Guess “Rock Doc” sounds better than “Quack Prac”…
This Nurse Prac (who called himself the “Rock Doc”) just landed a LONG federal jail sentence for illegaly prescribing opioids:
Tennessee nurse practitioner known as 'Rock Doc' gets 20 years for illegally prescribing opioids
A Tennessee nurse practitioner who called himself the “Rock Doc” has been sentenced to 20 years in prison for illegally prescribing thousands of doses of opioids including oxycodone and fentanyl in return for money and sex, federal prosecutors said Tuesday. Jeffrey W. Young Jr., was sentenced...
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Source: Student Doctor Network - March 21, 2024 Category: Universities & Medical Training Authors: DirtDocMD Tags: Anesthesiology Source Type: forums
Narcotic administration in cardiac surgery cases
I am curious what everyone is doing currently for narcotic administration in cardiac surgery cases? Are people using infusions or just giving boluses before times of stimulation?
Unfortunately sufantanil has been available for a long period of time. When I was a medical student and starting residency some attendings were still giving 2mg/kg of morphine. That later evolved to giving 5000-6000 ug fentanyl and later 1000-1500 mg sufentanil. When ERAS and early extubation became popular...
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Source: Student Doctor Network - February 23, 2024 Category: Universities & Medical Training Authors: Drwine Tags: Anesthesiology Source Type: forums
Benzodiazepines in palliative care
70 year old pancreatic cancer patient, unclear what stage, but receiving chemo/surgery for it. Also on fentanyl patch and oxycodone IR TID 5mg. Whats your overall policy with benzos in palliative care with a patient already on opioids? Are you more lenient, if patients respiratory function is being monitored? (Source: Student Doctor Network)
Source: Student Doctor Network - February 19, 2024 Category: Universities & Medical Training Authors: annoyedpsychiatrist Tags: Psychiatry Source Type: forums
Popliteal + Adductor Canal blocks not working for Achilles repairs
Hi. I've been having varied success and just plain straight-up weirdness with these blocks for Achilles repairs.
Had two the other day, both easy blocks, saw the LA spread around the sciatic (I'm injecting above the bifurcation), plus good spread in the adductor canal. 20 mL of 0.5% Ropi for the popliteal, with 10 mL of 0.25% Ropi for the adductor canal. After blocks, kept patients on 4% Et Desflurane. 50 ug fentanyl and nothing else during case. Zero change in vital signs throughout the...
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Source: Student Doctor Network - December 20, 2023 Category: Universities & Medical Training Authors: soorg Tags: Anesthesiology Source Type: forums
Yet another pain movie....Pain Hustlers on Netflix
i liked this one more than the others. Based on the fentanyl product Subsys. Better actors(Andy Garcia, Emily Blunt, and Chris Evans), better story, better comedy.
Pain Hustlers (2023) ⭐ 6.3 | Crime, Drama
2h 2m | R
www.imdb.com (Source: Student Doctor Network)
Source: Student Doctor Network - October 29, 2023 Category: Universities & Medical Training Authors: Doctodd Tags: Pain Medicine Source Type: forums
Diversion at Yale REI clinic
“In June 2020, Monticone began stealing fentanyl for her own use. She accessed secure storage areas and took vials of fentanyl, used a syringe to withdraw the narcotics from the vials, and reinjected saline into vials so that it would appear as if none of the narcotics were missing. The investigation revealed that approximately 75 percent of the fentanyl given to patients at the Yale REI clinic from June to October 2020 was adulterated with saline. Some of the vials contained diluted...
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Source: Student Doctor Network - August 5, 2023 Category: Universities & Medical Training Authors: nimbus Tags: Anesthesiology Source Type: forums
Bier Block + Local Question
In the OR today, had a hand surgeon ask for a Bier block and while doing the case asked how much 0.25 Bupivicaine he could give. I told him I'd prefer if he didn't since I can give fentanyl before/after tourniquet release to help with pain control once the block wears off. Settled for max of 1.25mg/kg instead of the normal 2.5mg/kg (so half dose). Case was a trigger finger release if I remember correctly so done right at the 30min mark.
Don't really do Bier blocks and I think he is the...
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Source: Student Doctor Network - July 7, 2023 Category: Universities & Medical Training Authors: ProPropofol Tags: Anesthesiology Source Type: forums
Butrans and Anesthesia
Can you anesthesia trained folks please direct me to guidelines for butrans and anesthesia?
My understanding is that it is safe to continue butrans (which fairly low dose compared to belbucca or oral bup), even in patients having GETA, because anesthesia can still give intraop/post op fentanyl and post-op PO oxy/Vicodin even while the patient continues butrans patch, because the fentanyl and post op oxy will overcome and supplement the butrans.
