with kids. You explain everything clearly, any kid would calmer after you explain everything.
Thanks for the kind words! I've considered pediatric (my anesthesia mentor during medical school is a peds anesthesiologist) but I have to say it's really intimidating. Kids have smaller physiologic reserves as compared to adults, so when things go wrong, they tend to go wrong *really* fast. Having said that, kids are usually really fun to work with, and especially when they're under the effects of anesthesia but not completely asleep haha.
Very true. Least in your case, with all the advances in medicine. The rate of things going bad have been cut drastically. I think doing obgyn is harder then peds since malpractice lawsuits are the highest in obgyn
Hey Max, I'm MS3, very interested in pediatric anesthesiology. Do you have any relationships with sub specialists in anesthesia? There isn't enough interview content for subspecialties and I would really like to hear what a pedi anesthesiologists has to say about their career. Also, an in depth review of how to even apply to anesthesiology would be dope considering it is difficult to understand how to apply for intern year (ped, IM, EM, etc.) and CA1-3 at the same time vs. what is transitional year/categorical etc etc. Anyway, Thanks for the videos, CR.
Hi Casey, I would love to interview a peds anesthesiologist and hope to do that sometime in the next 6 months or so. Good idea on a video about applying to anesthesia, that's something I'll try to do in the future as well. Personally, I was initially considering IM, then EM, and then finally anesthesia, so I do think there's a lot of interest overlap between those fields as well as gensurg.
Hello! Thanks for sharing. I just started anesthesiology and i was wondering if you can actually recommend a book to learn about the different surgeries with emphasis about the important stuff for anesthesia. Thanks and good luck on your next rotation.
Hi Chakib, the book you're looking for is by Richard Jaffe and is called Anesthesiologist's Manual of Surgical Procedures. It's great! I hope that helps.
How many anesthetics have you done for dental or maxillofacial cases? (e.g. wisdom teeth, implants, corrective jaw surgery, bone grafts, gum grafts, tooth restorations, facial trauma, oral cancer, etc.)?
Max, do you guys have a Talis (ARKS-based) anesthesia record system like we had at CCF, or does it directly link into Epic/EHR? Also, have you heard of the Safe Label System?
Hi DMC, as of a year ago, our anesthesia record system links directly with Epic. I haven't heard about the Safe Label System but I just looked it up-- it looks like a great way to keep patients safe and anesthesiologists more time efficient.
My first experience with a CRNA at Mt. Sinai was that I missed an IV on an extremely nervous patient, and a CRNA happened to be nearby and nailed the IV after I couldn't get it. More generally, the trend of increasing amount of care by midlevel providers in anesthesia is in line with other specialties. Many medical and surgical subspecialties have quite a few midlevel providers at a lot of hospitals, both inpatient and outpatient. For me, the most important thing is to develop a skillset that allows me to do cases that CRNAs can't do. I think that's just part of the reality of practicing medicine in a country where healthcare is very expensive, so naturally mechanisms come up to try to reduce costs.
Question. I'm an M1 and I think I might have a slight essential tremor. It's not too noticeable so far, except on really stressful or sleep deprived days. My dad is in his 70s and his tremor is quite bad at this point. Do you think I should stay away from something like anesthesia to be safe?
Hello Max newbie is here. I got a quick question for you. Why would propofol is preferred over ketamine when it comes to general anesthesia. Thank you very much.
Hi Chakrit this is a great question. We do sometimes use ketamine as an adjunct to maintenance of general anesthesia (usually along with propofol +/- dexmedetomidine at the same time). That being said, we don't usually induce or maintain general anesthesia with ketamine because the amount needed to do that will produce "emergence delirium" pretty consistently, which means a patient may just be sitting there staring off into space and not being particularly responsive for a while. This not only can slow down recovery time, but also the thoughts/dreamlike state that this produces can be unpleasant for patients. I think it's instructive that a classic research article about ketamine is titled, "Taming the Ketamine Tiger" (it's worth reading if you want to learn more about it).
Thank you Doctor! So many hours of work 😳 do the patients know you're (and the others) listening music when they are sleeping? 😂 I love Kenny Chesney' music very much 😍
Hello. How much time do you need to feel comfortable with intubation? And do you have some experience with left handed anesthesiologist? I am left handed and i am on start with my residency, so i am worried about intubation?
Hi Jack, obligatory "this is not medical advice" statement, but in our case we gave two doses of 10 micrograms of epinephrine. Hope AA school is going well- I went to med school in Ohio where I worked alongside AAs!
