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I just change it to the appropriate procedure. Give them what they want,
not what they say they want.
not what they say they want.
To be fair from this forum it sounds like ortho groups are getting to be more equitable with pain docs than my own experience working for one 15 years ago.I've had the opposite experience.
They have. I am currently in a pain only group, but just signed with a neurosurgical group. Best contract I have ever been offered and they were very receptive to why I will or won’t do certain things.To be fair from this forum it sounds like ortho groups are getting to be more equitable with pain docs than my own experience working for one 15 years ago.
"patient's moving!"I just change it to the appropriate procedure. Give them what they want,
not what they say they want.
In an ortho group, you won't take call and they don't want to be called at 2AM over MS Contin Rx. Also, no one wants those pts in their waiting room.
How does that work exactly?Plenty of ortho groups where the pain docs take call for them.
How does that work exactly?
I hear you. I think it is overblown in some cases, though esp in a city or place with other specialities.No calls as there are no pain emergencies except infected SCS implant, etc-
Nothing emergent could happen after an epidural injection?No calls as there are no pain emergencies except infected SCS implant, etc-
Nothing an anesthesiologist or physiatrist can fix besides a PDPH.Nothing emergent could happen after an epidural injection?
Can minimize it by not putting local in the therapeutic solution. Incidence of hematoma/infection/permanent nerve damage if proper precautions are taken are extremely low.Nothing emergent could happen after an epidural injection?
Of course… I’m not talking about needing to physically come in…. but if your patients have an after-hours issue (real or bs) they are told what? Go to ED?Can minimize it by not putting local in the therapeutic solution. Incidence of hematoma/infection/permanent nerve damage if proper precautions are taken are extremely low.
Of course… I’m not talking about needing to physically come in…. but if your patients have an after-hours issue (real or bs) they are told what? Go to ED?
Nothing emergent could happen after an epidural injection?
Yeah. Plenty of them in philly.Of course… I’m not talking about needing to physically come in…. but if your patients have an after-hours issue (real or bs) they are told what? Go to ED?
Q1-2 months… meh…Ye
Yeah. Plenty of them in philly.
Think you need to have a talk with the gray hairs upstairs..... no need for you to have your phone on after you leave work. Or god forbid... a beeper...Thats burnout material.
One night every 2 months? Or 1 week?Q1-2 months… meh…
1 night q 1-2 months. Outpatients only. Ortho handles all ER/inpatient call stuff.One night every 2 months? Or 1 week?
And are the ortho guys covering your call? Taking calls on your patients?
Just saw a patient last week, referred to me from neurosurgery for discussion of injection options. Had a CESI, developed an epidural hematoma requiring emergent decompression. Good neurologic outcome from the decompression but persistent neck pain.Yet to see an emergent post ESI, RFA or SCS complication.
Just saw a patient last week, referred to me from neurosurgery for discussion of injection options. Had a CESI, developed an epidural hematoma requiring emergent decompression. Good neurologic outcome from the decompression but persistent neck pain.
She had a mild thrombocytopenia, around 100k, nothing I would have worried about, but then also went on to tell me she had cirrhosis due to NASH. Also was told that during surgery she bled a lot. I sent her to heme.
Extremely unlikely using the 25g technique.Just saw a patient last week, referred to me from neurosurgery for discussion of injection options. Had a CESI, developed an epidural hematoma requiring emergent decompression. Good neurologic outcome from the decompression but persistent neck pain.
She had a mild thrombocytopenia, around 100k, nothing I would have worried about, but then also went on to tell me she had cirrhosis due to NASH. Also was told that during surgery she bled a lot. I sent her to heme.
No, I didn’t have the procedure note for this patient but have seen some procedure notes from him in the past using a catheter for CESI, so I’m guessing he does an 18g.Any idea needle gauge size?
18g Tuohy and a catheter...This is the type hardware you'd use that would increase the likelihood of unnecessary complications.No, I didn’t have the procedure note for this patient but have seen some procedure notes from him in the past using a catheter for CESI, so I’m guessing he does an 18g.
