3 year old boy dies during dental procedure

[ProwlerturnGas]

I can count

Not an anesthesiologist. Not a dentist.

Multiple teeth extraction for an infected gum. (The part that hasn't been mentioned yet is that there are a lot of pediatric dentistry scammers out there; if true then this at least seems to be indicated.)

“they gave [redacted] the [redacted] and that is when his right cheek swelled up”

30 minutes in. A reasonable dentist should be finished around that time. Sounds to me like they gave an IV antibiotic, there was anaphylaxis and they were late in recognizing it.

According to the report, the doctor who performed the dental procedures said he had never seen anything like this in his career, especially in someone without any known allergies.

This sure sounds to me that the dentist thought it was anaphylaxis. Could he be wrong? Absolutely.

But the timing, the reported observations, and these statements to me sound like they were unable to treat anaphylaxis in a sedated patient. That to me at least is actually worse that not being able to deal with LAST or more involved anesthesia complications.

I can count on one finger the number if times I gave an abx for these cases. Unless he had a cardiac issue that required abx, which should NOT be done in an office setting, the treatment is extraction.

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[Vandalia]

I can count

I can count on one finger the number if times I gave an abx for these cases. Unless he had a cardiac issue that required abx, which should NOT be done in an office setting, the treatment is extraction.

I won't disagree that is the "standard of care."

The problem is that there are a lot people out there that don't follow the "standard of care."

 

[Southpaw]

I won't disagree that is the "standard of care."

The problem is that there are a lot people out there that don't follow the "standard of care."

case to me, given the details, sounds like lost airway/obstruction/hypoxia until proven otherwise. I don’t care what the dentist says. Doesn’t help that I’ve given antibiotics for these cases approximately 0 times.

listen, if you work with CRNAs you’ll see some odd excuses for what turn out to be very easily fixable problems. It’s often oversedation/hypovent/hypoxia and they aren’t getting it or blaming it on something else.

 

[NicMouse64]

But if it were an anesthesiologist that this happened to, I could more easily say "Things happen, we did the best we could" .

When there is no anesthesiologist involved, and we are compromising on a lower cost substandard option, its hard to NOT think "Could it have been different with someone with a higher level of training present?" As a parent I would always wonder that. With the anesthesiologist I would feel that at least everything had been done with the most skilled provider possible.

totally agree. But we all know that the average person has no idea of the credentials of who is providing their anesthesia. Yet when I turn on the TV I get to be told to "choose an NP". If there's anything that the average american responds to, unfortunately it's fear, not logic. The ASA needs to make the American public afraid of the unsupervised CRNA.

 

[IMGASMD]

listen, if you work with CRNAs you’ll see some odd excuses for what turn out to be very easily fixable problems. It’s often oversedation/hypovent/hypoxia and they aren’t getting it or blaming it on something else.

CRNA after all is “nurse at heart”. They have no way, the desire nor the training to go head to head with surgeons. I’ve had “caught” my crna’s give medications without ever notifying me. When I ask about it, oh the surgeon said to give. Be it antibiotics, TxA or even “not” giving pressors. Then some **** hits the fan, I am the last one to know and I get to take the blame.

 

[Aheadbyacentury]

It's not LAST. Common things are common. It's too much sedation/obstruction/spasm something causing hypoxia or anaphylaxis.

Totally agree!

 

[Aheadbyacentury]

I also suspect that there were secretions or blood vs obstruction in an unsecured airway and that led to badness real quick.

Totally agree! This is why anyone who is NOT a peds anesthesiologist should be intubating these kids in my opinion.

 

[Aheadbyacentury]

Agreed. Also very strange that they wouldn’t be able to ventilate the kid especially if paralytic available. How hard can it be to mask ventilate a 3 year old?

Remember in residency when youre attending in peds would say, have IM sux and atropine available and s/he would say bad things happen real fast in children. Well I think bad things happened really fast and things spiraled out of control prior to them able rescue the kid. Panic set in and they called 911..

