David Rosen
@hdavidrosen
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Father and Family Man. Husband. Pediatric Anesthesiologist and Intensivist. Fmr. Coroner. Low-level Diva. Reformed foodie. 🏳️🌈
Joined October 2014
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Last Seen Profiles
Last evening I did a shift covering the overflow inpatient unit housed near the ED. Hallways lined with coughing, feverish kids and their distraught parents. We have infants and toddlers on high level respiratory support that would have been in ICU last year. Not normal times.
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The whole world stopped to help adult hospitals overwhelmed by COVID. Peds hospitals are now in the same position and we’re hearing “I’m not comfortable looking after kids”. NB: No one is comfortable with kids not having access to critical care. These are not normal times.
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I normally care for babies having heart surgery. Now my job is threatening to pivot to caring for their parents and grandparents in the ICU. This is really bad Ontario. Follow public health guidance and get a vaccine as soon as you are able!
@BogochIsaac
@CBCOttawa
@nilikm
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It took me years to name why I felt so uncomfortable in the Ortho rooms. The new generation of female, gay and allied orthopods have reduced the level of toxic masculinity to tolerable. This promotes effective communication and enhances both patient and psychological safety.
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Pediatric Anesthesia Pro Tip # 15: Heteronormative "banter" pre-induction can be distressing for LGBTQ youth. Assume your patient *isn't* straight when asking "innocent" questions about their social life, hobbies and interests.
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@foodandmed
There is nothing unprofessional about hair colour, piercings or tattoos*. Patients and especially children/youth appreciate providers who are "real people".
*There are problematic tattoo themes and images which are never okay.
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Colleagues from every area of our organization are signing up for extra “helper” shifts to assist in the care of the extremely high number of sick children. Despite years of stress and burnout, they are stepping up to assist their coworkers and their community ❤️
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@KameelaAlibhai9
Not okay. Please reach out for support. I am Anesthesia faculty at U of O and am happy to help investigate this behaviour. Thank you for speaking up.
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Just ratified: Canadian Pediatric Anesthesia Society endorses allowing and encouraging clear fluid intake up to *one* hour before elective anesthesia or sedation.
#CPAS2018
#pedsanes
#fastingguidelines
#cheo
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Pediatric Anesthesia Pro Tip
#13
: I don't care *how* you tape the tube. As long as it's secure and doesn't bunch up and... Oh let me do it.
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My incredible colleagues made me cry at morning report by giving me this terrific Anesthesiartwork as a thank you for completing my term as chief. ❤️❤️❤️
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The saying “don’t judge a person until you walk a mile in their shoes” was put to the test today. My colleagues and I spent the morning on the Peds wards helping out our overburdened colleagues 😅. Felt like med school all over but with less hair and (a bit) more confidence 😉.
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The same advice is true for faculty clinicians interacting with our trainees. Medical school and residency are tough enough without needing to worry about how *out* you are at work.
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I'm thrilled that Ontario is vaccinating hospital workers. I'm saddened that they have the "cocktail party" notion of what anesthesiologists do. Anesthesia providers are called to the hottest spots in the hospital to provide lifesaving AGMPs.
@fordnation
@picardonhealth
@CBCNews
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Pediatric Anesthesia Pro Tip
#19
: Never ask a toddler a yes/no question if you won't accept "no" as an answer.
E.g.: "Can I put this mask on your face?".
It sets off the wrong dynamic with the patient and makes you look like a dumbass. (Also applicable to parenting).
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I'm a pediatric anesthesiologist. I am used to stressful situations. Today I'm seeing kids congregating in the neighbourhood. They may be sharing coronavirus which may infect their parents who may bring it to work or the nursing home... See where this goes? Stay home please 🙏
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You know you're a pediatric anesthesiologist when you take care of three patients for surgery in a day and their total weight is nine kilograms ❤️
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When you’re having a bad day and your hubby comes home with these 🥹🥰
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Why can I place an arterial line in a 600g baby, but I can never, never judge the correct amount of spaghetti to put in the pot.
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@stephlococcus
Professionalism has nothing to do with apparel. It is about the way you treat people, honour your committments and behave with integrity. Tattoos, Crocs, piercings and clothes do not factor in. We are entitled to express ourselves while doing our work. ⚕️🏳️🌈
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As I enter my PGY34 year, top 10 anesthesia safety improvements over time:
10: EHR (I know, but….)
