- Joined
- Dec 17, 2003
- Messages
- 5,886
- Reaction score
- 22
Here is the clinical situation I was in the other day....see what everyone thinks.
An experienced crna is in the OR with 2 experienced surgeons doing a lap nissen what is quite challenging. Patient is a 60 year old with htn and reflux....otherwise healthy.
This is not my room, the anesthesiologist is a LT that both the crna and the surgeons did not trust, so they decide to call me into the room.
On coming into the OR, I note that the pulse ox reads 83% to 86% with a good wave form. The hr is 80 bpm and bp is 130/80.
I'm told by the surgeon that they think they may have entered the chest, and the crna says there is decreased breath sounds on the left.
My answer was, "go ahead and put in a chest tube on the left"
The surgeon asks me to please listen to the chest before he does that. My answer was decreased breath sounds doesn't necessarily mean a pneumo...other things like mucus plugs, lobar collapse, etc. can cause decreased breath sounds, and presence of breath sounds does not rule out pneumo either especially in this clinical situation.
I wasn't too concerned with a sat of mid 80's with good hemodynamics, so I told the surgeon that if he really wanted a diagnosis prior to putting in a chest tube, then we need to fluoro the chest.
He said get the fluoro in....then in the middle of it he changed his mind, and put in the chest tube.
There was no gush of air, but there was space in the pleura, and the sats took 15 more minutes to return to 95% on 100% fio2.
So what does everyone think of the stethescope in the OR....I know what they teach you, but I've found that the stethescope may help, but definitly not all the time.
An experienced crna is in the OR with 2 experienced surgeons doing a lap nissen what is quite challenging. Patient is a 60 year old with htn and reflux....otherwise healthy.
This is not my room, the anesthesiologist is a LT that both the crna and the surgeons did not trust, so they decide to call me into the room.
On coming into the OR, I note that the pulse ox reads 83% to 86% with a good wave form. The hr is 80 bpm and bp is 130/80.
I'm told by the surgeon that they think they may have entered the chest, and the crna says there is decreased breath sounds on the left.
My answer was, "go ahead and put in a chest tube on the left"
The surgeon asks me to please listen to the chest before he does that. My answer was decreased breath sounds doesn't necessarily mean a pneumo...other things like mucus plugs, lobar collapse, etc. can cause decreased breath sounds, and presence of breath sounds does not rule out pneumo either especially in this clinical situation.
I wasn't too concerned with a sat of mid 80's with good hemodynamics, so I told the surgeon that if he really wanted a diagnosis prior to putting in a chest tube, then we need to fluoro the chest.
He said get the fluoro in....then in the middle of it he changed his mind, and put in the chest tube.
There was no gush of air, but there was space in the pleura, and the sats took 15 more minutes to return to 95% on 100% fio2.
So what does everyone think of the stethescope in the OR....I know what they teach you, but I've found that the stethescope may help, but definitly not all the time.