Anesthesiologist on KevinMD today

[BrakngLyv]

http://www.kevinmd.com/blog/2013/01/cancelling-surgery-show.html

Thoughts? Comments?

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[pgg]

So, she witnesses a drug reaction leading to immediate dyspnea, yet she thinks asthma not anaphylaxis, and her immediate treatment involves steroids but not epi? Wouldn't have been my approach.

A little too much woe-is-me drama for my taste too.

I am dancing on a stage of fire, where the critics are relentless. One misstep, and I will be crucified. It was not my choice to be here. I never wished to perform.

I should have kept dancing.

The show must go on – at any cost.

 

[Arch Guillotti]

Good grief. She started a thread on sermo a while back just to promote herself and a lot of folks on there had some really nice things to say. Turns out she lifted those comments without permission and posted them elsewhere.

 

[Colbare]

She does make it sound really dramatic. That kind of drug reaction can't be super rare. Do attendings normally still find themselves in situations like this? I would think they would've encountered something like this in residency and know how to handle it more confidently.

 

[Planktonmd]

Too much drama!
Here is how it really went in my opinion:
She starts the antibiotic and she sees redness over the vein so she starts panicking and starts repeatedly asking the patient if she is having trouble breathing and if she is OK.
This anxious behavior is usually contagious especially when the patient is another nervous woman, and sure enough the patient responds to the anesthesiologist's hysteria by starting her own hysterical reaction, hyperventilating, and feeling that she can't breath, although not wheezing and no change in her SPO2.
At this point both the lady anesthesiologist and her patient are in fully blown panic attack.
This is not an uncommon situation unfortunately in our business.

 

[Colbare]

Just curious would this normally have been a reason to cancel surgery? Or since she was clearly getting O2 just fine would things have moved along if everyone had just remained mentally calm?

 

[pgg]

Just curious would this normally have been a reason to cancel surgery? Or since she was clearly getting O2 just fine would things have moved along if everyone had just remained mentally calm?

Depends. This was all prior to induction, so you're not committed to any path. Just a rash from the abx, proceed. Anaphylaxis, it'd be hard to defend a bad outcome if you went right ahead with an elective case.

Hard to tell from the actual article (80% creative writing, 20% medicine) what was really going on.

 

[Noegrus]

Too much drama!
Here is how it really went in my opinion:
She starts the antibiotic and she sees redness over the vein so she starts panicking and starts repeatedly asking the patient if she is having trouble breathing and if she is OK.
This anxious behavior is usually contagious especially when the patient is another nervous woman, and sure enough the patient responds to the anesthesiologist's hysteria by starting her own hysterical reaction, hyperventilating, and feeling that she can't breath, although not wheezing and no change in her SPO2.
At this point both the lady anesthesiologist and her patient are in fully blown panic attack.
This is not an uncommon situation unfortunately in our business.

ROFL @ the description

 

[Gern Blansten]

I knew one of those types once. It was pretty sad.

 

[aneftp]

Thoughts
1. Some anesthesiologists tend to me show more panic than others in times of crisis.
A. It's ok to show concern. But don't let the patient or other staff see it. As the anesthesiologist you gotta be under control.

2. If you gotta cancel a case (antibiotic reaction, failed airway or whatever). Do it and don't be wishy watchy. Again. You gotta be firm. Tell staff these are elective procedures. The goal is to make sure the patient leaves the same as they came in health wise. Of course you can't be canceling cases left and right all the time.

Agree on tremendous pressure in private practice about canceling cases. Hate to sound sexist. But women anesthesiologists sometimes do not command the same level of authority when dealing with some male surgeons. Unless the surgeons know them really well. Both my sisters are anesthesiologists and had issues very early in their careers. Not getting the same support from staff for canceling elective cases as their male counterparts.

 

[yappy]

Got to agree. I've always thought of doctoring and other executive-type-fields lending them selves to the male disposition better anyways. I work with a lot of nurses who are in an almost constant state of panic - I wonder how much of that behavior is common to female physicians too. What's the answer to the problem, though? Something like 50% of medical classes are filled with female students - the sit isn't getting any better with time.