 

[Aheadbyacentury]

Not an anesthesiologist. Not a dentist.

Multiple teeth extraction for an infected gum. (The part that hasn't been mentioned yet is that there are a lot of pediatric dentistry scammers out there; if true then this at least seems to be indicated.)

“they gave [redacted] the [redacted] and that is when his right cheek swelled up”

30 minutes in. A reasonable dentist should be finished around that time. Sounds to me like they gave an IV antibiotic, there was anaphylaxis and they were late in recognizing it.

According to the report, the doctor who performed the dental procedures said he had never seen anything like this in his career, especially in someone without any known allergies.

This sure sounds to me that the dentist thought it was anaphylaxis. Could he be wrong? Absolutely.

But the timing, the reported observations, and these statements to me sound like they were unable to treat anaphylaxis in a sedated patient. That to me at least is actually worse that not being able to deal with LAST or more involved anesthesia complications.

I think you raise some reasonable points in so far as "Multiple teeth extraction for infected gum".. There may have been mild or even moderate swelling pre-operatively. Even MORE reason to intubate.
This was not anaphylaxis.... or LAST. I agree though they will try to sell that point hard.
When a 3 year old dies in your care I certainly hope you would say " Ive never seen anything like this EVER"
And where have i heard that before.. oh yea crnas say that all the time "Ive never seen that before" or "ive never had a problem doing it this way for x years" Just because you havent experienced it doesnt mean it cannot happen. This is where training counts. When your attendings make your life as uncomfortable as possible so you can understand the possible ramifications as to what you do..

 

[nimbus]

Any takers?

No nights, no weekends, no call. Great lifestyle job for pediatric anesthesiologists. High volume pediatric dental surgery center providing care to children 1 month-10 years old, mainly ASA 1's and 2's. Must be willing to learn and use an open airway TIVA technique. Must work collegially with CRNAs $300/hr average 10-12 hours per day

GasWork.com - Reference #339753

Reference #339753

www.gaswork.com

 

[Aheadbyacentury]

Any takers?

No nights, no weekends, no call. Great lifestyle job for pediatric anesthesiologists. High volume pediatric dental surgery center providing care to children 1 month-10 years old, mainly ASA 1's and 2's. Must be willing to learn and use an open airway TIVA technique. Must work collegially with CRNAs $300/hr average 10-12 hours per day

GasWork.com - Reference #339753

Reference #339753

www.gaswork.com

yes this is exactly what it is.. tiva on 4-10 year olds.... No wonder they cant find MDs to do this.... for ANY amount.. and the Ad points out the patients are ASA 1 and 2 as if nothing bad could happen to that population.. And time and time again it has been demonstrated that this is exactly the population that this kinda stuff happens on.

 

[nimbus]

yes this is exactly what it is.. tiva on 4-10 year olds.... No wonder they cant find MDs to do this.... for ANY amount.. and the Ad points out the patients are ASA 1 and 2 as if nothing bad could happen to that population.. And time and time again it has been demonstrated that this is exactly the population that this kinda stuff happens on.

Funny part is the ad says age range is 1mo to 10yrs. I wanna know what dental procedures they do on 1mo infants lol.

 

[linkin06]

Tiny Teeth Pediatric Dentistry is devastated by the death of Abiel Valenzuela Zapata. We are praying for the family during this time and ask for the community to do so, as well.

Like Abiel’s family, we, too, want to understand how this tragic event may have occurred. Our practice has never experienced an incident like this, and we had no reason to expect this procedure would be anything other than routine.

We would like to thank the EMS first responders who arrived only a few minutes after we called 911. They continued the CPR efforts we had begun and worked feverishly to save Abiel.


Nobody expects emergencies, but you should always have the properly-trained personnel and equipment ready.

 

[deleted697535]

I do an adults dental office list once or twice a month. Lucrative but tricky days. Couldn't imagine doing that in an office on peds. Holy ****.