I'm 2 months into anesthesia residency. Right now I'm rotating in abdominal surgery as well. The most embarrassing and scary thing for me so far was when for the 1st time anesthesiologist I'm working with told me something like "ok, put the tube in, I'll be right back" and left the room. But I failed to bag mask ventilate the patient after induction. Switched to a vent trying to perform a jaw thrust with two hands - nothing. Panicked. Asked a nurse to call him and was trying to put oropharingeal airway in - failed. Turned out he was right behind the door. Lesson learned - intubation skill is nothing comparing to an ability to ventilate the patient. Also our hospital is far away from best at equipment maintenance. 2 or 3 days ago I were standing at the desk doing some paper work. Boom, electricity shots down. While thinking something among the lines "w/e, we have reserve power/batteries" I turn my head to monitors and machine and there was complete darkness, everything is turned off except old syringe pump. Freaked out. No electricity for about 30 seconds. At least this time I did well.
Those sound like scary experiences but important learning opportunities. I've had a similar experience about losing power to my monitoring equipment and am actually working on a video about that right now. One of the hardest parts of our job is being prepared for things that don't happen often, but can be catastrophic when they do happen. Best of luck in your training! Thanks for following along with these videos.
Sounds like when I first learned molecular biology and my PI weaned off on supervising me. By the end of grad school he left me alone for 3 months at a time lol
There are a number of different causes, and when it does happen (rarely) under anesthesia, it tends to be either during induction or emergence from anesthesia. Common causes include intubation, cold air, and histamine release (various medications can cause this). Hope that helps!
I was under for three hours or so .. Ortho surgeon stripped the head off of a screw and it became a complicated ordeal. I noticed I had basically pissed myself , but I had ( thank god ) no catheter in my urethra . How do you manage patients who need to pee? Just make sure and don't get hit?
Your channel was recommended in my TH-cam feed. Having been on the receiving end of a lot of surgeries it’s been interesting to watch. I do have to say the picture for this video is a little creepy. I never could get used to the mask. The smell and taste 🤢. How about a video on avoiding feeling sick from anesthesia?
Hi Leslie, thanks for watching and for your feedback! I didn't consider that the image of the mask could be disconcerting, especially for someone on the receiving end (I'm so used to being on the opposite side of it now). I admittedly struggle to come up with a variety of cover photos for videos that are distinct from each other, but open to suggestions! Interesting idea about a video about avoiding feeling sick. A lot of it comes down to two groups of factors: 1) non-modifiable factors such as age, gender, and surgery type 2) medications that the anesthesiologist uses. As far as I'm aware, there's not much that the patient can do differently, but if I learn about anything, I will share on my channel!
Hi Max! I really love your videos and I hope you keep posting. I think one strength of your content is how thorough it is--it's really helpful for medical students! One thing you can improve on would be to soften some of your body language and facial expressions. I think this is hard because you work very hard on creating quality content, but some of the scripted dialogue can seem forced. Consider ad libbing more in future videos!
Really appreciate the positive feedback and constructive criticism! Your advice is exactly what my wife told me, too haha. I will try making my next video more ad libbed and see how that comes out. Stay tuned!
@@MaxFeinsteinMD Actually, I love the pre-prepped, scripted stuff, it makes for more efficient, thorough and quality content. I love the details you've got here and how concise it is. It would be hard to think of all relevant or helpful info on the spot. You're great, dude!
CA1 year. I realize the title is somewhat confusing, and you'll also run into some confusing language because a lot of people refer to PGY-2s as "first year residents" including here at Sinai. Go figure.
@@MaxFeinsteinMD by the way, if it fits in with anything you're already doing, I would love to hear your take on why hospital culture still includes such long on-call rotations!
Surprisingly, the length and frequency of calls is less now than it has ever been. But it would be interesting to make a video about the benefits (there are some) of long calls, and also highlight the downsides (patient safety issues, not just sleep). Thanks for the idea!
Honestly I have a lot of fear around residents operating on me or doing my anesthesia. I think I have a bit of PTSD around surgeries and have an extreme need for control. I hate feeling out of control which is exactly what happens during anesthesia. Your videos are helping me to understand that you do know quite a lot and are quite competent... but I think I will still be avoiding teaching hospitals. I also don't like how our healthcare system forces residents to always be short on sleep, I think that dramatically increases the chance of errors.
