Anesthesiologist identified in Joan Rivers GI death

[deleted126335]

Pending legal action is official now (and apparently, there were 3 anesthesiologists involved, in addition to Dr. Cohen and Dr. Korovin)...

"Melissa Rivers, 47, filed a suit in Manhattan Supreme Court against the clinic and the two doctors and three anesthesiologists who treated her 81-year-old mother last August, Joan River's daughter filed a multi million dollar lawsuit Monday against the clinic and the doctors who treated her mother last August, charging that their negligence triggered a coma that ended in her mother's death."

"The lawsuit named the clinic, Yorkville Endoscopy, Frontier Healthcare, the company with partial ownership of the clinic that was responsible for credentialing the doctors, Rivers’ personal physician Gail Korovin and anesthesiologists Renuka Bankulla, Robert Koniuta and Suzanne Scarola as defendants."

"Rivers' only child, Melissa, 47, filed the lawsuit in Manhattan Supreme Court Monday, naming five doctors and the clinic as defendants."

Of note...

1. "Joan Rivers' doctors were so busy taking cell phone pictures of their famous patient that they missed the moment her vital signs plummeted — and they ignored pleas from the anesthesiologist to halt the procedure, according to a multi-million dollar lawsuit filed Monday by the comic’s daughter."

2. "During the procedures, doctors ignored the concerns of the acting anesthesiologist, who urged caution after noticing “incredible edema,” or swelling, in Rivers’ throat.

Anesthesiologist Renuka Bankulla suggested taking an internal picture to gauge how bad the swelling was, the suit said.

You’re being paranoid ... You’re such a curious cat. You always need to see everything, the lead doctor, Lawrence B. Cohen, told her, before proceeding over her objections, the suit said."

3. "Bankulla objected when Korovin entered the room for the procedure, but was overruled by Cohen."

4. As Dr. Korovin was attempting her second procedure..."That’s when Bankulla tried again to intervene — citing Rivers’ badly swollen throat — and was dismissed."

5. "As the team realized the seriousness of the problem, they called a Code Blue — but never administered a muscle relaxant that might have unlocked the muscle in Rivers’ throat, nor did they cut into her windpipe to let air into her body.

Instead, Cohen did frantic chest compressions; Bankulla tried but failed to intubate Rivers, and two other anesthesiologists, Koniuta and Scarola, rushed in to help with the hand pump to push air into her lungs.

They worked for 17 minutes before Bankulla called for a tracheotomy kit — but it was never used.

When Bankulla looked for Korovin, who could have done the emergency tracheotomy, she was nowhere to be found. Rivers’ doctor had left the room, the suit said."

Source: http://www.nydailynews.com/entertai...ssa-files-suit-mother-death-article-1.2092477

These are allegations. Legal complaints are a form of "protected speech" and you can almost always allege almost anything without fear of consequences if your allegations are inaccurate if they are part of a legal complaint.

I am really curious as to how the plaintiffs have gained knowledge as to the conversations in the OR. I wonder if some OR nurses are talking. Maybe an individual defendant(s)? cut a quick quiet deal for full cooperation so the plaintiff can make the case for punitive damages which are a much higher hurdle- This is pure speculation on my part.

Given the notoriety of Joan Rivers and the nature of the complaints (if accurate), - loss of medical license, forfeiture of personal assets (which is very rare) and even criminal charges are not out of the question-

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[Spinach Dip]

3. "Bankulla objected when Korovin entered the room for the procedure, but was overruled by Cohen."

4. As Dr. Korovin was attempting her second procedure..."That’s when Bankulla tried again to intervene — citing Rivers’ badly swollen throat — and was dismissed."

5. .... When Bankulla looked for Korovin, who could have done the emergency tracheotomy, she was nowhere to be found. Rivers’ doctor had left the room, the suit said."

Oh. My. God.

 

[BuzzPhreed]

I would like to know more about Korovin's particular practice.

From what little I (admittedly) know, she appears to be more concerned about "fluff and buff" medicine pampering and catering to celebrities rather than actually taking difficult cases. As evidenced by giving Ariana Grande a B12 shot back stage immediately before she went on Jimmy Fallon to "help her voice" and spraying Nathan Lane's vocal cords with some concoction before he went on stage when he was on Broadway when he was in "The Producers". I'd just like to know if she's actually spending any time in the OR working on real cases instead of requiring potential clientele to pony-up $500 cash for an initial consultation and then referring out the stuff that she doesn't really want to work on.

