SCS trials in office (oral sedation/antibiotics)
Due to limited OR availability, will be doing SCS trials in office. Outside of localizing the tract with a 25g spinal needle (0.25% marcaine : 1% lidocaine mix) prior to the Tuohy needle, what PO meds do you guys use for sedation? Was thinking potentially 5-10mg valium, and a 5mg percocet.
For antibiotics, doing an IV won't be logistically smooth. Heard about potentially being able to do PO antibiotics before/during trial, instead of the IV ancef. Any recs there? (Source: Student Doctor Network)
Source: Student Doctor Network - February 1, 2024 Category: Universities & Medical Training Authors: SgtThunderfistMD Tags: Pain Medicine Source Type: forums
Treating back pain in the ER
Hey all,
ER doc starting a pain fellowship next year. Wondering if you have any tips/tricks or nuances I could start implementing in the ER, particularly with respect to low-risk back pain (strain, sciatica). Actually didn't see much in residency (since 10 hour waits were typical) but see a bunch now in the community. Assuming no red flag symptoms, the typical approach amongst my colleagues is NSAIDs, Lidoderm +/- Robaxin/Flexeril/Valium (rarely). X-ray if patient insists (recognizing...
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Source: Student Doctor Network - December 16, 2023 Category: Universities & Medical Training Authors: TrailRun Tags: Pain Medicine Source Type: forums
Maryland dentist causes anesthesia overdose death (with a twist)
Maryland oral surgeon convicted of murder in death of girlfriend who overdosed on anesthetic drugs
"He watched her deteriorate before his eyes," the prosecutor told jurors.
www.cbsnews.com
"An autopsy found that Harris died of intoxication from ketamine, propofol and diazepam."
Ryan faces a maximum of 55 years in prison
I'm assuming he got these drugs from his dental office. (Source: Student Doctor Network)
Source: Student Doctor Network - August 30, 2023 Category: Universities & Medical Training Authors: coffeebythelake Tags: Anesthesiology Source Type: forums
ChatGPT multiple choice question
A 52-year-old female patient is brought to the psychiatric emergency service with marked motor abnormalities. On examination, she displays mutism, staring, grimacing, echolalia, and echopraxia. The patient is on high doses of diazepam, and previous laboratory findings revealed elevated levels of glutamic acid decarboxylase (GAD) antibodies. Her past medical history includes epilepsy and diabetes mellitus.
The patient's sister, who is her legal guardian and resides overseas, has instructed...
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Source: Student Doctor Network - August 11, 2023 Category: Universities & Medical Training Authors: Styrene Tags: Psychiatry Source Type: forums
Office Based Surgery
With it getting harder to buy into ASCs and PE taking over the area will younger Ophthalmologists turn to OBS due to the smaller footprint and costs? With more procedures being done with Valium vs IV sedation it seems like a possible option. (Source: Student Doctor Network)
Source: Student Doctor Network - July 2, 2023 Category: Universities & Medical Training Authors: percyeye Tags: Ophthalmology: Eye Physicians & Surgeons Source Type: forums
There are wins sometimes
December 2020: Patient presents for intake on following combination of medications (among others) from elderly out of state psychiatrist who is not good about responding to communication but patient kind of idolizes:
Diazepam 15 mg qAM, 10 mg qnoon, 10 mg q4PM, 15 mg qHS
Adderall IR 20 mg TID
temazepam 30 mg qHS
Ambien 15 mg qHS
gabapentin 600 mg qAM + 300 mg qHS
Patient had struggled to get off suboxone they were put on for chronic pain in the past but had been sober for a few years...
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Source: Student Doctor Network - May 26, 2023 Category: Universities & Medical Training Authors: clausewitz2 Tags: Psychiatry Source Type: forums
Tired of this
Here’s the med list for my consult today:
Diazepam 10 mg daily
Xanax 0.5 mg qid
Hydrocodone 7.5 mg qid
Ambien 10 mg at hs
So sick of dealing with this (Source: Student Doctor Network)
Source: Student Doctor Network - May 9, 2023 Category: Universities & Medical Training Authors: Attending1985 Tags: Psychiatry Source Type: forums
Questioning validity of oral sedation for pain procedures
Went for initial consultation for the ol' snip snip this past week. Nurse says, "if you want valium beforehand, only 2 of our docs offer it. It's 5mg 1hr prior and it has to be specifically requested beforehand."
