Anesthesiologist sues Salem surgery center for $1.6 million

[deleted1112838]

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M

 

[Beeftenderloin]

The biggest reason I don’t like nurses pushing the meds is because they always go WAY too slow. Like, slowly push the hypnotic over 30-60s, then slow saline flush, then slowly push the roc over another 60s. It’s nuts. I can get all the meds and the tube in before they’d be done flushing the hypnotic in.

 

[abolt18]

Doing a block is the only time I would consider having anyone else push drugs for me ever. Maybe in a really bad laryngospasm and I don't have a free hand...

Otherwise no one is touching my stuff...
I do 80% cardiac and icu. Lots of sick people and periarrest situations. Especially in those, no one is touching my stuff, or my patients... They would kill them

You mask induce a kid and they turn into a difficult 2-hand mask. Nurse gets the IV. You wouldn't consider having the nurse push drugs?

When I'm lining a patient, if the patient is becoming hypotensive, I'll ask the nurse to make changes to the vent or bolus a pressor. No big deal.

 

[coffeebythelake]

The biggest reason I don’t like nurses pushing the meds is because they always go WAY too slow. Like, slowly push the hypnotic over 30-60s, then slow saline flush, then slowly push the roc over another 60s. It’s nuts. I can get all the meds and the tube in before they’d be done flushing the hypnotic in.

And the pharmacist responding to these codes need to draw up every drop of drug... take 5 minutes for 2 syringes...I mean just hand me th3 damn drugs already!

 

[Beeftenderloin]

I have nurses push drugs on periarrest ICU code intubations all the time. Done probably 20 brink of death intubations in residency and only time I've had someone arrest was when a STEMI intubation that was ridin an impella at P3 I was called to died after a tiny dose of versed that I instructed to give. Relax.

Sounds like they needed and epi chaser with the midaz.

 

[deleted1112838]

M

 

[PpfSuxTube]

I have nurses push drugs on periarrest ICU code intubations all the time. Done probably 20 brink of death intubations in residency and only time I've had someone arrest was when a STEMI intubation that was ridin an impella at P3 I was called to died after a tiny dose of versed that I instructed to give. ReRelax.

No one believes you or cares

 

[deleted1112838]

No one believes you or cares

Relax.

 

[DazedWanderer]

we often have nurses push meds here at the direction of anesthesiologist.
when we block , we often have them push the meds
as long as we tell them exactly how many ml to push, i dont see what the problem is. they do it everywhere else. in other places they often dont do it infront of the physician...

when i order 50mcg of fentanyl, i assume the pacu nurse knows how to give it, without anesthesiologist standing next to them watching.

what the charge nurse did was ridiculous n my opinion

It is definitely legal and in many places customary for nurses to push induction meds. ICU and ED settings come to mind as common examples. It's probably a surgicenter policy/bylaw there that the nurse is not allowed to push certain meds at that facility. That having been said, it is completely inappropriate and extremely dangerous for the charge nurse to barge in and demand the OR Nurse stop pushing meds immediately half way through a high risk induction. This should have been something discussed after the fact, not during. She could have spoken to the involved parties and even submitted an incident report or whatever their equivalent is... afterward. This was a perfect example of a nurse being more concerned about being "by the book" than about what is actually best for the patient in the moment. In that moment the nurse was more concerned about being technically right than morally right. She had plenty of opportunity to bring down the compliance hammer after the fact, but she could have done it without endangering the patient in the moment.

Although I think the charge nurse was way out of line, I don't think the anesthesiologist has much of a case here. The courts don't really understand what is safe and what isn't and wont be able to wrap their heads around the danger the patient was exposed to. They will simply look at what the official policies actually were and who was violating the policies and who wasn't. Was the nurse technically allowed to push those meds? No? Ok so anesthesiologist is in the wrong, case dismissed. They won't really see the bigger picture of the patient endangerment that occurred due to the ill conceived timing of the interruption.

 

[PpfSuxTube]

You mask induce a kid and they turn into a difficult 2-hand mask. Nurse gets the IV. You wouldn't consider having the nurse push drugs?

When I'm lining a patient, if the patient is becoming hypotensive, I'll ask the nurse to make changes to the vent or bolus a pressor. No big deal.

Sorry you are correct, yes during lines I get thr perfusionist or someone close by to push phenyl

I don't do peds

 

[Beeftenderloin]

It is definitely legal and in many places customary for nurses to push induction meds. ICU and ED settings come to mind as common examples. It's probably a surgicenter policy/bylaw there that the nurse is not allowed to push certain meds at that facility. That having been said, it is completely inappropriate and extremely dangerous for the charge nurse to barge in and demand the OR Nurse stop pushing meds immediately half way through a high risk induction. This should have been something discussed after the fact, not during. She could have spoken to the involved parties and even submitted an incident report or whatever their equivalent is... afterward. This was a perfect example of a nurse being more concerned about being "by the book" than about what is actually best for the patient in the moment. In that moment the nurse was more concerned about being technically right than morally right. She had plenty of opportunity to bring down the compliance hammer after the fact, but she could have done it without endangering the patient in the moment.

Although I think the charge nurse was way out of line, I don't think the anesthesiologist has much of a case here. The courts don't really understand what is safe and what isn't and wont be able to wrap their heads around the danger the patient was exposed to. They will simply look at what the official policies actually were and who was violating the policies and who wasn't. Was the nurse technically allowed to push those meds? No? Ok so anesthesiologist is in the wrong, case dismissed. They won't really see the bigger picture of the patient endangerment that occurred due to the ill conceived timing of the interruption.

If you’re performing a “high risk induction” at an ASC, credibility is already suspect.

 

[DazedWanderer]

If you’re performing a “high risk induction” at an ASC, credibility is already suspect.

True, not high risk in absolute terms but relatively speaking, an obese young pediatric patient would be one of the higher risk inductions one would typically do at an ASC. Pretty easy to bronchospasm/laryngospasm if done improperly... such as when only given a half dose of induction agents.