Seems to be the case. But I could be completely wrong about that.

 

[deleted126335]

Oh. My. God.

Look. At. Her. Butt.

 

[BuzzPhreed]

Look. At. Her. Butt.

You had to go there...

 

[deleted126335]

You had to go there...

Actually I was thinking of

 

[Tee Cell]

This is such an awful situation. At least Bankulla is documented as not agreeing for the ENT to be in the room, not agreeing to the additional procedure, and voiced concern about continuing. It seems like she should have commanded a greater presence in the room and refused to do the case altogether. I can picture the GI doc and ENT completely oblivious to the vitals talking selfies while the sats drop and Bankulla starts to panic. What is amazing to me is that while the -ish was hitting the fan and the airway became compromised the ENT doc LEFT THE ROOM! OMG! Even though Bankulla has some fault, Cohen and Korovin should get the majority of the blame here.

 

[deleted126335]

This is such an awful situation. At least Bankulla is documented as not agreeing for the ENT to be in the room, not agreeing to the additional procedure, and voiced concern about continuing. It seems like she should have commanded a greater presence in the room and refused to do the case altogether. I can picture the GI doc and ENT completely oblivious to the vitals talking selfies while the sats drop and Bankulla starts to panic. What is amazing to me is that while the -ish was hitting the fan and the airway became compromised the ENT doc LEFT THE ROOM! OMG! Even though Bankulla has some fault, Cohen and Korovin should get the majority of the blame here.

You are assuming that the allegations in the complaints are factual. It wouldn't surprise me one bit if the Anesthesiologist/employee/low person on the totem pole cut a deal to hang out the celebrity ENT, Prominent GI Doc/ Medical Director who presumably have deeper pockets. All we have is speech out of the mouth of a lawyer with an agenda. Again pure speculation on my part. If you were the anesthesiologist what would you do after the event? If you were the plaintiff lawyer who would you see as the fattest targets?

 

[Spinach Dip]

Look. At. Her. Butt.

Pro.

How long did it take for that one to roll off your fingertips?

 

[1029384756x]

But she did train at an Ivy League program.

"Bankulla got her MD in 1991 from Gandhi Medical College in Hyderabad, India, state records show. She trained at Flushing Hospital and Beth Israel Medical Center. She no longer works at Yorkville Endoscopy, the clinic said."

????

 

[Tee Cell]

You are assuming that the allegations in the complaints are factual. It wouldn't surprise me one bit if the Anesthesiologist/employee/low person on the totem pole cut a deal to hang out the celebrity ENT, Prominent GI Doc/ Medical Director who presumably have deeper pockets. All we have is speech out of the mouth of a lawyer with an agenda. Again pure speculation on my part. If you were the anesthesiologist what would you do after the event? If you were the plaintiff lawyer who would you see as the fattest targets?

True, I am assuming this is factual information but it does answer some questions like why a surgical airway wasn't performed if an ENT was present in a presumed can't intubate situation. In a room with an ENT and an anesthesiologist the risk of losing an airway should be nil. (Assuming competency). But my assumption is that this is such a strong open and shut case that no one would be able to "cut a deal" with the lawyers.

 

[deleted126335]

Pro.

How long did it take for that one to roll off your fingertips?

Not long at all. My brain stopped developing at age 16.

 

[deleted126335]

I have been called much worse. Frequently.

 

[BLADEMDA]

So 3 Anesthesiologists couldn't intubate Joan Rivers but the EMT did just that upon arrival at the scene? Was that edema really laryngospasm plus edema which resolved once Joan Rivers was no longer able to maintain her vitals/perfusion to the larynx due to hypotension and hypoxia?

 

[deleted171991]

I have been called much worse. Frequently.

I meant: Since you seem to be older than I...

My brain stopped developing at age 16.

 

[Tee Cell]

So 3 Anesthesiologists couldn't intubate Joan Rivers but the EMT did just that upon arrival at the scene? Was that edema really laryngospasm plus edema which resolved once Joan Rivers was no longer able to maintain her vitals/perfusion to the larynx due to hypotension and hypoxia?

Is it verified that EMT intubated her? My assumption is that she was eventually intubated by one of the anesthesiologist maybe coinciding with the arrival of EMT. Maybe by the time the EMT arrived the spasm had abated making it easier to pass the tube? Just speculation. I'm sure it was an edematous blood mess. By that time the damage had already been done.