Hi Michelle, I can understand your concern about being taken care of by trainees. I agree that if you're uncomfortable with that idea, avoiding a teaching hospital will virtually eliminate the likelihood of a trainee taking care of you. Having said that, being taken care of by a trainee necessarily means an attending physician (non-trainee) is overseeing all aspects of care, so there is the benefit of having a fully trained physician plus an extra set of eyes/hands (the trainee). I will also point out that studies have not demonstrated increased morbidity or mortality in academic hospitals versus non-academic hospitals. Lastly, it's worth noting that attending physicians in private practice settings aren't subject to duty hour restrictions (like trainees are) so there is not necessarily a reason why they would be any more or less sleep deprived than a resident. Just some things to consider that come up in conversations among my colleagues.
So, what was the CAUSE of your pt's. severe bronchospasm? Was there a class of medications which you administered that should be avoided by her in the future, and about which she and her physician should be informed?
It was probably a combination of the patient's underlying medical conditions (the patient had two conditions that predispose to bronchospasm) as well as emergency from anesthesia, which is a higher risk time for bronchospasm.
@@MaxFeinsteinMD "Probably"? I'm sure her physician was very interested to learn of the occurrence and that her future anaesthesiologists will want to review those records carefully. Incidentally, IV ether as well as inhaled ether (and several other anesthetic gases) have been used effectively to treat status asthmaticus.
Come clean. The ASA classification is subjective. The higher the classification the more you bill the patient. If it’s an emergency more you can bill. Arterial line. Central line. Add expenses. Every 10 minutes the bill increases.
The ASA classification leaves room for clinical judgment and is therefore somewhat subjective, but likely not more than one ASA classification. You're not going to be able to bill for a bunch of ASA 4s and 5s if you're providing anesthesia to healthy 50 year-olds at an endoscopy clinic. Nor are you going to be able to start throwing in central lines for these patients and billing more for procedures without clear indications. And yes, the bill will increase as time elapses which seems like a reasonable way to compensate physicians for the time they spend taking care of patients.
![จากรุ่นใหญ่สุดรวยในเกม FIVEM สู่การติดคุกแก๊งแตกในชีวิตจริง [สรุปแก๊งOREO]](http://i.ytimg.com/vi/Vjj8EX4qpiU/mqdefault.jpg)
You reflect the energy of a sincere DOCTOR
Thank you!
My son just became a anesthesiology Doctor, I love watching your video's, so i can see everything he went through to archive his dream of been a Doctor.
Was feeling demotivated this week and this video is just what I needed. Good luck on your trauma rotation! Hopeful to be in your shoes next year 🙂
Thanks and keep at it! Once you hit CA1 year things get dramatically better.
Currently reviewing for our country's physician licensure exam and watching this during my coffee break. It's kind of inspiring for sure to hear about residency training. Stay safe, doc! 😃
Glad you enjoyed the video. Good luck with your licensure exam!
Thanks Max for sharing your experiences so flawlessly! I'm also 3 months into my anesthesia training in HK, and its reassurring to know that we all go through similar experiences and steep learning curves 😂
Hi Annie, thanks for the feedback! Yes, I can assure you that you, me, my co-residents, and I'm sure many anesthesia residents all feel like the learning curve can be very steep.
Dude this video is great! I haven't seen many channels dedicated to anesthesia so you are definitely filling a niche.
Thank you! Yes I had noticed there just aren’t many anesthesia videos. It’s such an interesting field so I thought it’d be fun to share.
I can tell that you are excited and dedicated to your specialty and your patients.
Reggaeton? Cool dude!! Thanks for the look around the OR, the explanations, stories and concrete examples and details. Very, very helpful!!! And your compassionate and open minded persona is great man!! :)
Thanks for watching! Appreciate the nice feedback.
Thank you so much for your videos. I'm a lay person from the UK but I do understand a little bit and enjoy geeking out or falling asleep to your videos. I've had a really tough time this week and watching you and/or your interviews have really helped me.
You do a very good job with these videos. One of your best qualities is that you aren't acting like a big shot, you are very easy to relate to. It sounds like you are speaking sincerely, you explain procedures or terms that most of us don't know. You are much more likeable than Dr.'s that act like they are God and we should worship them! Your pleasant attitude means so much to your patients, trust me! Surgery is a scary thing, having caring people around you makes a world of difference! I thank you on behalf of all your patients, they all appreciate you whether they know it or not!
Great video and channel, keep up the great work and I wish you all the best in your career, life!
Hi Dr. Feinstein, I can only hope my anesthesiologist will be as good as you. You are very thorough in your explanations!!
hey Max! Greetings from Turkey:) You have such an amazing content. They are great tools to get an insider look into anesthesia. I'll also start off my residency program in anesthesiology next month. Watching this video made me feel so proud for choosing this unique specialty! Pls keep on sharing your story with us:)
Thanks very much Sacakli, glad to hear from my Turkish anesthesia brethren!
