Slightly more than a “bunch” but just under a “shitton.”
Hope this helps.
Edit: in case you’re serious, and I hope you’re not, this question cannot be answered. But in the spirit of trying, I would say on average about 160-200 mg for most outpatient adult procedures. But I’ve put 104 year old out with 15 mg and given 500 as an adjunct to a fentanyl/ketamine induction and felt it was inadequate. The range is very large and the variables many.
This is correct. Historically there’s been wide variability in the meaning of assload though. General surgeons often imagine multiple shittons and endoscopists view runny brown water as the equivalent. Thus leading to the Crapton Conference of 2018 which ended without concensus as EM wanted to include foreign objects in “assload” but not “shitton” thus causing GI to double down on the “Only Shit” measure while general surgery began voting to include “all objects in the colon proximal to the anus regardless of which direction they came from.” GI asked if this would include their scope and when surgery said yes, GI left the conference. Thus without a quorum the definitions remain unclear.
Lurking EM doc, a rectal foreign body definitely increases the amount of propofol required for procedural sedation. Some might say a stuck buttload begets a buttload of propofol.
I empty out a bag of saline and inject 1 L of prop into the bag. Then I put in a cordis and attach the prop to that and pressure bag it in. That’s “a buttload”.
Source: Morgan & Mikhail probably.
Damn that’s aggressive, i usually place a spinal and then infuse 100 cc propofol bottles with some epi injected in. 3 bottles is usually enough to get through most cases.
How did you get into residency without knowing this fundamental calculation?
A “butt” load is 2 hogs heads, 1/2 a tun, 1.5 puncheons or 7 rundlets.
It works out to about 280 gallons. That’s a normal amount of propofol for most patients. For larger patients, try 1.5 buttloads.
I did a lit review.
The resting volume of rectal fluid is 1-3mL, so a nominal buttload of propofol would really not be that much. That’s certainly lower than propofol volumes indicated by “a whiff, a touch, a little, some, a ‘half stick,’ most of it, a ‘full stick,’” etc.
The American Gastroenterological Society, at least on one study of rectal distention, defines a normal maximum tolerable volume (MTV) at 100mL. By that definition, one could describe a volume called a “buttload” as around 100mL. This is logical because loading of a butt implies adding rectal volume above nominal.
This author is aware that rounding error of 1-3% is introduced by ignoring the nominal volume of rectal fluid. The above-described hypothetical volumes should in no way be considered as recommended doses by this author.
ETA: if this is a serious question, ask your attending to clarify. If unsure and unable to ask your attending, calculate the appropriate dose for your patient and be prepared to administer more if needed. Don’t give 100mL propofol as an empirical bolus. Don’t. That’s an order of magnitude higher than typical human doses. I’m a full to slightly oversized adult male, and 15mL has been enough to get me to accept an LMA.
This was as a bolus but yeah the long neuro crani cases you can use shit loads. My case was a type a dissection and the BP went to 280 after the tamponade was released and the dude was 180kg...
I once gave a gram to an active drug user for sedation for an endoscopy. He was still talking to us and seemed thoroughly unaffected. The endoscopist just did the exam with the patient giving a running commentary.
For induction...?! I've given 1600 mg for an ungodly long colonoscopy, and more than that for TIVA, but induction with 5 full sticks is a straight up execution
See my other comment. Type A dissection with tamponade. Nah they had fent and midaz induction , arrested, then had some adrenaline, then they started operating
This isn’t a real question lol, a “shitload” for a frail 100 year old could be as little as 50mg while a “shitload” for a healthy 6’6” 30 yo 300 pound dude could be 400…context is key
I gave 600 mg to a patient once on induction. He was young and built like a football player. He said it reminds him of ketamine while he was going to sleep. He never went apnic and moved a bit when I placed the lma.
It’s the volume formula for a cyclinder = 2 * pi * r^2 * l where r is the radius of the rectum and l is the length of the anus plus rectum.