Thoughts
1. Some anesthesiologists tend to me show more panic than others in times of crisis.
A. It's ok to show concern. But don't let the patient or other staff see it. As the anesthesiologist you gotta be under control.

2. If you gotta cancel a case (antibiotic reaction, failed airway or whatever). Do it and don't be wishy watchy. Again. You gotta be firm. Tell staff these are elective procedures. The goal is to make sure the patient leaves the same as they came in health wise. Of course you can't be canceling cases left and right all the time.

Agree on tremendous pressure in private practice about canceling cases. Hate to sound sexist. But women anesthesiologists sometimes do not command the same level of authority when dealing with some male surgeons. Unless the surgeons know them really well. Both my sisters are anesthesiologists and had issues very early in their careers. Not getting the same support from staff for canceling elective cases as their male counterparts.

 

[Noegrus]

Hey, shush. There is a perpetual need for damsels in distress.

 

[urge]

Just curious would this normally have been a reason to cancel surgery? Or since she was clearly getting O2 just fine would things have moved along if everyone had just remained mentally calm?

She has PTSD (my diagnosis). Apparently went through very nasty lawsuit.

Scrub tech with hep c at her hospital was injecting fentanyl and refilling syringes with saline. One of her pts must have gotten infected.

Once burned, twice shy.

Wrote a novel about it.

Wrote a second novel where a bitter vigilante anesthesiologists tortures the scum of the world by letting them be awake during surgery (haven't read it). She must be a cool lady.

 

[Bertelman]

Got to agree. I've always thought of doctoring and other executive-type-fields lending them selves to the male disposition better anyways. I work with a lot of nurses who are in an almost constant state of panic - I wonder how much of that behavior is common to female physicians too. What's the answer to the problem, though? Something like 50% of medical classes are filled with female students - the sit isn't getting any better with time.

It will self-correct. More female surgeons, so you will be adjusting as much as they will.

 

[gasattack3]

Too much drama!
Here is how it really went in my opinion:
She starts the antibiotic and she sees redness over the vein so she starts panicking and starts repeatedly asking the patient if she is having trouble breathing and if she is OK.
This anxious behavior is usually contagious especially when the patient is another nervous woman, and sure enough the patient responds to the anesthesiologist's hysteria by starting her own hysterical reaction, hyperventilating, and feeling that she can't breath, although not wheezing and no change in her SPO2.
At this point both the lady anesthesiologist and her patient are in fully blown panic attack.
This is not an uncommon situation unfortunately in our business.

Oh boy......

 

[gasattack3]

It will self-correct. More female surgeons, so you will be adjusting as much as they will.

I was astonished how many females in my med school class went into GEN surg. Crazy.

That being said we have some fantastic female anesthesiologists where I come from. To the extent that I'm requesting one for a procedure my dad will be having soon. Both I consider myself lucky to call mentors. Seriously awesome MD's.

I think it comes down to personal disposition rather than sex IMHO, at least as far as keeping calm under duress is concerned. Our biggest spaz is a dude.

As for the respect thing, yeah, I do think the ladies need to work a little harder especially when dealing with some foreign surgeons from more paternalistic cultures. I've seen that over and over again.

 

[Ronin786]

She has PTSD (my diagnosis). Apparently went through very nasty lawsuit.

Scrub tech with hep c at her hospital was injecting fentanyl and refilling syringes with saline. One of her pts must have gotten infected.

Once burned, twice shy.

Wrote a novel about it.

Wrote a second novel where a bitter vigilante anesthesiologists tortures the scum of the world by letting them be awake during surgery (haven't read it). She must be a cool lady.

If anybody is interested:

http://www.amazon.com/Its-Nothing-P...qid=1359601359&sr=8-1&keywords=kate+o'reilley

And this is the synopsis for the 2nd book:

My recently completed second novel, In Good Hands, also chronicles the plight of a female anesthesiologist, but the setting is much different. Dr. Amanda McGowen is beautiful, smart, and talented. She's blessed with two lovely children, and an incredibly handsome and devoted husband. Life for Dr. McGowen should be perfect, but it's not. After being brutally attacked in the hospital parking lot following an overnight shift, she begins to seek revenge. Working in a county hospital, there is no shortage of deserving subjects. Criminals and lowlifes are the mainstay of her patient population. Patient by patient, case by case, she perfects her craft. She becomes a master of allowing patients to remain aware during their surgeries -- paralyzed, but awake. In Good Hands is a riveting medical tale that will leave you dreading your next surgical procedure.