Are you okay after earthquake
Was eagerly waiting for a new upload! Immediately clicked on it! :D
Thanks Anusha!
This video is so informative, thanks for sharing!, right now you are one of my favorite vloggers!
Thanks Amber I really appreciate the nice comment and you following along!
Thank you taking the time to educate us. I love behind the scenes stuff. Science teacher here so I never lack questions.
Thanks for following along! And for being a teacher.
Hey Max, great video! Thanks for your hard work uploading these videos. I'm just about to start medical school and am very interested in anaesthesia; I find your videos both entertaining and informative.
Thanks Danny! Good luck with medical school, it's a journey that will be both very challenging and rewarding.
❤ The humor and bedside manor are second too none.
Got an operating room playlist? I too have had fantastic interactions with surgeons. Perhaps being at a teaching hospital has an impact in that regard
You explained bronchospasm better than my schools' lectureres bravo.
Love your videos! Very helpful and gets me excited for anesthesia. I’m applying to anesthesia residency for the 2022 cycle. 😍
Very interesting max I have 4 stents , no thyroid , and a few others you people have all my respect and the perfusion people too in my eyes you people are really in charge of the surgeries I hold up my glass to you all
Thanks for the video, was motivational, because I am an IMG and I want to be in there at the end of next year.
Could you share the playlists you usually play when in surgery? Btw I love your content, we need more doctors like you :)
Hey Juanita, thanks for the nice feedback! My two favorite Spotify playlists to put on in the OR are Mood Booster and Operating Room Mix. But I've been known to put on Bad Bunny radio :)
I have a fear of the or due to waking from surgery while still in there surgery was over but I freaked out a bit, recently I had to have surgery again, and there fear was there, my obgyn who is amazing, came in with me which made it easier, I don't remember much I recall her holding some leads in her hand, and pulling my arm out of the gown, some meds going in my iv, that's the last I recall, I woke with a male voice saying here's your little friend, which was my simba stuffy as it helps keep me grounded. good experience this time
Sorry you had that experience the first time around, it sounds really scary. It's very very rare for people to wake up during surgery, and is incredibly unlikely it would ever happen again to you.
Max deserves 7 million subs....I am scared to death for what's coming but I find a weird comfort in listening to him describe his job...god I'm scared tho
thank You, I am thinking about this specialization and Your videos are helping me a lot :)
This was a great video! I plan on applying to Anesthesia this year in the Match and
this video gives me life. Might need to apply to Mount Sinai if I can afford the cost of living lol
Here in India,we have 2nd highest population in the world...n during our 1st year of residency,we end up working nearly 12 hrs a day for routine surgery in govt college n on emergency day,it's straight 24 hrs... during routine surgery days we do nearly 9,10 cases per day..so nearly after 1st year,junior most become very much expert...yet in govt setup,we don't have all the monitors but have all the drugs available there..it's pleasure to see your setup...
Wow that sounds challenging but also like a great way to gain lots of experience early on! Thanks for watching.
@@MaxFeinsteinMD yes...but in operation theatre we have 2nd year n 3rd yr resident available along with assistant professor during the surgery..m doing freelance since last 7 yrs...but here we anaesthesiologists get 30% of surgeons charges in Pvt practice...(sad part) so we do 4,5 cases per day..take care
Yes!!! Thanks for making a new video!
Thanks for watching!
You are an EXPERT in your field. Wish you were here in Saginaw-Bay City, MICHIGAN. Love your videos and humor!!. KUDOS to you....👍
Liked. Subscribed. I start CRNA school in august!!! So stoked
Wow I'm so impressed. You seem to all ready so calm. I need to find all your videos. So interesting. I'm sure your helping allot of residents thinking about your field. Thanks for shareing. So interesting.Thanks. oh how long does it take to get use to the OR smell.
Thank you for the nice feedback on this and the other video you commented on! Exuding calmness is definitely a goal, even if I don't feel calm inside, it's important for the patient, surgeon, and OR staff for the anesthesiologist to remain calm especially when problems arise.
I've found that different ORs have different smells. In rooms where there's a lot of electrocautery (essentially a small, controlled burn that cuts through skin and other tissue) it tends to smell like burnt flesh, which I find very unpleasant and haven't gotten used to. A lot of the ORs where I work just have a sort-of sterile smell which doesn't bother me.
That’s hilarious!!! 😂😂😂😂 The sneeze 😂😂😂😂 I love your videos and you. 🥰
thanks for the update! will be following through your journey through CA-1 to CA-3. hopefully one day i can be in your shoes (?) fingers crossed. am a FMG from the UK, worried about cancelled electives and lack of UCSE for applications :x. any idea how the situation is like?