Do you do cervical epidural in office or Asc, with or without anesthesia, cardiac monitoring or no? Post-procedure lying flat or no? Thanks.18g Tuohy and a catheter...This is the type hardware you'd use that would increase the likelihood of unnecessary complications.
Use a 25g and never receive a phone call.
Clinic procedure room with no monitoring. I give Valium 2mg x 2 tabs. Take 30 min prior.Do you do cervical epidural in office or Asc, with or without anesthesia, cardiac monitoring or no? Post-procedure lying flat or no? Thanks.
Thanks, I wonder if this applies to most providers in this forum, the group I am in, makes a big fuss about cervical epidural, Mac monitoring with anesthesia, lying flat for 30 Minutes post-injection, I personally never heard it, it is an overkill, i heard there was some serious complications happened before.Clinic procedure room with no monitoring. I give Valium 2mg x 2 tabs. Take 30 min prior.
Me, C-Arm, XRAY tech and an MA.
When the needle is removed, you get up and walk to the chair you were sitting in before the procedure, we check your BP one more time and you go home.
Laying flat?
These procedures should be minimally intrusive overall. It's just a shot. You do not need to do anything extra and turn this into something.
No monitoring. No IVs. No laying flat. Get your shot and leave my facility. You don't need anything. Go home and live your life.
It's just a shot.Thanks, I wonder if this applies to most providers in this forum, the group I am in, makes a big fuss about cervical epidural, Mac monitoring with anesthesia, lying flat for 30 Minutes post-injection, I personally never heard it, it is an overkill, i heard there was some serious complications happened before.
Seems overkillThanks, I wonder if this applies to most providers in this forum, the group I am in, makes a big fuss about cervical epidural, Mac monitoring with anesthesia, lying flat for 30 Minutes post-injection, I personally never heard it, it is an overkill, i heard there was some serious complications happened before.
I'm coming to see you under private insurance good sir.
Great! I will get you set up with our in house chiropractor also.I'm coming to see you under private insurance good sir.
It would only be a failure for all parties involved if you saw them under work compI'm coming to see you under private insurance good sir.
Edit - Abysmal failure...I meant to write personal injury...
whoa, thats way overkill, and adds cost to the patientThanks, I wonder if this applies to most providers in this forum, the group I am in, makes a big fuss about cervical epidural, Mac monitoring with anesthesia, lying flat for 30 Minutes post-injection, I personally never heard it, it is an overkill, i heard there was some serious complications happened before.
I was able to take SIS course on cervical TFESI.
Did 2 or 3 in practice
Does anyone do this to help predict surgical level in practice and what’s their protocol. What is Amt numbing used?
Please don’t send furman paper on how it’s not selective, etc or how one should not do it.
SMH. ok.There are multiple renowned SIS faculty that utilize this approach for surgical level prediction with benefit. I think it’s a tool. Don’t want to state name here on forum.
If I can help reduce a 3 level fusion to 2 level fusion, may be worth it. Helps some surgeon with planning at times when ambiguity arises. Adds some info one way or another.
EMG/NCS not specific either, but adds info one way or another at times
Anyone on forum who does this in practice?
There are multiple renowned SIS faculty that utilize this approach for surgical level prediction with benefit. I think it’s a tool. Don’t want to state name here on forum.
If I can help reduce a 3 level fusion to 2 level fusion, may be worth it. Helps some surgeon with planning at times when ambiguity arises. Adds some info one way or another.
EMG/NCS not specific either, but adds info one way or another at times
Anyone on forum who does this in practice?
What's the injectate volume/concentration. Do you start with lidocaine/numbing medication?Taus and I both were trained on Ctfesi in fellowship. I wouldn’t feel comfortable only after a course.
Both of us will do cervical SNRB by touching bone at posterior foramen and then directing the needle anterior to the nerve root. Safer than entering the foramen for a full CTFESI.
I still don’t advise that you do cervical snrb but if you do, this technique is safer.
What's the injectate volume/concentration. Do you start with lidocaine/numbing medication?
Also, how does this help surgeon?
Question posed was is this her shoulder causing pain or coming from neck at C4-C5 where there was severe narrowing - not sure if injection would help answer that?