I’d appreciate it some of the anesthesia...
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Source: Student Doctor Network - May 6, 2023 Category: Universities & Medical Training Authors: bedrock Tags: Pain Medicine Source Type: forums
Husel suing Trinity Health / Mt Carmel Health System for $20M+
Former physician acquitted of patient deaths sues Trinity
William Husel, a former Mount Carmel physician acquitted in the death of 14 patients, has filed a $20M lawsuit against Trinity Health for malicious prosecution.
www.beckershospitalreview.com
Doctor acquitted in 14 patient deaths sues health system in Detroit
William Husel was originally indicted on 25 murder counts by using high dosages of fentanyl. He was later found not guilty, but not before he was fired and...
Source: Student Doctor Network - May 5, 2023 Category: Universities & Medical Training Authors: coffeebythelake Tags: Anesthesiology Source Type: forums
Pharmacodynamics, Pharmacokinetics, and jaw thrusts
Still, after all these years, I am surprised about the huge variability from patient to patient (kinda like every time I do a spinal, I’m shocked it actually works…spinal = magic).
ASA1 45 y/o for a circ under MAC.
2 mg midazolam makes him sleepy. 50 mcg of fentanyl makes him arousable to voice with a significant shoulder tap. I’m thinking, this guy is a lightweight. My plan was to give 50mg propofol before the penile block and glans penis local (I mean, holy crap, give me the whole stick...
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Source: Student Doctor Network - April 27, 2023 Category: Universities & Medical Training Authors: epidural man Tags: Anesthesiology Source Type: forums
Versed and fentanyl for sedation
What are y'all's thoughts on the common practice and combination of versed and fentanyl for procedural sedation and Mac? This practice is incredibly pervasive in anesthesia. In my reading and understanding it seems like versed alone would be the much better agent as combining the two makes a patient much more prone to respiratory depression per benzodiazepine warnings. Yet we routinely give both. Is there any utility to fentanyl for minimal stimulation procedures aka less painful? I'm a...
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Source: Student Doctor Network - March 23, 2023 Category: Universities & Medical Training Authors: medicine2wallstreet Tags: Anesthesiology Source Type: forums
Cutting Fentanyl patch?
Hey team,
I am helping wean a patient whose pain continues to improve with lower doses of fentanyl patch. She is mid 40s and was on 100mcg for long time, by the time she got to me she was weaned to 25mcg/hr patch and continues to do well. She went from 100-->25 patch relatively quickly, and now desires further decrease.
I am concerned due to her length of time on fentanyl + speed of taper, and want to continue but slow down. She does not want to take anything orally. They only make...
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Source: Student Doctor Network - March 5, 2023 Category: Universities & Medical Training Authors: thecentral09 Tags: Pain Medicine Source Type: forums
Baby fentanyl OD
Family sues Airbnb after 19-month-old dies from fentanyl in Florida
“The only thing we have here is our common sense,” Scolaro said. “It was definitely in that unit, that Airbnb. Which particular person left the drugs is frankly not anything IR…
nypost.com
Sad story. But it seems like the lay public and law enforcement still believes that fentanyl is absorbed transdermally or airborne? (Source: Student Doctor Network)
Source: Student Doctor Network - March 5, 2023 Category: Universities & Medical Training Authors: Kryptocoin Tags: Emergency Medicine Source Type: forums
I need some serious help - please advise. IT opioid delivery
To start off, please read this article:
Doctor and Office Manager Indicted in Scheme to Defraud Medicare, Manufacture and Distribute Fentanyl
Dr. David J. Smith, a pain management physician, and his office manager, Julia Ann Oertle, are charged in a federal grand-jury indictment with perpetuating a long-running scheme to commit healthcare fraud and to manufacture and distribute adulterated fentanyl.
www.justice.gov
Patient comes to our hospital to the IM clinics. The IM doctor call...
Source: Student Doctor Network - January 24, 2023 Category: Universities & Medical Training Authors: epidural man Tags: Pain Medicine Source Type: forums
A case of alleged intraop recall in the news
He says he woke up during surgery. His lawsuit blames it on anesthesiologist's fentanyl abuse
A lawsuit against UC San Diego alleges a former anesthesiologist was a longtime drug addict who did not give enough anesthesia to a patient.
www.google.com
UCSD, plantiff lawyer alleges the anesthesia record was falsified. Is this a trend in the legal world to readily assert a bad outcome ? I don't work there but would be surprised if they aren't using an EMR. CRNA denies changes to the medical record and little incentive to do so. There could be othe...
Source: Student Doctor Network - November 26, 2022 Category: Universities & Medical Training Authors: TheLoneWolf Tags: Anesthesiology Source Type: forums