Hi Brandon, thanks for following along on my journey through residency!
As far as elective cancellations, what I've seen is that many programs have been opening anesthesia rotations back up to their own students over the last 1-2 months. I suspect it will be a bit longer before rotations are opened up to students that aren't at the affiliated medical school. One of the other complicating factors is that many hospitals require 14-day quarantine periods before their own employees can return to work after travel to many parts of the US (as well as outside the US, depending on where exactly). I'm sure outside rotators will be subject to the same requirement.
What do you mean by UCSE? Not sure I understand.
@@MaxFeinsteinMD sorry for using abbreviations! I meant United States clinical experience! Fair! Must be really hard for even their own employees to get around covid. Haha! Anyway appreciate the reply. Lookin forward to mee vids! Funny content BTW!
Oh got it, yeah hopefully soon things will open up so outside rotators can come in! Best of look with everything and thanks for the nice feedback!
Hope to play lofi music in my OR’s some day. That Music has literally helped me through the entirety of undergrad study sessions.
12:26 when things are wrapped like that, does that mean the entire thing gets thrown away when it's used? Is it just basically plastic housing, or is that actually like a camera inside that gets thrown away as well?
We generally have to buy from out side an arterial line .And we are doing ultrasound guided cvp line .
glad you are doing well any closer to showing a couple of inductions
Still would love to do this but haven't had the right situation yet! I'm waiting for the right patient to come along who potentially would be comfortable with me filming them. Hopefully can do this soon- I'll let you know.
@@MaxFeinsteinMD ok cool also can muscle relaxants be used if intubating with a lma or can only be used if using a et tube
This is a good question. Muscle relaxants generally shouldn't be used with LMAs because with an LMA, you're depending on a patient to breath spontaneously (ie. on their own with very little ventilatory support) for the entire case. The reason for that is since an LMA doesn't actually go past the vocal cords, you can't deliver much positive pressure through one (you risk a leak that would lead to filling up the stomach with air, and more importantly not getting adequate oxygenation and ventilation of the lungs), which ultimately means that using a ventilator through one isn't a good idea. Let me know if I didn't explain it well.
@@MaxFeinsteinMD you explained it well im not a physician i knew exactly what you were talking about thanx for confirming it
woww you are the best, man. Thanks for sharing.
Thanks for watching!
that little skit you did was funny, surprised you didn't scream corona and call for back up....drs here did, was funny as heck...have surgery tomorrow, I hope my anesthesia Dr. has a good sense of humor like you, last one I think sat on a thumb tack, mr, crabby pants
Glad you thought it was funny! It's important to have a good sense of humor in medicine, and especially in anesthesia. Thanks for watching.
Can you do a video on the different lines -example central line vs arterial line
Hi Dr Feinstein just wanted to say how I appreciate your videos, they are so informative and I love your great sense of humour. I have a question for you (I will just give you a long background story to go with it) I have a child multiple disabilities Autism primarily being the biggest challenge, he has required quite a few surgeries- we have done 4 general anaesthetics this year with another one to go. I have had pretty much a different anaesthesiologist each time for my son, some anaesthetics have been really easy and relaxed (one of the drs came to the ward chatted to my son gave him her swipe card so he could open all the doors on the way to theatre and made him really relaxed which helped me as a parent) another was quite abrupt and what I thought was rude about not having notes ready etc and made the room really tense and stressful) my question is do you get training in dealing with children/individuals with disabilities/challenging behaviours? I really feel for staff when they maybe put into these situations with children like mine who require extra support. I really hope staff get support and appropriate training Thanks so much Katrina from Australia 🇦🇺
I know you're only in your 1st year and haven't gotten into a pediatric anesthesiology rotation, have you thought about doing pediatrics? I think you would do well with kids. You explain everything clearly, any kid would calmer after you explain everything.
Thanks for the kind words! I've considered pediatric (my anesthesia mentor during medical school is a peds anesthesiologist) but I have to say it's really intimidating. Kids have smaller physiologic reserves as compared to adults, so when things go wrong, they tend to go wrong *really* fast. Having said that, kids are usually really fun to work with, and especially when they're under the effects of anesthesia but not completely asleep haha.
Very true. Least in your case, with all the advances in medicine. The rate of things going bad have been cut drastically. I think doing obgyn is harder then peds since malpractice lawsuits are the highest in obgyn
imagine getting surgery and just chillin under anesthesia and not knowing that WAP is playing in the background
Hey Max, I'm MS3, very interested in pediatric anesthesiology. Do you have any relationships with sub specialists in anesthesia? There isn't enough interview content for subspecialties and I would really like to hear what a pedi anesthesiologists has to say about their career. Also, an in depth review of how to even apply to anesthesiology would be dope considering it is difficult to understand how to apply for intern year (ped, IM, EM, etc.) and CA1-3 at the same time vs. what is transitional year/categorical etc etc. Anyway, Thanks for the videos, CR.