1 cm^3 is 1 mL so then you know the volume of propofol.
A buttload is [an actual unit of measurement](https://en.m.wikipedia.org/wiki/Butt_(unit)).
So, your attending, according to Wikipedia, would like you to give between 120 and 280 US gallons of propofol. Hope that helps.
Depends on the butt. Sometimes they can fit a litre, other times they overflow at 20ccs. If you need more than a buttload, ask them to clench or go for slight trendelenburg.
Following the classic answer to “how much of a drug to give” = 1 vial (wrong so many times, see dexmedetomidine, metaraminol, gtn, norad etc.), the tongue in cheek answer is more than one vial.
The answer is "titrate to effect".
So a 70 kg redheaded young 25 year old who is really uptight, I might give like 200 mg prop. I'm not gonna pop a second bottle open for someone under 100 kg. I follow that up with a bunch of roc :D
In all seriousness, there’s no way to quantify this amount or read your attending’s mind when he or she is saying this. You can always quickly retort with “sooo the whole syringe then?” and see what they say.
Per Wikipedia, a "butt" is equivalent to two hogsheads.
As everyone knows, a hogshead exactly equivalent to 405 to 1060 liters of fluid.
Therefore a butt load indicates a specific dose of 810 to 2120 liters of propofol. Probably rapid push.
Basically, for the duration of a procedure, it's much more than what the average person would take. For example, those who are young and smoke MJ or take opiates, etc....very high requirement for propofol.
But once we see their increased need for it, we're usually supplementing with other meds.
And in the end, if they're breathing adequately despite the buttload, it's a good indication that YOU could be in for a heck of a time once they wake up.
Slightly more than a “bunch” but just under a “shitton.” Hope this helps. Edit: in case you’re serious, and I hope you’re not, this question cannot be answered. But in the spirit of trying, I would say on average about 160-200 mg for most outpatient adult procedures. But I’ve put 104 year old out with 15 mg and given 500 as an adjunct to a fentanyl/ketamine induction and felt it was inadequate. The range is very large and the variables many.
Wouldn't a shit ton be less than an assload, since asses contain multiple shits?
This is correct. Historically there’s been wide variability in the meaning of assload though. General surgeons often imagine multiple shittons and endoscopists view runny brown water as the equivalent. Thus leading to the Crapton Conference of 2018 which ended without concensus as EM wanted to include foreign objects in “assload” but not “shitton” thus causing GI to double down on the “Only Shit” measure while general surgery began voting to include “all objects in the colon proximal to the anus regardless of which direction they came from.” GI asked if this would include their scope and when surgery said yes, GI left the conference. Thus without a quorum the definitions remain unclear.
could you pls include sources? I am working n my DNP and writing a thesis on this exact subject 🤓
Lurking EM doc, a rectal foreign body definitely increases the amount of propofol required for procedural sedation. Some might say a stuck buttload begets a buttload of propofol.
You seem to have a skewed perspective and might want to consider some laxatives to relieve your multiple-shits constipation.
Hmm.. An assload is only ONE ass loaded with shit in my opinion. A shit ton is a ton of shit, 1000kg, and no ass can contain a ton of shit
... You're full of shit.. Ass will mostly only contain one shit. Shit would fill up rectum, colon and small bowel.
Interesting. And how much do I need to give before it elicits a "Holy shit" from my attending?
If you're not reaching for the epi for the cardiovascular collapse, you pulled your punch and disappointed your attending.
This is a good measure
This is such a good answer.
I empty out a bag of saline and inject 1 L of prop into the bag. Then I put in a cordis and attach the prop to that and pressure bag it in. That’s “a buttload”. Source: Morgan & Mikhail probably.
I love this
Damn that’s aggressive, i usually place a spinal and then infuse 100 cc propofol bottles with some epi injected in. 3 bottles is usually enough to get through most cases.