Also this was 1000% airway. Dental always is. Peds always is... So why would peds dental be different.
I dont even want to hear any other details... Anything else is just whataboutery

 

[GassYous]

Funny part is the ad says age range is 1mo to 10yrs. I wanna know what dental procedures they do on 1mo infants lol.

That's exactly what I was thinking

I guess it's the dental version of the hemi hip on a demented 95 year old

 

[coffeebythelake]

Any takers?

No nights, no weekends, no call. Great lifestyle job for pediatric anesthesiologists. High volume pediatric dental surgery center providing care to children 1 month-10 years old, mainly ASA 1's and 2's. Must be willing to learn and use an open airway TIVA technique. Must work collegially with CRNAs $300/hr average 10-12 hours per day

GasWork.com - Reference #339753

Reference #339753

www.gaswork.com

Nope, not even for 1000 an hour.
Not worth the risk.
What they are asking for is putting your medical license and good judgement on the line for dentist convenience.
Just no.

 

[coffeebythelake]

I want to know when was the last time this unsupervised CRNA in question ever intubated someone. Lack of skills plus lack of training probably played a part in this tragic outcome.

 

[ProwlerturnGas]

No peds dental TIVA without ET tube. Never. That Gaswork post is scary

 

[DirtDocMD]

These dentists have been blowing smoke for YEARS, that these kids need all this “dental rehab” on their baby teeth. SERIOUS decay affects development of permanent teeth?? Ok, maybe...

Don’t tell me that multiple small cavities need all this “dental rehab”, though. This is a “cash grab” for Medicaid dollars.

“Oh, but they could get an abscess, and require emergency care!!”

You know how many pediatric dental abscesses I’ve seen in 19 years??? I’m not saying they don’t exist, but it’s ZERO.

Stop risking kids’ lives, and spending hundreds of millions, if not billions, of dollars, to fix teeth that are going to fall out in a few years. Show some discretion....

In the meantime, these yahoos wanna put us in a situation with the potential for death (and millions in liability), while Medicaid pays $18 a point ($150-$200 a case). I avoid these cases like the PLAGUE, and feel 1/2 to 2/3 of them are unnecessary....

 

[NicMouse64]

These dentists have been blowing smoke for YEARS, that these kids need all this “dental rehab” on their baby teeth. SERIOUS decay affects development of permanent teeth?? Ok, maybe...

Don’t tell me that multiple small cavities need all this “dental rehab”, though. This is a “cash grab” for Medicaid dollars.

“Oh, but they could get an abscess, and require emergency care!!”

You know how many pediatric dental abscesses I’ve seen in 19 years??? I’m not saying they don’t exist, but it’s ZERO.

Stop risking kids’ lives, and spending hundreds of millions, if not billions, of dollars, to fix teeth that are going to fall out in a few years. Show some discretion....

In the meantime, these yahoos wanna put us in a situation with the potential for death (and millions in liability), while Medicaid pays $18 a point ($150-$200 a case). I avoid these cases like the PLAGUE, and feel 1/2 to 2/3 of them are unnecessary....

I also am trying to wrap my head around why you wouldn't do a nasopharyngeal intubation if sedating. I was at a hospital that did dental work for my anesthesia rotation and all of the kids got a NTI. Idk if that is standard of care of not, just what I saw.

 

[okayplayer]

Any takers?

No nights, no weekends, no call. Great lifestyle job for pediatric anesthesiologists. High volume pediatric dental surgery center providing care to children 1 month-10 years old, mainly ASA 1's and 2's. Must be willing to learn and use an open airway TIVA technique. Must work collegially with CRNAs $300/hr average 10-12 hours per day

GasWork.com - Reference #339753

Reference #339753

www.gaswork.com

What exactly is the arrangement here? Firefighter/liability sponge?

Does not sound like care team model from that ad.

What a nightmare. Some things are not worth any amount of $ to me.

 

[deleted126335]

I also am trying to wrap my head around why you wouldn't do a nasopharyngeal intubation if sedating. I was at a hospital that did dental work for my anesthesia rotation and all of the kids got a NTI. Idk if that is standard of care of not, just what I saw.