Hi Casey, I would love to interview a peds anesthesiologist and hope to do that sometime in the next 6 months or so. Good idea on a video about applying to anesthesia, that's something I'll try to do in the future as well. Personally, I was initially considering IM, then EM, and then finally anesthesia, so I do think there's a lot of interest overlap between those fields as well as gensurg.
Surgeons listening to CardiB in the OR, now that may laugh out loud! 🤣 Never expected that!
Hello! Thanks for sharing. I just started anesthesiology and i was wondering if you can actually recommend a book to learn about the different surgeries with emphasis about the important stuff for anesthesia.
Thanks and good luck on your next rotation.
Hi Chakib, the book you're looking for is by Richard Jaffe and is called Anesthesiologist's Manual of Surgical Procedures. It's great! I hope that helps.
Thanks :))
ROFLMAO all the way from Australia.. junior registrar calling the consultant cos the patient sneezes!!!!
Boy you work hard! those under eye bags really tell the story. Hold on and thx for videos.
Not the bucket and mop song😩🤣I know EXACTLY what song that was… and I oop!🤣
It’d be really helpful if you made a video speaking about the loans you had to take out if any?
Great vid! 👍 I have a question, does the pt get informed they had an emergency during surgery, if it ended up being taken care of?
Generally speaking, yes. Unless it didn’t directly involve the patient, they should be informed.
How many anesthetics have you done for dental or maxillofacial cases? (e.g. wisdom teeth, implants, corrective jaw surgery, bone grafts, gum grafts, tooth restorations, facial trauma, oral cancer, etc.)?
I love your videos I have a question do they teach how to treat people with developmental disabilities who are adults
Very scaring the part of the bronchospasm. That's why they say you have to be calm in crisis to be a good anesthesiologist.
Yes and I've had several experiences that were more scary since I recorded this video less than a week ago..!
@@MaxFeinsteinMD Nice, a lot of experiences to share over time. Looking forward for new videos.
Max, do you guys have a Talis (ARKS-based) anesthesia record system like we had at CCF, or does it directly link into Epic/EHR? Also, have you heard of the Safe Label System?
Hi DMC, as of a year ago, our anesthesia record system links directly with Epic. I haven't heard about the Safe Label System but I just looked it up-- it looks like a great way to keep patients safe and anesthesiologists more time efficient.
What has been your experience with mid-levels, (CRNA/AA)?
How does that dynamic work?
My first experience with a CRNA at Mt. Sinai was that I missed an IV on an extremely nervous patient, and a CRNA happened to be nearby and nailed the IV after I couldn't get it.
More generally, the trend of increasing amount of care by midlevel providers in anesthesia is in line with other specialties. Many medical and surgical subspecialties have quite a few midlevel providers at a lot of hospitals, both inpatient and outpatient. For me, the most important thing is to develop a skillset that allows me to do cases that CRNAs can't do. I think that's just part of the reality of practicing medicine in a country where healthcare is very expensive, so naturally mechanisms come up to try to reduce costs.
@@MaxFeinsteinMD and if all else fails I guess you can grab a fellowship in pain, cardiac, or critical care
After watching your video I am wondering what is more stressful; Teaching a teenager how to drive, or working as an attending at a teaching hospital.
Hah I would say it probably depends on the teenager / the residents in question.
I had a bi-lateral mastectomy and they did a nerve block.
I believe that’s fairly routine to have nerve blocks for breast surgery. I hope that was helpful for pain control.
wow thank you!
Question. I'm an M1 and I think I might have a slight essential tremor. It's not too noticeable so far, except on really stressful or sleep deprived days. My dad is in his 70s and his tremor is quite bad at this point. Do you think I should stay away from something like anesthesia to be safe?
Hello Max newbie is here. I got a quick question for you. Why would propofol is preferred over ketamine when it comes to general anesthesia. Thank you very much.
Hi Chakrit this is a great question. We do sometimes use ketamine as an adjunct to maintenance of general anesthesia (usually along with propofol +/- dexmedetomidine at the same time). That being said, we don't usually induce or maintain general anesthesia with ketamine because the amount needed to do that will produce "emergence delirium" pretty consistently, which means a patient may just be sitting there staring off into space and not being particularly responsive for a while. This not only can slow down recovery time, but also the thoughts/dreamlike state that this produces can be unpleasant for patients. I think it's instructive that a classic research article about ketamine is titled, "Taming the Ketamine Tiger" (it's worth reading if you want to learn more about it).