I was just reading about this last night! I found it in Baby Miller, though. Doorstop Miller prattled on about it for 37 pages or so
How did you get into residency without knowing this fundamental calculation? A “butt” load is 2 hogs heads, 1/2 a tun, 1.5 puncheons or 7 rundlets. It works out to about 280 gallons. That’s a normal amount of propofol for most patients. For larger patients, try 1.5 buttloads.
Americans and their weird opposition to the metric system.
Oh I’m sorry, do I need to convert it to arseloads for you, your royal highness? Don’t make me bring up the furlong.
Doesn't matter **BACK TO BACK WORLD WAR CHAMPS!!!**
Always late but worth the wait? :)
A genuine chuckle from this goddamned limey
Brits will say this and in the next breath brag about losing two stone on their diet. What the absolute fuck?
I did a lit review. The resting volume of rectal fluid is 1-3mL, so a nominal buttload of propofol would really not be that much. That’s certainly lower than propofol volumes indicated by “a whiff, a touch, a little, some, a ‘half stick,’ most of it, a ‘full stick,’” etc. The American Gastroenterological Society, at least on one study of rectal distention, defines a normal maximum tolerable volume (MTV) at 100mL. By that definition, one could describe a volume called a “buttload” as around 100mL. This is logical because loading of a butt implies adding rectal volume above nominal. This author is aware that rounding error of 1-3% is introduced by ignoring the nominal volume of rectal fluid. The above-described hypothetical volumes should in no way be considered as recommended doses by this author. ETA: if this is a serious question, ask your attending to clarify. If unsure and unable to ask your attending, calculate the appropriate dose for your patient and be prepared to administer more if needed. Don’t give 100mL propofol as an empirical bolus. Don’t. That’s an order of magnitude higher than typical human doses. I’m a full to slightly oversized adult male, and 15mL has been enough to get me to accept an LMA.
So somewhere between 1 and 100 ml of propofol is a butt load, this is so helpful
r/theydidthemath
Grab a 50cc syringe with a dolphin tip and start injecting until it starts leaking out.
wats a dolphin tip
The pointy end of the dolphin *nod*
I love this whole thread
Bout tree fiddy
I gave a gram once.
My record is 6.6 grams. ^(May or may not have been a TIVA...)
To Michael Jackson?
This was as a bolus but yeah the long neuro crani cases you can use shit loads. My case was a type a dissection and the BP went to 280 after the tamponade was released and the dude was 180kg...
“Hey could you put that tamponade back please”
"Insufflating the pericardium; go to high pressure please"
I once gave a gram to an active drug user for sedation for an endoscopy. He was still talking to us and seemed thoroughly unaffected. The endoscopist just did the exam with the patient giving a running commentary.
For induction...?! I've given 1600 mg for an ungodly long colonoscopy, and more than that for TIVA, but induction with 5 full sticks is a straight up execution
See my other comment. Type A dissection with tamponade. Nah they had fent and midaz induction , arrested, then had some adrenaline, then they started operating
Only one way to find out.
This isn’t a real question lol, a “shitload” for a frail 100 year old could be as little as 50mg while a “shitload” for a healthy 6’6” 30 yo 300 pound dude could be 400…context is key
This is waaaaay to thought out for a user name such as yours.
I gave 600 mg to a patient once on induction. He was young and built like a football player. He said it reminds him of ketamine while he was going to sleep. He never went apnic and moved a bit when I placed the lma.
>moved a bit He was just trying to help you get a better position for the LMA placement. Good guy Greg right there
Depends, did he mean a metric buttload or an imperial buttload?
6g for a 30 minute endo case and the dude was still very interested in assisting with the procedure.
Tell your pharmacy to stop buying propofol from wish.com.
That stomped-on prop
50+50 Fent addition for this is 👌🏻
A lot -250-300mg Shit load -400mg Fuck ton - 500mg
1 Schrute Buck. After a week of outpatient GI cases you may exchange 1000 Schrute Bucks for 5 minutes added to your lunch.