-quicker
-cheaper (don't need a machine and a whole bunch of other stuff) plus faster turnover.
-99.9% of the time will be fine if a skilled clinician. Lots of resources and time needed to tack on a few more "9s" to that number.

 

[dabears505]

Keep in mind those that say intubation is the answer. You can have spasm hypoxia when you pull tube. You can have failure to secure Airway when you put to sleep. Incubating has its fair share of consequences and dangers. For the most part these are simple very routine cases that don't need a full on general.

 

[propadope]

Funny part is the ad says age range is 1mo to 10yrs. I wanna know what dental procedures they do on 1mo infants lol.

I’m guessing lingual frenectomy but 1mo is obviously a poor candidate for anesthesia in that setting. That goes for anyone under 2 years in my opinion

 

[propadope]

These dentists have been blowing smoke for YEARS, that these kids need all this “dental rehab” on their baby teeth. SERIOUS decay affects development of permanent teeth?? Ok, maybe...

Don’t tell me that multiple small cavities need all this “dental rehthough. This is a “cash grab” for Medicaid dollars.

“Oh, but they could get an abscess, and require emergency care!!”

You know how many pediatric dental abscesses I’ve seen in 19 years??? I’m not saying they don’t exist, but it’s ZERO.

Stop risking kids’ lives, and spending hundreds of millions, if not billions, of dollars, to fix teeth that are going to fall out in a few years. Show some discretion....

In the meantime, these yahoos wanna put us in a situation with the potential for death (and millions in liability), while Medicaid pays $18 a point ($150-$200 a case). I avoid these cases like the PLAGUE, and feel 1/2 to 2/3 of them are unnecessary....

Unfortunately these procedures are necessary; but decay is mostly due to poor oral hygiene, poor diet, neglect, lack of education and other circumstances. In other words it is usually preventable

 

[ProwlerturnGas]

These dentists have been blowing smoke for YEARS, that these kids need all this “dental rehab” on their baby teeth. SERIOUS decay affects development of permanent teeth?? Ok, maybe...

Don’t tell me that multiple small cavities need all this “dental rehab”, though. This is a “cash grab” for Medicaid dollars.

“Oh, but they could get an abscess, and require emergency care!!”

You know how many pediatric dental abscesses I’ve seen in 19 years??? I’m not saying they don’t exist, but it’s ZERO.

Stop risking kids’ lives, and spending hundreds of millions, if not billions, of dollars, to fix teeth that are going to fall out in a few years. Show some discretion....

In the meantime, these yahoos wanna put us in a situation with the potential for death (and millions in liability), while Medicaid pays $18 a point ($150-$200 a case). I avoid these cases like the PLAGUE, and feel 1/2 to 2/3 of them are unnecessary....

The dentists that I worked with were very conscientious of the risks and need for GA. I can’t say what you described is out there, but that is not my experience.

 

[ProwlerturnGas]

I also think these dentists are caught between a rock and hard place. Where I work now, a peds dentist gets one OR day per month maybe two. They’re capped at 5 kids per day. The number of children with serious oral health or orthodontic issues far exceeds the number of OR days at a hospital. It’s also difficult to get an ASC spot

Now imagine a kid with several tooth abscesses that affects not only his future adult teeth but their jaw, sinuses and overall health. Dentist tries oral versed and nitrous. Kid perhaps gets a nerve block. The dentist now gets one shot at taking care of the kids pathology. Many of these kids have several teeth abscessed. If it cannot be done at one visit, that kid will now not do well at all for any subsequent visits.

If you haven’t been really involved with pediatric dentistry, it can be an eye opener! You wouldn’t believe some of the bombed out mouths I have seen. Sometimes all 20 teeth abscessed.

 

[Southpaw]

Any takers?

