Clinical decision support that reasons like an anesthesiologist: grade the physical status, work the difficult airway, weigh the preoperative risk — with the decision rule and exactly what would change it. Built for verified anesthesiologists.
Two real anesthesiology questions, each reasoned the way HeyHippocrates answers: the skills fire, the answer is cited, the decision rule is explicit, and what's missing is flagged. Scroll to each.
Emergent RSI, can't intubate after two attempts, oxygen saturation drifting to 88% on mask ventilation — next step?
Declare a can't-intubate situation and follow the difficult-airway algorithm: call for help, limit further laryngoscopy, and move to a supraglottic airway to restore oxygenation (Plan B). If oxygenation still fails — a can't-intubate-can't-oxygenate emergency — go to front-of-neck access (scalpel–bougie cricothyroidotomy) without delay. Oxygenation, not intubation, is the priority.
Decision ruleFailed intubation → call help, cap attempts, supraglottic airway; if can't-intubate-can't-oxygenate → front-of-neck access now; oxygenate first, then decide wake vs proceed.
Not established from this alone — mask-ventilation grade, the surgical urgency, aspiration risk and equipment change the plan.
65-year-old for elective major non-cardiac surgery, hypertension and diabetes, climbs two flights of stairs without symptoms — cardiac workup first?
Estimate perioperative risk (RCRI) and functional capacity. Climbing two flights is roughly >4 METs — good functional capacity — so with a stable patient, routine preoperative stress testing is not indicated and adds delay without benefit. Continue statin and any established beta-blocker, manage antiplatelet and diabetes agents, and optimize blood pressure.
Decision ruleGood functional capacity (>4 METs) + stable → proceed without further cardiac testing; test only if it would change management; continue statin/beta-blocker, plan antiplatelet.
Not established from this alone — active cardiac symptoms, the RCRI, surgical risk and recent events change the workup.
Illustrative simulations. The physician always decides.
The exact questions your field searches for — answered in the format the knowledge base speaks: the answer, the decision rule, what's missing, and the source.
ASA physical status grades the patient, not the surgery: I a healthy patient; II mild systemic disease (controlled hypertension, smoker); III severe systemic disease that limits activity (poorly controlled diabetes, COPD); IV severe disease that is a constant threat to life; V a moribund patient not expected to survive without the operation; VI a brain-dead organ donor. Add "E" for an emergency.ASA classification
Decision ruleGrade the patient's systemic disease (I–VI), append E for emergency; it flags risk and staffing, but does not by itself cancel a case.
Missing data: the specific comorbidities, their control and functional capacity refine the grade.
Work the plan: Plan A is facemask and tracheal intubation with optimized attempts (limit the number); Plan B is a supraglottic airway to restore oxygenation; Plan C is a final attempt at facemask ventilation; Plan D is front-of-neck access. Call for help early, keep the patient oxygenated between attempts, and never fixate on intubation while the saturation falls.DAS · guideline
Decision ruleOptimize and cap intubation attempts → supraglottic airway → facemask → front-of-neck access; oxygenation is the priority throughout.
Missing data: the airway exam, ventilation grade, urgency and available equipment change each step.
Combine surgical risk, a cardiac risk index (RCRI) and functional capacity. A patient with good functional capacity (roughly >4 METs) and no active cardiac condition generally proceeds without further testing. Order stress imaging only when the result would change management — poor or unknown capacity with elevated risk. Continue statins and established beta-blockers; individualize antiplatelet timing.ACC/AHA · perioperative
Decision ruleActive cardiac condition → evaluate/treat first; otherwise >4 METs → proceed; test only if it changes management; continue statin/beta-blocker.
Missing data: unstable symptoms, the RCRI, surgical urgency and stent/antiplatelet status drive the decision.
Suspect LAST with neurologic signs (perioral numbness, agitation, seizures) or cardiovascular collapse after a local-anesthetic dose. Stop the injection, call for help, secure the airway with 100% oxygen, and give 20% lipid emulsion (a bolus of about 1.5 mL/kg, then an infusion). Treat seizures with a benzodiazepine, use reduced-dose epinephrine, avoid vasopressin and propofol as the rescue drug, and resuscitate for a prolonged period.ASRA · LAST
Decision ruleStop injection → airway/oxygen → 20% lipid emulsion bolus + infusion → benzodiazepine for seizures, reduced-dose epinephrine, prolonged resuscitation.
Missing data: the agent, dose and site, the timing and the cardiovascular picture change the response.
Your whole practice, one specialist brain — grounded in champion-authored, cited knowledge.
A generalist anesthesiology colleague across airway, preoperative assessment, regional, general anesthesia and perioperative safety — cited, non-directive, always with the decision rule.
Deep specialist agents for cardiac, obstetric, pediatric and regional & pain anesthesia — each its own soul and knowledge base — plus your own uploaded materials.
In anesthesia the margin is seconds. Only one of these reasons like an anesthesia colleague whose every claim you can trace.
The waitlist is a founding cohort. Members shape the anesthesiology build, get in before anyone else, and lock the founding price for good.
Leave your name and work email. We'll reach out the moment anesthesiology opens — with your Founding Anesthesiologist offer.
One email at launch. No spam, ever.
It reasons in the tools you use — ASA physical status, the RCRI and functional capacity — and always shows the reasoning behind the grade, the disposition, and what would change it. The decision always stays your call.
Both. Residents use it to pressure-test a plan and learn the decision rule; attendings use it as a fast, cited second opinion before induction and in a crisis. Access is gated to verified physicians.
Cardiac, obstetric, pediatric and regional & pain each have their own deep specialist agent on the Pro plan, on top of the full general anesthesiology scope on Basic.
No. It is physician-facing clinical decision support — a cited thinking partner. It does not diagnose, does not treat, and gives no patient-facing advice. The decision always stays with you.
Every answer is grounded only in champion-authored, cited anesthesiology knowledge — traceable, not hallucinated — and always states the decision rule plus what data is missing, instead of a confident guess.
HeyHippocrates