Also there are a lot of Beth Israel Hospitals. I believe there is one in Queens NY. I don't think she was at Beth Israel Deaconess in Mass which is ivy league.

 

[deleted126335]

50 +.

 

[BLADEMDA]

Is it verified that EMT intubated her? My assumption is that she was eventually intubated by one of the anesthesiologist maybe coinciding with the arrival of EMT. Maybe by the time the EMT arrived the spasm had abated making it easier to pass the tube? Just speculation. I'm sure it was an edematous blood mess. By that time the damage had already been done.

If you have an 80+ year old patient "code" on you the prognosis won't be good regardless if you are a superstar with the Cric kit by your side. The key is adequate BP and VENTILATION in prompt manner to reverse the hypoxia which quickly sets in. The lack of SUX was a major cause of JR's death that day but the biggest single reason she died was Dr. Cohen's arrogance.

Even if you had been in the GI suite that day and rushed in to help the primary anesthesia provider the outcome would likely have been the same (even with your 45 second Cric).

 

[urge]

If you have an 80+ year old patient "code" on you the prognosis won't be good regardless if you are a superstar with the Cric kit by your side. The key is adequate BP and VENTILATION in prompt manner to reverse the hypoxia which quickly sets in. The lack of SUX was a major cause of JR's death that day but the biggest single reason she died was Dr. Cohen's arrogance.

Even if you had been in the GI suite that day and rushed in to help the primary anesthesia provider the outcome would likely have been the same (even with your 45 second Cric).

I'm starting to think they did not have ANY muscle relaxant around.

It sucks for the other 2 anesthesiologists who tried to help and now are involved in this.

 

[Tee Cell]

If you have an 80+ year old patient "code" on you the prognosis won't be good regardless if you are a superstar with the Cric kit by your side. The key is adequate BP and VENTILATION in prompt manner to reverse the hypoxia which quickly sets in. The lack of SUX was a major cause of JR's death that day but the biggest single reason she died was Dr. Cohen's arrogance.

Even if you had been in the GI suite that day and rushed in to help the primary anesthesia provider the outcome would likely have been the same (even with your 45 second Cric).

Agreed. I just find it sleazy that the ENT snuck out the building at least Cohen stuck around to do compressions.

 

[Ignatius J]

Wow. That is truly disturbing if the anesthesiologists' pleas were ignored.

That said, if I start seeing desaturations and arrythmias which surely preceded the code, I am not asking them to stop. I'm telling them. And I'm generally a laid back, passive guy. But the few times I have been in these situations, my adrenaline speaks for me.

 

[IlDestriero]

I won't hesitate to make it clear that bad things are imminent and I'm not waiting for one more look/photo/biopsy, etc., it's time to actively intervene.
I told one new attending if she didn't take the scope out that I would during an EGD in a sick kid who was decompensating.
That got her attention, and the scope out.
It boils down to respect and partnership with the surgeon/proceduralist. If you are a nameless cog in the wheel from the AMC or a servant employee, or prone to dramatics and hand waving and bluster, you're not going to be starting from a good place.

 

[Planktonmd]

If you are a nameless cog in the wheel from the AMC or a servant employee, or prone to dramatics and hand waving and bluster, you're not going to be starting from a good place.

Nice!

 

[BuzzPhreed]

"Bankulla got her MD in 1991 from Gandhi Medical College in Hyderabad, India, state records show. She trained at Flushing Hospital and Beth Israel Medical Center. She no longer works at Yorkville Endoscopy, the clinic said."

????

http://www.bidmc.org/Medical-Educat...in-Medicine/Anesthesia-Residency-Program.aspx

 

[BuzzPhreed]

Actually, according to Doximity, she actually trained at Mt. Sinai Beth Israel in NYC.

https://www.doximity.com/pub/renuka-bankulla-md

So, I stand corrected.

(And for the record, I could care less where someone went to medical school. Where they trained is far more important.)

 

[NoFreeLunch]

Agreed. I just find it sleazy that the ENT snuck out the building at least Cohen stuck around to do compressions.

Well, now there's today's NYT article stating that "Dr. Korovin’s lawyer said that contrary to claims in a malpractice lawsuit filed by Ms. Rivers’s daughter, Melissa, Dr. Korovin had faithfully stood by her patient and was in fact the last doctor remaining in the procedure room, not the first to leave."

