PGY3 MD Anaesthesiology RMLH Delhi l MBBS AIIMS Bhopal l Feminist l Nerd #MedReadsAnesthesia
Delhi, India
Joined April 2023
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I have attended the 5th ATLS student provider course at @sgrhindia as a faculty for 3 days (19/11/25-21/11/25) and I'm afraid I have absolutely killed it.
#ATLS
#Trauma
Certified ATLS Instructor (for doctors)
December'24 , I took an ATLS provider course curated by the American College of Surgeons- Committee On Trauma, solely for the love of Trauma management and Trauma Anaesthesiology. At the end of the course, I was identified as a candidate with instructor potential (IP).
Last weekend, I took the instructor course. After two and half days of amazing guidance and feedback on being an interactive educator for adults , I was certified as an ATLS instructor.
During such sessions, the course director asked "Do you think there is room for any improvement?"
I wanted to scream at the top of my lungs, "I see a whole freaking villa for improvement 😭".
I was initially glad for being identified as someone with instructor potential, but only later realised how big of a responsibility it is to be one. As I wait for years of experience to contribute to my confidence, I take a deep breath and teach.
See you at your ATLS course!
(I also turned 25 that weekend, so you know who not to ask how to celebrate birthdays🥂)
#ATLS
#Trauma
#anesthesia
Suchitha Kuntla retweeted
Book collecting is an obsession, an occupation, a disease, an addiction, a fascination, a fate.
Drug so cool and beautiful that people add using it to their personal field interests!
#anesthesia
Suchitha Kuntla retweeted
The fact that you can read, write, sing, dance, laugh and speak, are all political.
No woman is free until all women are free.
Suchitha Kuntla retweeted
The biggest issue in medical residency academics is stagnation. Tied to a single dept and it's pool of consultants for whole of your training isnt the most enriching experience.
Suchitha Kuntla retweeted
Must watch!
“If courts don't step in, it's a licence to the police to get away with absolutely anything becoz they know they have the sanction of their political masters.”
- Sr. Adv. Gopal Sankaranarayanan
on the excessive force used by police against Jantar Mantar protestors.
Suchitha Kuntla retweeted
To any mom with a newborn diagnosed with Down syndrome (DS): please hear this: it is NOT your fault. ❤️
• Every child is unique; there is a huge variation in how DS affects a person.
• normal chromosomes don't guarantee a life free of health issues!
• Wonderful online support groups are out there waiting to help you and guide you.
-You are not alone on this journey.
-God's plan for each family is different.
-Think of what is in your hands; to change. Stop thinking about why your baby and why you...
Suchitha Kuntla retweeted
LOCAL ANESTHETICS AND METHEMOGLOBINEMIA
While prilocaine and benzocaine takes all the lime light, lignocaine is one another local anesthetic agent that can cause methemoglobinemia.
Hydrolyzed metabolites of these amide group of local anesthetics are known to oxidise iron in hemoglobin from Ferrous (Fe2+) form to Ferric form (Fe3+).
Methemoglobinemia with Prilocaine:
-Oxidising metabolite: Ortho-Toludine
-Safe dose limit: 8mg/Kg, but incidence of methemoglobinemia noted at doses as low as 4.2mg/kg IBW too.
-Factors increasing the risk of methemoglobinemia:
>Renal failure
>Younger age/neonates
>Female sex
>Higher drug concentration
>Injecting into active bleeding site
>Concomitant use of other oxidising drugs
Read further: pmc.ncbi.nlm.nih.gov/article…
Methemoglobinemia with lidocaine:
-Oxidising metabolite: 2,6-Xylidine
-Majority of cases seen with FOB/ esophagogastroduodenoscopy
-Risk factors:
>Using Bupivacaine + Lignocaine combination: Displaces lignocaine from its protein bound state
>Severely malnourished/ cirrhotics: Hypoalbuminemia
>Beta blockers: reduced hepatic blood flow/ impaired hepatic metabolism n clearance of drug
>Pre-existing hepatic insufficiency or G6PD deficiency
-Minimum dosage hasn't been described.
Read further: degruyterbrill.com/document/…
Read on drug metabolism:
sciencedirect.com/science/ar….
#anesthesia
#LocalAnesthetics
Suchitha Kuntla retweeted
To all the new doctors and especially for new cardiologists from India-
Any degree only means that you have the basic necessary knowledge on the subject and a basic level of competency can be expected from you.
Thats it.
Learning is a continuous process. Try and learn to do and the nuances of whatever your field demands.
Even if you think this might not help you right now, but it will one day surely help you when you least expect it to.