9: remifentanil
8: BIS/EP
7: u/s availability
6: dexmedetomidine
5: videolaryngoscopy
4: sugammadex
3: propofol
2: AAs on team
1: Culture shift towards improved communication.
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Pediatric Anesthesia Pro Tip
#45
: You know you’re a pediatric anesthesiologist when you call for assistance and 8 colleagues appear immediately and jump in to help ❤️.
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Pediatric Anesthesia Pro Tip
#34
: Always keep your cart organized and prepared for the next case. Can you tell what list I’m doing?
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A special Happy Father's Day to those Dads who never thought it would be possible to be a parent when they were kids. 🏳️🌈❤️🏳️🌈
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Pediatric Anesthesia Pro Tip
#26
: Never lie to a child. Always describe a version of the care plan that allows things to move forward while being truthful.
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Hypothetically if you’re on call and you haven’t been called in once all day, and it’s 6 pm, do you jinx it by brag-tweeting about it?
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Pediatric Anesthesia Pro Tip
#26
: Aim to have a healthy child or teen asleep within 3 minutes of entering the OR. Giving them time to ponder their circumstances rarely decreases their anxiety.
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Pediatric Anesthesia Pro Tip
#48
: BPD stands for Be Prepared Dudes. It’s difficult to adequately prepare trainees for the reality that these sweet looking babies can misbehave majestically once intubated for their “low risk” procedures.
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I just watched "Thirteen Lives" and I couldn't be more proud to be an anesthetist.
Risk analysis, innovative thinking and patient advocacy are the cornerstones of our profession.
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I thought this was a joke but apparently methoxyflurane inhalers are very much in use. What's next? Chloroform-soaked rags?
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To all my fellow anesthesiologists, AAs, intensivists, nurses and RTs. We've got this. We know how to safely intubate people with infections. Stay calm and practice donning and doffing ❤️
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My mom saw
@lmsamson
on the national news last night describing the crisis in pediatric healthcare. She texted me at 11 pm to say that Lindy looks the same as she did in high school and to say hi from her. Moms are the best. 🥰🥰🥰
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Haircut? Absolutely. When there is a SARS CoV-2 vaccine in my arm 😎
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While I was in call, my dog ate a half pound of butter and threw up all over the house. After my 17 year old daughter cleaned it all up she said: "This is why I'm not having children!". I replied: "Then you'll have no one to clean up your dog's barf in 20 years" 🤣🤣🤣
#mentorship
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Pediatric Anesthesia Pro Tip
#33
: Never underestimate the power of laughter and kind words to get you through a difficult day.
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I’ve got my superhero gear on and ready for call. I’m looking at you Ortho.
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Pediatric anesthesia is like working in a kitchen. Sometimes you're baking and need precision and rigor. Other times you are cooking, using intuition and love.
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Pediatric Anesthesia Pro Tip
#31
: While our EDs, wards and ICUs are surging there are things we can do to help.
1. Be patient.
2. Offer to help transport your patients.
3. Think about how you can assist with care (eg: placing long lines in the OR)
We’re in this together!
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Pediatric Anesthesia Pro Tip
#40
: (My junior colleagues mock me for this one, but…) Alway intubate a patient for pinning of a supracondylar #. You won’t regret it.
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Pediatric Anesthesia Pro Tip
#29
: Honour the *art* of anesthesia. How you interact with patients, how gentle you are with the airway, team dynamics, and many other non pharmacological factors likely contribute to outcomes. Much harder to collect data on this, but we should try!
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Cardiac Surgeon: It's 0805 why aren't we ready to cut??
Anesthesia: 😐
Also Cardiac Surgeon: Call Biomed to check my personal intra-op neck warmer. I want to make sure it's working before I scrub.
OR Nurse: That will take 45 min.
Cardiac Surgeon: I'm not in a rush.
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Antidepression strategy
#1
: Full On Julia Child. 👨🏼🍳
Coming soon: Online shopping for stretchy jeans 😀
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Pediatric anesthesia pro tip
#67
: Don't cancel a case due to a fasting violation out of principle. Perform a risk assessment and do what's best for the patient.
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✅ Went to the gym this evening.
✅ I wore a 😷.
❎ 245/250 gym patrons didn’t.
❎ “Mask Recommendations” don’t work. If we want people to wear ‘em we gotta make rules.
❎ Many folks at the gym were coughing.