Also, according to the article, Dr. Bankulla, the anesthesiologist, was the one who intubated the patient...

"The call to resuscitate Ms. Rivers was made at 9:28 a.m. on Aug. 28, according to the suit. Dr. Bankulla finally succeeded in intubating Ms. Rivers — putting a tube in her windpipe to deliver oxygen — at 9:48, the court papers say."

Source: http://www.nytimes.com/2015/01/29/n...ations-that-she-fled-procedure-room.html?_r=0

Finally, for whatever it may be worth (or not), Dr. Bankulla was apparently targeted in a 2005 malpractice suit for dispensing anesthesia "in an inadequate manner". The patient died and the suit was settled without going to trial.

Source: http://www.nydailynews.com/new-york...previously-sued-malpractice-article-1.2094322

I would still like to know by whom Bankulla was paid. Salaried? Was she Cohen's employee? To me, this is a critical issue.

Toward the end of the 2nd article above, Dr. Bankulla is referred to as a freelance anesthesiologist hired by the Yorkville clinic, which (if true) would lead to the presumption that she was not a full-time (or even part-time), salaried employee of Yorkville Endoscopy.

 

[aneftp]

<inappropriate ad deleted by mod>

That's not the big picture.

The big picture (and I'm shocked the anesthesia community doesn't call these GI centers out on it ).

The big picture is some outpatient GI centers routine do not carry sux. And it's financially motivated cause they don't want to pay for the $3000 or so yearly cost of maintaining MH drugs.

 

[criticalelement]

That's not the big picture.

The big picture (and I'm shocked the anesthesia community doesn't call these GI centers out on it ).

The big picture is some outpatient GI centers routine do not carry sux. And it's financially motivated cause they don't want to pay for the $3000 or so yearly cost of maintaining MH drugs.

agreed

 

[Gasman23]

That's not the big picture.

The big picture (and I'm shocked the anesthesia community doesn't call these GI centers out on it ).

The big picture is some outpatient GI centers routine do not carry sux. And it's financially motivated cause they don't want to pay for the $3000 or so yearly cost of maintaining MH drugs.

Many of these centers will be quick to blame anesthesia in the event of laryngospasm but not mention that they didn't want to pay the cost associated with maintaining sux in their facility.

 

[DrCommonSense]

Many of these centers will be quick to blame anesthesia in the event of laryngospasm but not mention that they didn't want to pay the cost associated with maintaining sux in their facility.

Part of the problem is the physician running the GI center doesn't even believe you need an anesthesiologist there. The anesthesiologist that was there was kind've used as a patsy.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2886410/

 

[deleted171991]

Many of these centers will be quick to blame anesthesia in the event of laryngospasm but not mention that they didn't want to pay the cost associated with maintaining sux in their facility.

Why does that sound similar to what happens after any surgical complication anywhere?

 

[deleted682700]

<inappropriate ad deleted by mod>

Seriously? What's it called, Ancient Anesthesiology?

The maneuver is well-documented online, and most anesthesiologists know it, no need to buy a book for that.
https://en.wikipedia.org/wiki/Laryngospasm_notch

I have used it in the past. Sux is much better. I don't even bother with anything else when I hear stridor.

That works well in kids. But i try it in adults. Succinylcholine is the wonder drug. I always carry it in my pocket. And if i happen to give anesthesia in some shack in new york will smuggle my sux with me. Would have given rocuronium in this case if i had access to it?

 

[IlDestriero]

Do you really think this place has Roc either? If the patient needs paralysis, they need to go to another facility. One could keep a vial of Roc ready to go if it all goes bad, with some reversal and a portable twitch monitor, and deal with the delays and foot stomping by the GI guys afterward. Expect that the day you use it and put the breaks on their cash cow assembly line will be your last there, even though you saved the patient and a lawsuit.


--
Il Destriero

 

[aneftp]

Do you really think this place has Roc either? If the patient needs paralysis, they need to go to another facility. One could keep a vial of Roc ready to go if it all goes bad, with some reversal and a portable twitch monitor, and deal with the delays and foot stomping by the GI guys afterward. Expect that the day you use it and put the breaks on their cash cow assembly line will be your last there, even though you saved the patient and a lawsuit.


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Il Destriero

Pretty sure the place had roc.