Be curious always, be receptive to a good advice, and always try and form your trusted circle- people whom you can call and ask for an insight.
Read, read and read some more. Try and attend specific workshops related to your field. Do not go into conferences expecting to learn new subject matter- so there to refine existing knowledge and to clear your doubts once you get over your degree.
Workshops are a great way to do that.
Know how to handle basic emergencies and guidelines related to them. Never be afraid to refer a patient that you feel you cannot help much. You cannot save everyone, and sometimes you shall receive patients who are already at the point of no return. Learn to communicate clearly, respectfully but still softly- while breaking bad news.
Always have the phone number of your nearby police station handy. Be ethical, you know when you toe that ethical boundary- stay within it at all times.
Never rely on the vitals and clinical description of someone else - see for yourself or have an equally competent person check it. I tend to trust electronics for my vitals more than many people now.
Delegate. Do not try to do everything by yourself.
Take out time for you and your family. You are also a human. The same problems you are treating, can happen to you too- so take care of your health. Your patients will forget you the moment you die, but your children, spouse and children will not.
Be happy: do not chase money. Do ethical work, the money may be slow, but it will eventually come to you. Never give into the pressure of the corporates. They are there to make a profit, you are there to treat patients.
Have a spine, say when things are not right.
Upgrade as and when you can.
Suchitha Kuntla retweeted
What causes tolerance to nitroglycerin?
A good n concise read providing three possible mechanisms and scope for further research to deal with them at molecular level.
#pharma #MedTwitter #ICU
pubmed.ncbi.nlm.nih.gov/1976…
Suchitha Kuntla retweeted
Shouldn't there be an open portal where doctors and nurses working in that Government hospital can also file complaints for lack of beds, medicines, surgical OTs, MRI/ CT machines, working hours? And there be an escalation ladder for the same?
How can doctors bring in beds? If there are no beds then what if the complications happen? Who will be responsible?
People defending the violence by saying NICU bed should have been made available. How is this possible?
World Federation of Societies of Anesthesia-Tutorial of the week dated today, 30/06/2026, is about perioperative care of Transgender and Gender-Diverse individuals.
And all the contributing authors are Indian.
One step a day 🚶♀️
#lgbtqia #Anesthesia
Source: World Federation of Societies of Anesthesiologists share.google/ycmAru37m8BwlCH…
There was a time in anesthesia where people were more afraid of anesthesia than the surgery itself, given history of deaths in family on exposure to the gases. They all died turning hot and stiff.
It was hypothesised to be a result of changes in central temperature set points.
But then, a bunch of pigs showed same features on exposure to stressful environments during shipping, fighting, coitus (they been real hard on themselves), where they turned hot and died.
Later, the meat from such pigs was found to be pale, soft and exudative, giving us the idea of Malignant Hyperthermia being a disorder of muscle indeed.
Porcine stress syndrome and samples from such pigs lead to the first identified RyR1 (Ryanodine receptor) mutation, and the rest 229 followed. (230 known mutations till date).
Well, let's just say I'm thankful to the butcher who reported the changes in meat quality instead of just grinding it to make lousy sausages 👨🍳
Currently reading: The Picture of Dorian Gray, Oscar Wilde/ 1890s
Dreadfully demoralizing and I'm loving it!
#BookTwitter
Esmolol bolus n infusion for rate control in caffeine induced myocardial irritability.
Theophylline and Caffeine induced arrythmias require you to think out of ACLS guidelines.
open.substack.com/pub/litann…
(I'm finding it weirdly uncomfortable sharing substack links on X lol, that's some crossover)
Esmolol, a short acting cardio-selective Beta-1 adrenergic antagonist, is one the common drugs used for:
-rate control in SVTs
-hypertensive emergencies
-aortic dissection
-thyrotoxicosis
and in the Perioperative period as a hypotensive agent.
It is given as boluses/ continuous infusions, at well defined rates of 150-1000mcg/kg/min.
One needs to understand that Esmolol is hydrolysed by RBC and Plasma non-specific esterases, into acid metabolites (1/1500 times potent as esmolol) and METHANOL. Both the products are excreted by renal routes.
The methanol produced is barely closer to toxicity thresholds. But, on prolonged continuous infusions, accumulation of methanol can result in toxidrome of it's own.
It isn't very common occurrence and only anecdotes are all we have now, but, unexplained metabolic acidosis with High anion and Osmolal gaps in a patient on continuous infusion of ESMOLOL should probe you to think of its metabolite: METHANOL.
Sources:
1.applications.emro.who.int/im…
2.ncbi.nlm.nih.gov/books/NBK51…