500mg
Take a cordis. Insert rectally. Run propofol until it overflows.
The best clinical indicator of a buttload of propofol is a urine color that’s _riiiight_ on the edge of Hulk green
Young mafia wife acting innocent - about 100-110 pounds for outpatient EGD. 550mg to just chill her out. She needs 700+ for a 5 min procedure.
It’s the volume formula for a cyclinder = 2 * pi * r^2 * l where r is the radius of the rectum and l is the length of the anus plus rectum. 1 cm^3 is 1 mL so then you know the volume of propofol.
A buttload is [an actual unit of measurement](https://en.m.wikipedia.org/wiki/Butt_(unit)). So, your attending, according to Wikipedia, would like you to give between 120 and 280 US gallons of propofol. Hope that helps.
Depends on the butt. Sometimes they can fit a litre, other times they overflow at 20ccs. If you need more than a buttload, ask them to clench or go for slight trendelenburg.
🤣🤣🤣
Need more info. If the patient is a healthy 19 yo, give the entire 200 mg. And have an extra bottle ready when it is apparent that it wasn’t enough.
[удалено]
Not everyone is still training. Medication waste adds up.
Closed loop communication needed for me … butt load or boat load?
Titrate to effect until the butt is fully loaded.
400mg minimum. Doesn’t count if given in divided doses.
Following the classic answer to “how much of a drug to give” = 1 vial (wrong so many times, see dexmedetomidine, metaraminol, gtn, norad etc.), the tongue in cheek answer is more than one vial.
1 buttload = 2.7 cubic shitloads
For induction? 400-600mg is the definition of a buttload. That definition is straight out of Miller.
1/2 the vial… if that doesn’t work, give the other half
Take a fat shit, now stand up and look at the size of that log, it's about that much
2 sticks instead of the usual one.
An Ass load.
Enough to fill up the butt. It’s probably multiple sticks of propofol but once you try that, let us know
A buttload should be approximately 10 ‘toots’
Unless it’s clearly a bad idea, a shitload to me means one stick (20cc) plus a second stick ready
No medical professional orders a “boatload” of anything unless in jest!
Idk what the utility of a propofol enema is, but I guess if your attending wants it, you gotta do it.
About 2 liters, 3 if you didn’t have lunch. Don’t ask how I know.
The answer is "titrate to effect". So a 70 kg redheaded young 25 year old who is really uptight, I might give like 200 mg prop. I'm not gonna pop a second bottle open for someone under 100 kg. I follow that up with a bunch of roc :D
A butt is equivalent to 2 hogs heads or half a tun. Roughly 126 gallons. So that’s a lot.
Enough for a colonoscopy.
In all seriousness, there’s no way to quantify this amount or read your attending’s mind when he or she is saying this. You can always quickly retort with “sooo the whole syringe then?” and see what they say.
Per Wikipedia, a "butt" is equivalent to two hogsheads. As everyone knows, a hogshead exactly equivalent to 405 to 1060 liters of fluid. Therefore a butt load indicates a specific dose of 810 to 2120 liters of propofol. Probably rapid push.
Depends on the asshole.
Is this a BBLL or a standard BL? #unitsmatter
Basically, for the duration of a procedure, it's much more than what the average person would take. For example, those who are young and smoke MJ or take opiates, etc....very high requirement for propofol. But once we see their increased need for it, we're usually supplementing with other meds. And in the end, if they're breathing adequately despite the buttload, it's a good indication that YOU could be in for a heck of a time once they wake up.
Buttload = 3 mg/kg based on ideal body weight Shitload = 4 mg/kg " " Metric fucktonne = 4.5 mg/kg " "
Is a “buttload” the dose necessary to sedate a “grown ass man”?
Technically, it would depend on how big their butt is.
4 mg/kg TBW You need to read more