This isn’t going to end well…
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You know when you’re a pediatric anesthesiologist when your job consists of 6 people frantically singing “The wheels of the bus” while you do an sitting inhalational induction in a child who beat their premed.
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@DGlaucomflecken
Don't skip the rehab. All doctors do and as someone who did, I don't recommend it. Its the mind rehab that's most important!
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@reece_nguyen
@DoctorLandin
One year's leave in Canada. How are you supposed to go back to work with a neonate at home and recovering from delivery etc. I barely coped working full time with a new born babies and I didn't birth 'em.
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Being a cardiac anesthesiologist helps me with my hot tub maintenance. Frequent adjustment of pH, add calcium, the occasional shock treatment and all is good.
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Pediatric Anesthesia Pro Tip
#63
: Sometimes extubating a patient is life saving. Just because you can pass a suction catheter doesn’t mean there is no clot or plug blocking your ETT. It takes bravery to extubate a patient who is critically ill but sometimes bravery is needed.
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Pediatric Anesthesia Pro Tip
#55
:
Emergence agitation after anesthesia should be rare. Evidence based prevention including treatment of pain, giving intraop dexmed (or propofol) and TIVA makes PACUs quieter, safer and promotes better family experience.
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Pediatric Anesthesia Pro Tip
#36
: This is 100% fact: the pre-schooler who is notably calm/sweet/hilarious in pre-op will *always* show signs of unbridled rage in the post-op unit. Consider pre-treating them for ED. 😏
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Pediatric Anesthesia Pro Tip
#28
: Have diluted epinephrine on your cart for every neonatal case. You won’t regret it.
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Pediatric Anesthesia Pro Tip
#18
: BP probably matters more than we used to think in anesthetized infants and children. Why do we avoid pressors at all costs? Get out the phenyl. Or for relative bradycardia, atropine. Your own adrenal glands will thank you.
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I’ve noticed recently that being a leader seems to be the highest form of praise. I agree that leadership skills are helpful. They should be balanced with teamwork, humility, empathy and kindness.
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Pediatric Anesthesia Pro Tip
#30
: Surgeons are often nervous before a big case and sometimes say “goofy” things. Getting into an argument w them just before surgery doesn’t help the patient. Let it go for a bit, do the case, then discuss the matter afterwards. But do discuss.
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Pediatric Anesthesia Pro Tip
#51
: Always. Eat. Lunch.
Addendum: If anyone offers you a break, say yes. We need to take care of ourselves so we can care for others. Don’t let the memes shame you into skipping coffee!
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Pediatric Anesthesia Pro Tip
#50
: Be proud of yourself when you have given potassium in the OR despite your deepest fears.
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Pediatric Anesthesia Pro Tip
#25
: Don’t let anyone tell you that *advocacy* isn’t part of your job. Ensuring that a proposed surgery/imaging/treatment is done with high quality and safety is one of the main reasons our specialty is so important.
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I might need to go back on vacation. I started to get furious at this vial because in thought it said antisemitic. That would have made it a vile vial.
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Look what I found tucked into my bike helmet when I left work this evening 😄
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Pediatric Anesthesia Pro Tip
#39
: If you keep your OR nurses laughing you will have a great day. (The nurses this morning said they heard I was funny on Twitter. I was like 🥹)
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Pediatric Anesthesia Pro Tip
#35
: When a baby’s end tidal tracing suddenly goes wonky for no obvious reason: prepare but don’t panic. A quick scan of the equipment (tube kink, ETCO2 line disconnect, etc.) will save you from unnecessary activity.
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@cliffreid
Each arrest in an OR is unique and the DDx is influenced by surgical factors, the anesthetic, patient factors and stuff you just couldn’t make up because it’s so bizarre. Led by anesthesia but always best if someone not involved in the case comes in to take over with fresh eyes.
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Happy Mother's Day to all those dads who are also moms 🏳️🌈❤️
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Pediatric anesthesia pro tip
#3
: it's nice if your surgeon likes you but it's essential that your OR staff loves you.
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Pediatric Anesthesia Pro Tip
#41
: Never less than 5 cm of PEEP in an intubated patient. Never. Open lung strategy in infants and children is important. Recruit, PEEP & repeat with each disconnect.
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@AlexMunter
@CHEO
And flu is next! Immunizing against influenza will be extremely valuable this year to reduce pediatric hospitalizations.