I covered a GI only center 5 years ago. They didn't have sux. I had a vial of sux (from hospital) in drawer with me all the time. Never had to use it.

They had roc in refrigerator. It was def a cost issue. Roc is dirt cheap.

 

[VCD/Laryngospasm lady]

<quoted post with inappropriate ad deleted by mod>

Seriously? What's it called, Ancient Anesthesiology?

The maneuver is well-documented online, and most anesthesiologists know it, no need to buy a book for that.
https://en.wikipedia.org/wiki/Laryngospasm_notch

I have used it in the past. Sux is much better. I don't even bother with anything else when I hear stridor.

----------------------------
Hi FFP,

You learned how to do the Larson Maneuver from Wikipedia? Good for you!

You might find it interesting to speak with Dr. C. P. Larson himself, to see if he has any free information that is in addition to what you found in Wikipedia.

Here is Dr. C. P. (Charles Philip) Larson's email: [email protected]

I would share his phone number with you, but it would probably be more politically correct for you to ask him yourself for his phone number.

I was accused of "advertising" Dr. Larson's book, and that is not correct. Yes, I did pay a few dollars for Chapter 5 in his new book, since it was about laryngospasms, including citing the sad case of Joan Rivers.

Sincerely, VCD/laryngospasm lady

 

[deleted171991]

----------------------------
Hi FFP,

You learned how to do the Larson Maneuver from Wikipedia? Good for you!

You might find it interesting to speak with Dr. C. P. Larson himself, to see if he has any free information that is in addition to what you found in Wikipedia.

Here is Dr. C. P. (Charles Philip) Larson's email: [email protected]

I would share his phone number with you, but it would probably be more politically correct for you to ask him yourself for his phone number.

I was accused of "advertising" Dr. Larson's book, and that is not correct. Yes, I did pay a few dollars for Chapter 5 in his new book, since it was about laryngospasms, including citing the sad case of Joan Rivers.

Sincerely, VCD/laryngospasm lady

While I have all due respect for Dr. Larson's maneuver, it's no panacea for treating laryngospasm. The name for the latter is succinylcholine.

And, btw, I learned the Larson maneuver (and many others) during my training. It's not like it's some state secret. I actually saw it in action, including when it didn't work.

Now can you stop educating us, please?

 

[IlDestriero]

If you're an anesthesiologist and can't manage laryngospasm, it's time to hang it up. That's anesthesia 101, chapter 1.
Regards,
The no laryngospasm dude


--
Il Destriero

 

[deleted171991]

If you're an anesthesiologist and can't manage laryngospasm, it's time to hang it up. That's anesthesia 101, chapter 1.
Regards,
The no laryngospasm dude


--
Il Destriero

@VCD/Laryngospasm lady, please meet the Emperor of all laryngospasms: the pediatric anesthesiologist. For every one of my posts, he has probably treated or actively prevented a laryngospasm.

 

[pgg]

I was accused of "advertising" Dr. Larson's book, and that is not correct.

Whatever your purpose, be aware that this forum is for physicians and physicians-in-training. Readers from outside those groups are generally welcome, but posts from them are rarely appropriate. We are not here to educate the public or give medical advice.


Registering on a professional forum for the purpose of posting info from a book you read is weird. Posting that author's contact information is bizarre. Presuming to teach a bunch of doctors something fundamental to their profession is presumptuous. Please stop.

 

[VCD/Laryngospasm lady]

Whatever your purpose, be aware that this forum is for physicians and physicians-in-training. Readers from outside those groups are generally welcome, but posts from them are rarely appropriate. We are not here to educate the public or give medical advice.


Registering on a professional forum for the purpose of posting info from a book you read is weird. Posting that author's contact information is bizarre. Presuming to teach a bunch of doctors something fundamental to their profession is presumptuous. Please stop.

 

[VCD/Laryngospasm lady]

Hi PGG,

I'm sorry that you consider it "weird" that anyone could post "Larson maneuver" info from the new book by innovative anesthesiologist, Dr. C. P. Larson Jr., M.D. I'm also sorry that you think all physicians and physicians-in-training here, would not be interested in learning something new about anesthesiology. From reading MANY open minded comments here, I learned that some physicians here, DO like the results of their using the Larson Maneuver, to PREVENT and TREAT LARYNGOSPASMS, and, as I understand it, that's why Dr. Larson wrote his new book--to SHARE information with his fellow physicians regarding anesthesiology practices!