No nights, no weekends, no call. Great lifestyle job for pediatric anesthesiologists. High volume pediatric dental surgery center providing care to children 1 month-10 years old, mainly ASA 1's and 2's. Must be willing to learn and use an open airway TIVA technique. Must work collegially with CRNAs $300/hr average 10-12 hours per day

GasWork.com - Reference #339753

Reference #339753

www.gaswork.com

That ad's a disaster

 

[DirtDocMD]

Don’t expect “qualified PACU nurses” at many of these places, either.

These guys could make plenty, sticking to legit cases, done with proper anesthesia and recovery staff. Instead, there’s plenty of “pediatric dentistry mills”, out there. Herd ‘em in, herd ‘em out...

 

[Aheadbyacentury]

They want it to be anaphylaxis so they just blame the patient.

 

[secretasianman]

they’ll just settle, and all this will get swept under the rug without any wrong doing accepted, and then the same thing will keep happening..

 

[Vandalia]

They want it to be anaphylaxis so they just blame the patient.

How exactly does that work?

If I am them I would be praying for some unusual cardiac abnormality or something similar.

Or at least the infection was far more advanced than initially thought which led to airway compromise.

Something.

There is absolutely no way from a malpractice point of view in front of a jury, or for their marketing, that I would pin it on "we weren't able to manage an allergic reaction." Because I can guarantee you that this is exactly how the parent's lawyers will phrase anaphylaxis.

 

[Aheadbyacentury]

How exactly does that work?

If I am them I would be praying for some unusual cardiac abnormality or something similar.

Or at least the infection was far more advanced than initially thought which led to airway compromise.

Something.

There is absolutely no way from a malpractice point of view in front of a jury, or for their marketing, that I would pin it on "we weren't able to manage an allergic reaction." Because I can guarantee you that this is exactly how the parent's lawyers will phrase anaphylaxis.

I see what you are saying, but what would you rather defend? We gave him too much sedation and he coded and died? or he had an anaphylactic reaction coded and died? EIther way they should have been able to handle both.

 

[VA Hopeful Dr]

These dentists have been blowing smoke for YEARS, that these kids need all this “dental rehab” on their baby teeth. SERIOUS decay affects development of permanent teeth?? Ok, maybe...

Don’t tell me that multiple small cavities need all this “dental rehab”, though. This is a “cash grab” for Medicaid dollars.

“Oh, but they could get an abscess, and require emergency care!!”

You know how many pediatric dental abscesses I’ve seen in 19 years??? I’m not saying they don’t exist, but it’s ZERO.

Stop risking kids’ lives, and spending hundreds of millions, if not billions, of dollars, to fix teeth that are going to fall out in a few years. Show some discretion....

In the meantime, these yahoos wanna put us in a situation with the potential for death (and millions in liability), while Medicaid pays $18 a point ($150-$200 a case). I avoid these cases like the PLAGUE, and feel 1/2 to 2/3 of them are unnecessary....

I've been in family med for 11 years now and have seen exactly 1 peds dental abscess. So yeah, pretty darned rare.

 

[pgg]

I don't doubt that there's more peds dentistry that needs to be done than ORs can support, and that office based procedures are the answer. That doesn't excuse the corner cutting these dentists are famous for.

So many of these dentists buy used outdated monitors, reuse consumables, don't pay for PACU space or personnel or equipment, won't pay for emergency drugs or equipment (hey that's what 911 is for!). They demand room air general TIVAs with unsecured airways to keep the meat moving because an endotracheal tube adds 3 minutes up front and 5 on the back side (longer if there's no PACU, which there never is) and of course the tube itself is a $6 consumable.

They might bill $400 or more to the parents (cash up front) for the anesthesia service, of which $80 goes to some retread CRNA making $160/hr.

Not to mention that so many of these procedures are totally unnecessary in the first place.

This is a problem that starts and ends with the dentists.

 

[caligas]

Keep in mind those that say intubation is the answer. You can have spasm hypoxia when you pull tube. You can have failure to secure Airway when you put to sleep. Incubating has its fair share of consequences and dangers. For the most part these are simple very routine cases that don't need a full on general.

Failure to secure airway is almost non existent now with fiberoptic laryngoscopy, and if it does happen on induction at least you are actively managing the airway without a throat full of blood and dental equipment in your way, same with extubation.