Makes me wonder -- if urologists aren't routinely giving benzos for vasectomies and those who do only give 5mg...why are pain docs giving any at all for our procedures? (Source: Student Doctor Network)
Source: Student Doctor Network - December 30, 2022 Category: Universities & Medical Training Authors: Baron Samedi Tags: Pain Medicine Source Type: forums
Critical care billing
Does anyone have a good resource for what they use to determine if critical care time was met?
I work at a shop where he have people who only bill for it in near death cases and some who do for everything they can think of.
For example, every sepsis rule out that meets sirs criteria they will put on critical care time.
Another example, alcohol withdrawal with HR of 101 requiring one dose of Valium.
I was never taught in the above manner to bill time although am I incorrectly missing...
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Source: Student Doctor Network - December 20, 2022 Category: Universities & Medical Training Authors: valianteffort Tags: Emergency Medicine Source Type: forums
Oral Sedation Cocktail
Hey guys/gals - what are your favorite cocktails for oral sedation for in office procedures? Don't have the staff/setup for IV in office and have no interest in that anyway.
I used the typical 5-10mg Valium for a while but starting 5mg Valium + 5mg Baclofen and seems to work a lot better and people don't complain as much.
A lot of my patient population think a procedure involving a needle should be completely pain free and other practices around me who use moderate sedation for...
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Source: Student Doctor Network - December 10, 2022 Category: Universities & Medical Training Authors: runfastnow Tags: Pain Medicine Source Type: forums
Doctors behaving badly
"Dattoli in trouble"
Radiation oncologist gets valium for himself by posing as his partner and calling in the prescription for his wife, neither party is aware he is doing this. Rinse and repeat.
The most fascinating thing about this thread to me is that the radiation oncologists aren't concerned that he stole another doctor's identity to call in controlled substances. If someone did that using my name I'd be calling the police, too. Also a good reminder to check your prescription...
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Source: Student Doctor Network - December 28, 2021 Category: Universities & Medical Training Authors: Agast Tags: Pain Medicine Source Type: forums
Whiskey Discussion
Physician work is stressful. Whiskey has similar effect to Valium and is legal (Source: Student Doctor Network)
Source: Student Doctor Network - December 20, 2021 Category: Universities & Medical Training Authors: seper Tags: Radiation Oncology Source Type: forums
Dattoli in trouble
Sarasota oncologist arrested, charged with prescription fraud
Two Sarasota pharmacies filled prescriptions for Diazepam under Dattoli’s wife’s name
www.mysuncoast.com
Of course innocent until proven guilty (Source: Student Doctor Network)
Source: Student Doctor Network - December 17, 2021 Category: Universities & Medical Training Authors: Chartreuse Wombat Tags: Radiation Oncology Source Type: forums
phenobarb vs benzos for alcohol detox
Im just curious what detox protocol you guys are using on CSU/inpatient units/detox centers etc. The CSU affiliated with us loves phenobarb but I always tended to CIWA and/or valium taper. Thoughts on phenobarb? (Source: Student Doctor Network)
Source: Student Doctor Network - September 7, 2021 Category: Universities & Medical Training Authors: DrAmazingishere Tags: Psychiatry Source Type: forums
Kyphoplasty in clinic
For those who do kyphoplasty, are you doing this in clinic or OR/ASC? I'm considering adding this to my practice (outpatient clinic). We don't use IV sedation for procedures (valium 5-10mg for SCS trials), but I know kyphoplasty is a different- would it be reasonable to rely on oral sedation and sufficient local though? Thanks (Source: Student Doctor Network)
Source: Student Doctor Network - June 29, 2021 Category: Universities & Medical Training Authors: tmvguy03 Tags: Pain Medicine Source Type: forums