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Dear Canadian Officials: Protest is a part of a strong democracy. Please legislate these ones to take place away from healthcare workers. We are NOT okay and REALLY don't need to experience negative energy as we make our way into work on the front lines 🙏🏼
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I absolutely LOVE my job. That said: I am a bit envious of people who can work remotely; say from Cape Town. That also said: I prefer vacation to remote work.
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Pediatric Anesthesia Pro Tip
#85
: It’s never *just* a myringotomy/ASD/hernia/etc. Poo can happen in any case at any time. This is why care provided by experienced pediatric anesthesia providers makes surgery safer.
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So far 2023 is 6.02 × 10²³ times better than 2021. You could say a “moleion times better”
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@stephlococcus
Don't beat yourself up. In a real code, there are team members who have each others' backs. Safety culture should encourage them to speak up if they are worried about a mistake☺️
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@BirthControlDoc
@picardonhealth
My sense as well. The stress is showing in all areas of medicine and healthcare. Big investments and changes are needed...
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@MaximeBernier
@AndrewScheer
Not only do we need immigration to fuel our economy, it's the right thing to do. Your platform is divisive, mean spirited and wrong.
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I never would have imagined a year ago when we were bracing for more ICU admissions and racing for a vaccine that we'd have our neighbours shouting at cancer patients and throwing rocks at the PM because our brilliant scientists and brave study participants developed a vax. 😪
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Going out, I used to worry about getting bullied for being too gay. Now I worry about being judged for not being gay enough. Given the options, I prefer now 🏳️🌈❤️
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So my tweet generated a call from CTV. Ready for my close-up Mr DeMille. 😁
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The Ottawa protest is not peaceful. I can't watch commentators keep saying this as our neighbours are harassed and traumatized and our co-workers are spending hours getting to and from work. It's a violent occupation.
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Pediatric Anesthesia Pro Tip
#38
: Pharmacokinetics isn’t an abstract notion. If a child is on an infusion of opioid and they are having significant breakthrough pain, increasing the infusion by 10% won’t fix it. Bolus to get the desired effect; then increase the infusion.
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Pediatric Anesthesia Pro Tip
#90
: It’s perfectly okay to give flumazenil to reverse midaz-induced sedation or titrate a bit of naloxone if the patient didn’t require as much opioid as they received. It’s not failure and it’s not harmful. It’s good care and keeps PACU flowing.
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Pediatric Anesthesia Pro Tip
#47
: Be grateful that people call you STAT. I am happy to be able to help patients in ED, NICU, ICU in addition to my “home” areas. Please don’t take offence if my affect is a little flat at 0130 during a stat call from home 🙏🏼.
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Pediatric Anesthesia Pro Tip
#23
: If you've worked at the same hospital for a while, prepare for the kid who looks at you and says: "you don't look anything like your badge". I'm still working on my comeback ;)
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Pediatric Anesthesia Pro Tip
#24
: Never be ashamed of not understanding all the intricacies of MRI sequencing despite being in the scanner once or twice a month for 25 years. You’re concentrating on other things.
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Pediatric Anesthesia Pro Tip
#62
: Positioning patients for long cases, especially prone, is an important shared responsibility. Always ensure a “walk around” with staff surgeon & nurse before starting to prep. Your patient will benefit from this structured approach to pt safety.
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When our kid was in preschool we ruined Mother's Day bc the teacher didn't want our daughter to feel left out. So without talking to us they renamed it Parents' Day. Don't do that. Gaybies know that their families are different and special. Happy Mother's Day. ❤️
@fakedansavage
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Pediatric Anesthesia Pro Tip
#27
: Only use an oral airway when needed. You should develop good primary airway skills and not contribute to additional plastic waste 🙏🏼.
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@NightShiftMD
This is how healthcare should work. Patient's journey simplified. Services working together with the patient as the focus.
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@nilikm
@BogochIsaac
@CBCOttawa
Thanks Nili. To be clear, we will ensure that there are enough expert clinicians to care for infants, children and youth through all this.
@CHEO
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I can't count the number of times I've been told that a child would be afraid of me only to have us walking down the OR corridor singing "Let It Go" ten minutes later.
#pediatricanesthesia
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Pediatric Anesthesia Pro Tip
#50
: Sometimes you have to wait until your patient is born to go to the OR.
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Pediatric Anesthesia Pro Tip
#5
: When are you new in any department, first make sure you learn the names of the clerks, porters, cleaners, nurses, volunteers and AAs. These folks are critical to the provision of efficient, safe and comfortable patient care.
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