IDK maybe it’s a reasonable risk to do what they are doing for the overall good of taking care if a $hit ton of rotten teeth at a manageable cost, but there’s no way it’s as safe as an Anesthesiologist and a secure Airway.

 

[yossarian22]

Failure to secure airway is almost non existent now with fiberoptic laryngoscopy, and if it does happen on induction at least you are actively managing the airway without a throat full of blood and dental equipment in your way, same with extubation.

IDK maybe it’s a reasonable risk to do what they are doing for the overall good of taking care if a $hit ton of rotten teeth at a manageable cost, but there’s no way it’s as safe as an Anesthesiologist and a secure Airway.

Sorry I can’t get past the first sentence. Failure to secure an airway is still a huge risk in anesthesia.

 

[coffeebythelake]

Sorry I can’t get past the first sentence. Failure to secure an airway is still a huge risk in anesthesia.

Failure to oxygenate and ventilate is the risk. As long as you are able to do that the patient is safe.. aka don't perseverate on the need to "secure the airway". (But honestly virtually all young children are easy to intubate by DL unless they have some sort of congenital abnormality.)

 

[epidural man]

You guys are such negative Nellies.

Sure a kid died, that is sad.

But think of the money the dentist saved.

No one ever thinks of the poor dentist.

 

[Urzuz]

Failure to secure airway is almost non existent now with fiberoptic laryngoscopy...

Fiberoptic laryngoscopy? Have you ever worked at a standalone, private OR? As people were discussing above, most surgeons (or I guess dentists in this case) are way, way too cheap to pay for your unnecessary equipment to keep a patient 'safe.' All they see are the $$$ they save by reusing and recycling. I floated through a plastic surgery office where he was too cheap to throw ANYTHING away. ETT stylets, arm straps, the little blue cap that comes on the Y-connecter of the circuit that the ETCO2 line plugs into....all those things got saved and reused in some way. The most ridiculous was that he had a disposable foam headrest that never got thrown away. It was stained with betadine, chloraprep, blood, and God knows what else. If I asked him to buy a fiberoptic laryngoscope and showed him the price tag his head would have actually exploded.

 

[GassYous]

Fiberoptic laryngoscopy? Have you ever worked at a standalone, private OR? As people were discussing above, most surgeons (or I guess dentists in this case) are way, way too cheap to pay for your unnecessary equipment to keep a patient 'safe.' All they see are the $$$ they save by reusing and recycling. I floated through a plastic surgery office where he was too cheap to throw ANYTHING away. ETT stylets, arm straps, the little blue cap that comes on the Y-connecter of the circuit that the ETCO2 line plugs into....all those things got saved and reused in some way. The most ridiculous was that he had a disposable foam headrest that never got thrown away. It was stained with betadine, chloraprep, blood, and God knows what else. If I asked him to buy a fiberoptic laryngoscope and showed him the price tag his head would have actually exploded.

we put a pillowcase on ours!

 

[coffeebythelake]

I’m guessing lingual frenectomy but 1mo is obviously a poor candidate for anesthesia in that setting. That goes for anyone under 2 years in my opinion

You mean surgery for tongue tie in a baby? That does not require anesthesia other than some local. It literally takes 30 seconds to perform.

 

[propadope]

You mean surgery for tongue tie in a baby? That does not require anesthesia other than some local. It literally takes 30 seconds to perform.

Who knows what kind of nonsense goes on there.

 

[Barleycorn]

Fiberoptic laryngoscopy? Have you ever worked at a standalone, private OR? As people were discussing above, most surgeons (or I guess dentists in this case) are way, way too cheap to pay for your unnecessary equipment to keep a patient 'safe.' All they see are the $$$ they save by reusing and recycling. I floated through a plastic surgery office where he was too cheap to throw ANYTHING away. ETT stylets, arm straps, the little blue cap that comes on the Y-connecter of the circuit that the ETCO2 line plugs into....all those things got saved and reused in some way. The most ridiculous was that he had a disposable foam headrest that never got thrown away. It was stained with betadine, chloraprep, blood, and God knows what else. If I asked him to buy a fiberoptic laryngoscope and showed him the price tag his head would have actually exploded.