Thank you Doctor! So many hours of work 😳 do the patients know you're (and the others) listening music when they are sleeping? 😂 I love Kenny Chesney' music very much 😍
Hello. How much time do you need to feel comfortable with intubation? And do you have some experience with left handed anesthesiologist? I am left handed and i am on start with my residency, so i am worried about intubation?
I’m an AA student doing my first 2nd year rotation! What dose of epi did you use to treat the bronchospasm?
Hi Jack, obligatory "this is not medical advice" statement, but in our case we gave two doses of 10 micrograms of epinephrine. Hope AA school is going well- I went to med school in Ohio where I worked alongside AAs!
great video
Thanks Ryan!
Same here in Pakistan.. I thought it didnt occurred in USA.Standards of monitoring are followed every where.
So interesting
‘Bring a bucket, bring a mop’?? I thimk that song was WAP by Cardi B haha. But she says ‘get a bucket and a mop’
Haha yes it was that song, and you're right about the lyrics.
What did you use to deepen your anesthesia during the bronchospasm? Volatiles or Propofol?
Propofol since the patient wasn’t really moving air so volatiles wouldn’t have been able to get into the lungs well.
I'm 2 months into anesthesia residency. Right now I'm rotating in abdominal surgery as well. The most embarrassing and scary thing for me so far was when for the 1st time anesthesiologist I'm working with told me something like "ok, put the tube in, I'll be right back" and left the room. But I failed to bag mask ventilate the patient after induction. Switched to a vent trying to perform a jaw thrust with two hands - nothing. Panicked. Asked a nurse to call him and was trying to put oropharingeal airway in - failed. Turned out he was right behind the door. Lesson learned - intubation skill is nothing comparing to an ability to ventilate the patient.
Also our hospital is far away from best at equipment maintenance. 2 or 3 days ago I were standing at the desk doing some paper work. Boom, electricity shots down. While thinking something among the lines "w/e, we have reserve power/batteries" I turn my head to monitors and machine and there was complete darkness, everything is turned off except old syringe pump. Freaked out. No electricity for about 30 seconds. At least this time I did well.
Those sound like scary experiences but important learning opportunities. I've had a similar experience about losing power to my monitoring equipment and am actually working on a video about that right now. One of the hardest parts of our job is being prepared for things that don't happen often, but can be catastrophic when they do happen.
Best of luck in your training! Thanks for following along with these videos.
Sounds like when I first learned molecular biology and my PI weaned off on supervising me. By the end of grad school he left me alone for 3 months at a time lol
What tends to cause broncospasm during surgery?
There are a number of different causes, and when it does happen (rarely) under anesthesia, it tends to be either during induction or emergence from anesthesia. Common causes include intubation, cold air, and histamine release (various medications can cause this). Hope that helps!
Will you do any other rotations besides anesthesia?
Yes, 4 months of ICU (plus various other rotations I did during intern year)
I was under for three hours or so .. Ortho surgeon stripped the head off of a screw and it became a complicated ordeal. I noticed I had basically pissed myself , but I had ( thank god ) no catheter in my urethra . How do you manage patients who need to pee? Just make sure and don't get hit?
One of my favorite songs is a Metallica remake of "Die Die My Darling" by the Misfits. Would that be considered a bit cheeky in an OR setting?
Your channel was recommended in my TH-cam feed. Having been on the receiving end of a lot of surgeries it’s been interesting to watch. I do have to say the picture for this video is a little creepy. I never could get used to the mask. The smell and taste 🤢. How about a video on avoiding feeling sick from anesthesia?
Hi Leslie, thanks for watching and for your feedback! I didn't consider that the image of the mask could be disconcerting, especially for someone on the receiving end (I'm so used to being on the opposite side of it now). I admittedly struggle to come up with a variety of cover photos for videos that are distinct from each other, but open to suggestions!
Interesting idea about a video about avoiding feeling sick. A lot of it comes down to two groups of factors: 1) non-modifiable factors such as age, gender, and surgery type 2) medications that the anesthesiologist uses. As far as I'm aware, there's not much that the patient can do differently, but if I learn about anything, I will share on my channel!
Hi Max! I really love your videos and I hope you keep posting. I think one strength of your content is how thorough it is--it's really helpful for medical students! One thing you can improve on would be to soften some of your body language and facial expressions. I think this is hard because you work very hard on creating quality content, but some of the scripted dialogue can seem forced. Consider ad libbing more in future videos!
