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Tube or not. Next🙂.78 yo f 50 kg pmh pancreatic duct stricture with previous dilation, htn hld comes in for elective egd eus. Anything you want to know? Plan?
Is that the WHOLE pmhx?78 yo f 50 kg pmh pancreatic duct stricture with previous dilation, htn hld comes in for elective egd eus. Anything you want to know? Plan?
Three minute case my ass. This case would take 1.5 hours at my shop, would also be prone.It’s an EGD, assuming she’s NPO just give your lido/propofol , do the 3 minute case and move on.
Anything you want to know? Plan?
Maybe I can trade you my EUS guy for yours? Pretty please?EGDs can be 3 minutes for a diagnostic scope with a biopsy if they find nothing. But this is a lateral case and usually not more than 30 minutes max. This one ended up just under 30 minutes of procedure time and less than 40 minutes in the OR.
thanks for presenting this interesting case, but personally i prefer when all the details and events are laid out, and then discussion ensues, instead of intermittently revealing pieces of the story. its hard to comment when your not sure which direction the discussion is going to go.. just my 0.02Ha
So I started with a prop drip for "mac" and the egd went okay, didn't see anything. Only issue was that one time the patient's head was a little flexed and she obstructed. Repositioned head and ventilation resumed.
Gastroenterologist couldn't pass the EUS scope. So decided to paralyze with roc and intubate. He brought out the small scope and we passed the tube in fiberoptically. No issues with the vocal cords, trachea and main bronchi looked fine as we got the tube in. EUS finished, no lymph nodes or anything of note.
Turned off gas, gave sugammadex and extubated. Tidal volumes around 200. Took her out to pacu and saw the next patient.
Returned to pacu, sat is 70.
Ha
So I started with a prop drip for "mac" and the egd went okay, didn't see anything. Only issue was that one time the patient's head was a little flexed and she obstructed. Repositioned head and ventilation resumed.
Gastroenterologist couldn't pass the EUS scope. So decided to paralyze with roc and intubate. He brought out the small scope and we passed the tube in fiberoptically. No issues with the vocal cords, trachea and main bronchi looked fine as we got the tube in. EUS finished, no lymph nodes or anything of note.
Turned off gas, gave sugammadex and extubated. Tidal volumes around 200. Took her out to pacu and saw the next patient.
Returned to pacu, sat is 70.
I am trying to gear my cases towards students and residents reading this forum. I don't want to give them the whole thing upfront so that we can at least pretend to think about the preop, intraop and postop. I am sorry that you don't like my presentation style.
The ultrasound scope was getting caught around 15 or so and the gastroenterologist was wondering if there's some aberrant anatomy. He didn't notice anything on the EGD. He wanted to see if there was anything affecting the airway as well so he wanted to take a look and also thought that paralysis would help with passing the scope.
Have you ever perforated the lung during an egd? I've never heard of that happening although I have heard of colonic perfs during lower scopes.
It definitely can be inadequate reversal. I used roc 50 and gave sugammadex 200 maybe 10 minutes later. I didn't check postreversal twitches but I thought that with a good tidal volume patient would be okay.
Every EUS I have ever staffed takes longer than this.This is a 10 minute case in my place unless they find stuff they want to biopsy… then all bets are off. I have never been asked to intubate and paralyze to be able to get the scope down- sounds like a proceduralist that should stay in his or her lane.
Every EUS I have ever staffed takes longer than this.
Never paralyzed just to get the scope down. If anything they complain about the ET tube impeding the scope from passing down.
it does keep them from trying to dilate the vocal cords though.Every EUS I have ever staffed takes longer than this.
Never paralyzed just to get the scope down. If anything they complain about the ET tube impeding the scope from passing down.