I'm sure his lobby was really nice though.

 

[Gern Blansten]

Tiny Teeth Pediatric Dentistry is devastated by the death of Abiel Valenzuela Zapata. We are praying for the family during this time and ask for the community to do so, as well.

Like Abiel’s family, we, too, want to understand how this tragic event may have occurred. Our practice has never experienced an incident like this, and we had no reason to expect this procedure would be anything other than routine.

We would like to thank the EMS first responders who arrived only a few minutes after we called 911. They continued the CPR efforts we had begun and worked feverishly to save Abiel.


Nobody expects emergencies, but you should always have the properly-trained personnel and equipment ready.

They worked feverishly. Sounds like it was MH...

 

[coffeebythelake]

They worked feverishly. Sounds like it was MH...

No pun intended?

 

[caligas]

Sorry I can’t get past the first sentence. Failure to secure an airway is still a huge risk in anesthesia.

I’ve done over 10k anesthetics and never failed to secure an airway. Isn’t that what we are trained to do?

 

[pgg]

I’ve done over 10k anesthetics and never failed to secure an airway. Isn’t that what we are trained to do?

**** happens. I haven't lost one yet either, but ...

I saw a neck get cut a few weeks ago - I was doing an ENT room and someone ran in to get my surgeon, who ran out to do an emergent surgical airway a couple doors down. I have a good colleague who lost an airway and the patient died some years back. One of my attendings in residency lost an airway in the hallway between the OR and PACU and it wasn't detected until the patient coded and suffered a hypoxic brain injury. Another colleague lost an airway on induction and the gen surgeon cut the neck last year. All good anesthesiologists.

In each of those cases I can chuck some rocks and say they did or didn't do things the way I'd have done them. But there but for the grace of god go I ...

I am less philosophical about it when corners are cut in the name of profit, which is always the case in these office anesthesia deaths. Or when people disable safety equipment (lookin' at all you *****s who put the monitors on CPB mode to permasilence alarms).

I don't know what the CRNA in this case did or didn't do, and I bet I coulda done it better, but I also bet the dentist set that person up for failure with profit-driven compromises on equipment/facility/personnel decisions. So for once I'm not inclined to rag on the CRNA.

 

[propadope]

I've been in family med for 11 years now and have seen exactly 1 peds dental abscess. So yeah, pretty darned rare.

Yeah but ask a pediatric dentist or even peds EM how often they see them.

 

[nimbus]

**** happens. I haven't lost one yet either, but ...

I saw a neck get cut a few weeks ago - I was doing an ENT room and someone ran in to get my surgeon, who ran out to do an emergent surgical airway a couple doors down. I have a good colleague who lost an airway and the patient died some years back. One of my attendings in residency lost an airway in the hallway between the OR and PACU and it wasn't detected until the patient coded and suffered a hypoxic brain injury. Another colleague lost an airway on induction and the gen surgeon cut the neck last year. All good anesthesiologists.

In each of those cases I can chuck some rocks and say they did or didn't do things the way I'd have done them. But there but for the grace of god go I ...

I am less philosophical about it when corners are cut in the name of profit, which is always the case in these office anesthesia deaths. Or when people disable safety equipment (lookin' at all you *****s who put the monitors on CPB mode to permasilence alarms).

I don't know what the CRNA in this case did or didn't do, and I bet I coulda done it better, but I also bet the dentist set that person up for failure with profit-driven compromises on equipment/facility/personnel decisions. So for once I'm not inclined to rag on the CRNA.

Or the CRNA willingly compromised in order to get the work.

The ad I posted for the dental surgery center in Fresno is telling. There’s a reputable pediatric anesthesia group in nearby Madera at Valley Children’s. I wonder why they aren’t working at the dental place.