To be honest, I wouldn't mind reading that 2nd one.

 

[yappy]

I didn't think about that... you're right.

It will self-correct. More female surgeons, so you will be adjusting as much as they will.

 

[Random Anesthesiologist]

I gotta say, doing my electives in a male-dominated field (anesthesia) working with men in a male-dominated field in the OR (surgery), I've come across some real prima donnas with a Y chromosome.

But I do love any and all inappropriate jokes. Some women say sexual harrassment, I say dark humor I just give it right back.

 

[KLPM]

If anybody is interested:

http://www.amazon.com/Its-Nothing-P...qid=1359601359&sr=8-1&keywords=kate+o'reilley

Oh wow ....... We had a similar incident here a few years ago regarding the spread of Hep C. Except it wasn't someone stealing narcotics it was just a new nursing graduate who apparently did not have a clue that you were meant to change needles for every new patient.

Also I might consider reading the second book as well. Although I have to say the description sounds a tad pretentious and too good to be true.

 

[Silent Cool]

Oh wow ....... We had a similar incident here a few years ago regarding the spread of Hep C. Except it wasn't someone stealing narcotics it was just a new nursing graduate who apparently did not have a clue that you were meant to change needles for every new patient.

Also I might consider reading the second book as well. Although I have to say the description sounds a tad pretentious and too good to be true.

Whaaaaat....please tell me you are kidding...

 

[KLPM]

Whaaaaat....please tell me you are kidding...

I wish I was but no. It was at a private general practice clinic in a rural region if I recall correctly. But apparently all the patients had to be called back to get tested.

 

[pgg]

Whaaaaat....please tell me you are kidding...

Those people are out there.

You haven't known despair until you've run into an OR to help with a code, see chest compressions in progress, and have to turn the sevo vaporizor off from 8%.

 

[KLPM]

When I had my anaesthesia rotation everyone enjoyed sharing horror stories from their earlier days. The one that made the greatest impression on me was the following:

The patient was a 20 something pregnant Asian woman (can't speak English) who married came to the country after marrying her Caucasian husband.

Pregnancy was uneventful until the day of her emergency C-section (can't remember the exact indication, something about pre-eclampsia). When the spinal was being prepared (upright position) the husband suddenly has an expression of horror. Anaesthetist decided to have a look at the mother. Foam starts coming out of her mouth and shortly goes into cardiopulmonary arrest (all that has been done so far was the skin prepped for the spinal). Patient tubed and baby removed. At this point the mother was pretty much presumed dead. As she was wheeled out of the OR, the woman wakes up with the ETT down her airway.

Once the tube was out they tried to communicate with her. When the interpreter came they realised she was blind (she had perfect vision prior to surgery). Admitted to ICU and slowly recovered her vision over the next few days. Discharged as good as new. No idea what happened.

 

[Planktonmd]

Those people are out there.

You haven't known despair until you've run into an OR to help with a code, see chest compressions in progress, and have to turn the sevo vaporizor off from 8%.

Been there!

 

[Planktonmd]

When I had my anaesthesia rotation everyone enjoyed sharing horror stories from their earlier days. The one that made the greatest impression on me was the following:

The patient was a 20 something pregnant Asian woman (can't speak English) who married came to the country after marrying her Caucasian husband.

Pregnancy was uneventful until the day of her emergency C-section (can't remember the exact indication, something about pre-eclampsia). When the spinal was being prepared (upright position) the husband suddenly has an expression of horror. Anaesthetist decided to have a look at the mother. Foam starts coming out of her mouth and shortly goes into cardiopulmonary arrest (all that has been done so far was the skin prepped for the spinal). Patient tubed and baby removed. At this point the mother was pretty much presumed dead. As she was wheeled out of the OR, the woman wakes up with the ETT down her airway.