Really appreciate the positive feedback and constructive criticism! Your advice is exactly what my wife told me, too haha. I will try making my next video more ad libbed and see how that comes out. Stay tuned!
@@MaxFeinsteinMD Actually, I love the pre-prepped, scripted stuff, it makes for more efficient, thorough and quality content. I love the details you've got here and how concise it is. It would be hard to think of all relevant or helpful info on the spot. You're great, dude!
What do you do about body fluids?
Suction them into a canister!
Is this the first three months of PGY-1 or CA-1?
CA1 year. I realize the title is somewhat confusing, and you'll also run into some confusing language because a lot of people refer to PGY-2s as "first year residents" including here at Sinai. Go figure.
Apologies if I'm wrong, but you seem a bit sleep-deprived in this video. Don't let it creep up on ya!
Yep, it’s tiring to be a resident!
@@MaxFeinsteinMD by the way, if it fits in with anything you're already doing, I would love to hear your take on why hospital culture still includes such long on-call rotations!
Surprisingly, the length and frequency of calls is less now than it has ever been. But it would be interesting to make a video about the benefits (there are some) of long calls, and also highlight the downsides (patient safety issues, not just sleep). Thanks for the idea!
Honestly I have a lot of fear around residents operating on me or doing my anesthesia. I think I have a bit of PTSD around surgeries and have an extreme need for control. I hate feeling out of control which is exactly what happens during anesthesia. Your videos are helping me to understand that you do know quite a lot and are quite competent... but I think I will still be avoiding teaching hospitals. I also don't like how our healthcare system forces residents to always be short on sleep, I think that dramatically increases the chance of errors.
Hi Michelle, I can understand your concern about being taken care of by trainees. I agree that if you're uncomfortable with that idea, avoiding a teaching hospital will virtually eliminate the likelihood of a trainee taking care of you. Having said that, being taken care of by a trainee necessarily means an attending physician (non-trainee) is overseeing all aspects of care, so there is the benefit of having a fully trained physician plus an extra set of eyes/hands (the trainee). I will also point out that studies have not demonstrated increased morbidity or mortality in academic hospitals versus non-academic hospitals. Lastly, it's worth noting that attending physicians in private practice settings aren't subject to duty hour restrictions (like trainees are) so there is not necessarily a reason why they would be any more or less sleep deprived than a resident. Just some things to consider that come up in conversations among my colleagues.
@@MaxFeinsteinMD Thank you for your thoughtful reply!
I sometimes wonder whether anaesthetists have had general anaesthesia?!
Some have, some have not!
Thanks for the upload.. xd
Thanks for watching!
Those machines beeping sound like music
Can you watch the surgeries?
Yes, I generally have a good vantage point of what’s going on with Surgery, and I do enjoy watching.
i like the apollo 13 version better, 3 hours of boredom followed by 7 seconds of sheer terror
Unfortunately doctors in our hospital aren't being supportive and don't teach anything so I feel demotivated and don't want to attend
So, what was the CAUSE of your pt's. severe bronchospasm? Was there a class of medications which you administered that should be avoided by her in the future, and about which she and her physician should be informed?
It was probably a combination of the patient's underlying medical conditions (the patient had two conditions that predispose to bronchospasm) as well as emergency from anesthesia, which is a higher risk time for bronchospasm.
@@MaxFeinsteinMD "Probably"? I'm sure her physician was very interested to learn of the occurrence and that her future anaesthesiologists will want to review those records carefully. Incidentally, IV ether as well as inhaled ether (and several other anesthetic gases) have been used effectively to treat status asthmaticus.
@@wholeNwon lol wtf
NOT THE SONG
Come clean. The ASA classification is subjective. The higher the classification the more you bill the patient. If it’s an emergency more you can bill. Arterial line. Central line. Add expenses. Every 10 minutes the bill increases.
The ASA classification leaves room for clinical judgment and is therefore somewhat subjective, but likely not more than one ASA classification. You're not going to be able to bill for a bunch of ASA 4s and 5s if you're providing anesthesia to healthy 50 year-olds at an endoscopy clinic. Nor are you going to be able to start throwing in central lines for these patients and billing more for procedures without clear indications. And yes, the bill will increase as time elapses which seems like a reasonable way to compensate physicians for the time they spend taking care of patients.
Dr. Sleep
Reggeaton 🤣😂😂😂😂
Lol no lie
Five antisemeties thumbed this down
...or maybe lots of other reasons?!
The slippery garage echographically print because transaction temporarily inject inside a yellow vase. savory, silly decade