Surprise! Stories of went better than expected or things were worse than billed.

[Robotic Wis-Hipple]

I’ve had a rash of cases personally lately where I’ve thought to myself; “wow, that went better than I thought it would” or “Oof that was definitely underbilled”. Not sure if that says anything about me or not….

So I thought this could be a storyboard of those cases. To help show ourselves and residents that things aren’t always as they seem.

Case: Young decently healthy patient, normal-ish size. Known myxoma. Recent TTE read as ~2cm. For excision.

Residents/Fellows: think about possible induction/management pitfalls.

Surprise!

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[Hork Bajir]

I really hope this was a case where things went better than expected, and not worse. Because if it’s the latter, I can see where this is going, and I’m already cringing (not much you can do from the head of the bed once you’re down that path…)

 

[coffeebythelake]

I’ve had a rash of cases personally lately where I’ve thought to myself; “wow, that went better than I thought it would” or “Oof that was definitely underbilled”. Not sure if that says anything about me or not….

So I thought this could be a storyboard of those cases. To help show ourselves and residents that things aren’t always as they seem.

Case: Young decently healthy patient, normal-ish size. Known myxoma. Recent TTE read as ~2cm. For excision.

Residents/Fellows: think about possible induction/management pitfalls.

Surprise!

Wow that is impressive

 

[Robotic Wis-Hipple]

I really hope this was a case where things went better than expected, and not worse. Because if it’s the latter, I can see where this is going, and I’m already cringing (not much you can do from the head of the bed once you’re down that path…)

Well, in this case I knew I was going after a myxoma (though imagine if you didn’t?). Pt absolutely tried to crump with/after induction. After fighting that off I eventually dropped the TEE and saw that monstrosity which is where I thought “yikes, they undersold that one didn’t they”.

This case was awhile ago, so I don’t know my exact induction doses or approximate HR/BP pre induction etc. But in the end, the surgery and patient did well and there wasn’t any particular issues after attempted crash and my recognition of just how potentially occlusive it was.



I’m sure all of us have stories or findings similar to this. Let’s hear em.

 

[Iso4ane]

Well, in this case I knew I was going after a myxoma (though imagine if you didn’t?). Pt absolutely tried to crump with/after induction. After fighting that off I eventually dropped the TEE and saw that monstrosity which is where I thought “yikes, they undersold that one didn’t they”.

This case was awhile ago, so I don’t know my exact induction doses or approximate HR/BP pre induction etc. But in the end, the surgery and patient did well and there wasn’t any particular issues after attempted crash and my recognition of just how potentially occlusive it was.



I’m sure all of us have stories or findings similar to this. Let’s hear em.

I fine that cardiologist tend to undersell their TTE findings. Granted I understand that general anesthesia can change the loading conditions, but still.

 

[ISoNitrous]

I had a similar one where the cardiologists read the TTE as “small atrial myxoma causing pseudo-MS physiology.” I was preparing for a ditzel sometimes getting near the mitral valve.

Coded on induction - but nothing a little epi couldn’t solve. The RNFA, without saying anything, just gave some compressions, and then walked back over to put the foley in as if nothing had happened.

I totally agree that the cardiologists undercall it all. I think every RV on a TTE is read as normal.

 

[Robotic Wis-Hipple]

I had a similar one where the cardiologists read the TTE as “small atrial myxoma causing pseudo-MS physiology.” I was preparing for a ditzel sometimes getting near the mitral valve.

Coded on induction - but nothing a little epi couldn’t solve. The RNFA, without saying anything, just gave some compressions, and then walked back over to put the foley in as if nothing had happened.

I totally agree that the cardiologists undercall it all. I think every RV on a TTE is read as normal. View attachment 350108

Yup, very similar. I think every myxoma I’ve ever done was larger than the CT w/u expected.

Sort of rams home the points of “trust but verify” and treat it like it’s worse than it is, which is always my personal policy with AS, MS, RV dysfunction, and pHTN especially.

 

[nimbus]

This was posted on Twitter a few weeks ago. Thought it was worth a screenshot.