My recommending that physicians consider learning new information (that may be "new" to them) about how to deal with the potentially fatal problem of laryngospasms, using the Larson Maneuver, should not be seen by you, as "presumptuous". I'm truly sorry that you were so bothered by that, that you felt the need to write, "Please stop".

Sincerely, VCD/laryngospasm lady

 

[Robotic Wis-Hipple]

This is why any skilled anesthesiologist should be able to perform a completely drug free anesthetic:

I myself start with the Vulcan Death/Sleep grip (narrow therapeutic window here guys) and then emerge with its antidote the Vulcan Wake Grip (aka the Larson's Maneuver).

Of note, the Wake Grip is also quite effective when you took the Big Pharma route and need to show your attending; "hey look they do respond to painful stimuli".

 

[IlDestriero]

Hi PGG,

I'm sorry that you consider it "weird" that anyone could post "Larson maneuver" info from the new book by innovative anesthesiologist, Dr. C. P. Larson Jr., M.D. I'm also sorry that you think all physicians and physicians-in-training here, would not be interested in learning something new about anesthesiology. From reading MANY open minded comments here, I learned that some physicians here, DO like the results of their using the Larson Maneuver, to PREVENT and TREAT LARYNGOSPASMS, and, as I understand it, that's why Dr. Larson wrote his new book--to SHARE information with his fellow physicians regarding anesthesiology practices!

My recommending that physicians consider learning new information (that may be "new" to them) about how to deal with the potentially fatal problem of laryngospasms, using the Larson Maneuver, should not be seen by you, as "presumptuous". I'm truly sorry that you were so bothered by that, that you felt the need to write, "Please stop".

Sincerely, VCD/laryngospasm lady

The problem is that it is not even remotely the new information that you think it is.
So, please stop.
Regards,
The Emperor of Laryngospasm
PS If you're going to "teach" us all something, post some YouTube videos on emergent cricothyrotomy, jet ventilation, etc. or fund some workshops at big anesthesia meetings. That's the real end of the line, and unless you've practiced in the .mil or at a big trauma center, people don't know how to do that very well if at all. All roads lead to the surgical airway, and I could have saved Joan and her skinny long neck with the pocket knife on my keys and a 5.0 ETT.
People wait way, way too long ****ing around with an impossible airway in a critical situation. Taking 20 min to secure an airway when you're not ventilating at all guarantees that you're resuscitating a potted plant.

--
Il Destriero

 

[IlDestriero]

By the way, it is a little known fact that Darth Vader's chokehold was really just inducing laryngospasm with the force. If only the victim knew the Larson maneuver, he could have saved himself.


--
Il Destriero

 

[sigrhoillusion]

I always go for the People's Elbow for my induction. Sometimes you have to move the anesthesia machine out of the way to get a better running start though. Fastest way to Stage 3 of anesthesia known to man!

 

[criticalelement]

Oh, I found Joan River's ANesthesiologist.

 

[WholeLottaGame7]

I love posters like that. Keeps the forum entertaining and builds morale when we can all be on one side for a change.

I hate to break it to whoever is vouching for "innovative anesthesiologist, Dr. C. P. Larson Jr., M.D," but the Larson maneuver is what you do for ****s and giggles in the 5 seconds while the resident/CRNA grabs the sux.

 

[WholeLottaGame7]

I worked with Dr Larson. He had several questionable techniques that ALWAYS worked. Except for the few times they didnt.

Was one of them wearing "Sex Panther" cologne?

 

[chocomorsel]

I love posters like that. Keeps the forum entertaining and builds morale when we can all be on one side for a change.

I hate to break it to whoever is vouching for "innovative anesthesiologist, Dr. C. P. Larson Jr., M.D," but the Larson maneuver is what you do for ****s and giggles in the 5 seconds while the resident/CRNA grabs the sux.

Assuming one works with a resident or CRNA. I just reach for it immediately since I work alone and the nurses are sometimes clueless.

 

[deleted162650]

How often are you guys seeing L-spasm that necessitates sux?? Granted I haven't been doing this that long (out of training for 3.5 years) but I haven't had 1 spasm that had me reaching for sux. Occasionally a little squeckiness that needs a little PP and Larson but that's it.

Disclaimer: I don't do a ton of peds (maybe 10-15% of my practice is healthy peds), but I always do have a pre-drawn dose appropriate sux stick at the ready for those little spasm monsters.