Once the tube was out they tried to communicate with her. When the interpreter came they realised she was blind (she had perfect vision prior to surgery). Admitted to ICU and slowly recovered her vision over the next few days. Discharged as good as new. No idea what happened.

 

[Gern Blansten]

When I had my anaesthesia rotation everyone enjoyed sharing horror stories from their earlier days. The one that made the greatest impression on me was the following:

The patient was a 20 something pregnant Asian woman (can't speak English) who married came to the country after marrying her Caucasian husband.

Pregnancy was uneventful until the day of her emergency C-section (can't remember the exact indication, something about pre-eclampsia). When the spinal was being prepared (upright position) the husband suddenly has an expression of horror. Anaesthetist decided to have a look at the mother. Foam starts coming out of her mouth and shortly goes into cardiopulmonary arrest (all that has been done so far was the skin prepped for the spinal). Patient tubed and baby removed. At this point the mother was pretty much presumed dead. As she was wheeled out of the OR, the woman wakes up with the ETT down her airway.

Once the tube was out they tried to communicate with her. When the interpreter came they realised she was blind (she had perfect vision prior to surgery). Admitted to ICU and slowly recovered her vision over the next few days. Discharged as good as new. No idea what happened.

Is it possible that they had just watched the movie Alien and were describing the final dinner scene and they were just pulling your leg?

 

[KLPM]

Is it possible that they had just watched the movie Alien and were describing the final dinner scene and they were just pulling your leg?

For this guy I highly doubt it but you never know. Although I have heard one where the girl swore that all all her patients had anaphylaxis (the consultant pulled me aside and said she was kind of ******ed).

 

[dotcb]

Sounds like PRES:

http://en.wikipedia.org/wiki/Posterior_reversible_encephalopathy_syndrome

Seen this ~ 3 times in 6 years. Sort of a new name for a brand of hypertensive encephalopathy. May have relationship w/ pregnancy, and tends to have visual symptoms.

When I had my anaesthesia rotation everyone enjoyed sharing horror stories from their earlier days. The one that made the greatest impression on me was the following:

The patient was a 20 something pregnant Asian woman (can't speak English) who married came to the country after marrying her Caucasian husband.

Pregnancy was uneventful until the day of her emergency C-section (can't remember the exact indication, something about pre-eclampsia). When the spinal was being prepared (upright position) the husband suddenly has an expression of horror. Anaesthetist decided to have a look at the mother. Foam starts coming out of her mouth and shortly goes into cardiopulmonary arrest (all that has been done so far was the skin prepped for the spinal). Patient tubed and baby removed. At this point the mother was pretty much presumed dead. As she was wheeled out of the OR, the woman wakes up with the ETT down her airway.

Once the tube was out they tried to communicate with her. When the interpreter came they realised she was blind (she had perfect vision prior to surgery). Admitted to ICU and slowly recovered her vision over the next few days. Discharged as good as new. No idea what happened.

 

[rsgillmd]

Sounds like PRES:

http://en.wikipedia.org/wiki/Posterior_reversible_encephalopathy_syndrome

Seen this ~ 3 times in 6 years. Sort of a new name for a brand of hypertensive encephalopathy. May have relationship w/ pregnancy, and tends to have visual symptoms.

May or may not be PRES. Hard to diagnose in the pregnancy setting because changes due to severe preeclampsia/eclampsia can look like PRES on imaging.

Transient visual loss has been reported before in preeclamptic patients, but it's got to be rare.

I've seen the blindness once. Postpartum return. It started as headache and blurry vision and progressed to loss of vision. Interestingly the patient was very calm about it and recovered by the next day.

 

[KLPM]

May or may not be PRES. Hard to diagnose in the pregnancy setting because changes due to severe preeclampsia/eclampsia can look like PRES on imaging.

I thought about PRES as well when I first heard the story. He said that when it happened he searched the literature and found a handful of similar sounding case reports.

 

[gasattack3]

Is it possible that they had just watched the movie Alien and were describing the final dinner scene and they were just pulling your leg?

Little bastard would be a b.tch to intubate with that underbite....

Really though, what a great movie, from what? 1979?? The graphics and cinematography were superb and are to this day.