Anesthesiologists and/or residents doing LPs

[DenRock]

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Just curious - how many of you are doing diagnostic LPs? When there are neurology/medicine residents in house? Asking because I was consulted a short time ago for a 'STAT Lumbar Puncture' on a L&D patient. I was consulted by the 'neurology service' who had not even seen the patient, had just phoned in verbal orders. I did the LP, but was a little disgusted when I learned why none of the neuro/medicine residents/attendings would do it.

 

[jetproppilot]

Just curious - how many of you are doing diagnostic LPs? When there are neurology/medicine residents in house? Asking because I was consulted a short time ago for a 'STAT Lumbar Puncture' on a L&D patient. I was consulted by the 'neurology service' who had not even seen the patient, had just phoned in verbal orders. I did the LP, but was a little disgusted when I learned why none of the neuro/medicine residents/attendings would do it.

HAHAHHA

Funny you bring this up.

At my previous gig, one of my partners was on call...low and behold at 2am he was paged to the ICU for an LP (never happened B4)...so being the good hearted dude Jeff was, he comes in...and....the neurologist who ordered it HADNT EVEN SEEN THE PATIENT....bad, very bad, since we were a strong, well respected group.

Jeff does the LP.

Then he calls the neurologist.

Exact words: (we did our residency together):

"Dr Hashmurad? Hey its Jeff R. I just did the LP. Where are you?"

Dr Hashmurad: "HEY! Thanks. I'm at home."

Jeff R. "Dude, are you serious? What the F uck? You called me in the middle of the night and you havent even seen the patient????? Thats disgusting. And YOU are disgusting. We are not an LP service. You REALLY need to get your a ss in here. I won't stand for this abuse."

Eloquently said by my partner.

We were never consulted for another LP.

 

[Carm]

HAHAHHA

Funny you bring this up.

At my previous gig, one of my partners was on call...low and behold at 2am he was paged to the ICU for an LP (never happened B4)...so being the good hearted dude Jeff was, he comes in...and....the neurologist who ordered it HADNT EVEN SEEN THE PATIENT....bad, very bad, since we were a strong, well respected group.

Jeff does the LP.

Then he calls the neurologist.

Exact words: (we did our residency together):

"Dr Hashmurad? Hey its Jeff R. I just did the LP. Where are you?"

Dr Hashmurad: "HEY! Thanks. I'm at home."

Jeff R. "Dude, are you serious? What the F uck? You called me in the middle of the night and you havent even seen the patient????? Thats disgusting. And YOU are disgusting. We are not an LP service. You REALLY need to get your a ss in here. I won't stand for this abuse."

Eloquently said by my partner.

We were never consulted for another LP.

Hey Jet. We need to get this guy signed up for the forum!

In all honesty, this is what anesthesia is missing. It was probably a little on the crude side, but the point is valid. Too many times anesthesiologists allow themselves to be "hey anesthesia". One of the advantages to being MD's delivering anesthesia in it's various forms is that we are doctor colleagues. Understanding that we are consultants, we still need to be vigilant and adament in our protection of our views in the OR, ICU, etc. Just as the surgeons are 'fighting for the patient' from their training standpoint, we likewise have a unique perspective on what the patient needs.

 

[Annette]

I'll do the LP!!!!! But no one ever asks the IM residents. 🙁

Last LP interventional radiology passed on. 1 RBC. Oh, well.

 

[stephend7799]

I would politely tell the nurse.. I dont do other peoples work for them...

and not do it.. I wouldnt even call t he neurologist.. wouldnt even get that far...

THey are capable to do an LP...

 

[jetproppilot]

I would politely tell the nurse.. I dont do other peoples work for them...

and not do it.. I wouldnt even call t he neurologist.. wouldnt even get that far...

THey are capable to do an LP...

Here's Jet's way to deal with total-bu ll s hit-that-you-have-been-consulted-upon:

As an aside, in-the-moment is no time to deal with political B.S.

Perform whatever has been asked of you.

The patient will benefit.

Then take the lazy-piece-of-s hit-doctor who consulted you out of laziness into the parking lot and settle it GANGSTA style.

And if that approach intimidates you, settle it gangsta style over the phone.

 

[rn29306]

Here's Jet's way to deal with total-bu ll s hit-that-you-have-been-consulted-upon:

As an aside, in-the-moment is no time to deal with political B.S.

Perform whatever has been asked of you.

The patient will benefit.

Then take the lazy-piece-of-s hit-doctor who consulted you out of laziness into the parking lot and settle it GANGSTA style.

And if that approach intimidates you, settle it gangsta style over the phone.

I have seen some Gangsta 1-on-1 and 2-on-1 MD confrontations in the ICU hallways back in my time. I always thought MDs really didn't get in yo face with each other, boy they sure do in Atlanta. Pulmonary pulled surgery to side over consultation issues and strong-armed the surgeon about pulmonary not managing ANY of his ICU patients any more if surgeon consulted the other group. Not that I was evesdropping or anything, but have heard some nice telephone converstations over exactly what Jet alluded to - pulmonary being called in at 0200 for a unit pt when GI hadn't even seen the new admit during day shift. Damn was he mad. GI had better been glad he wasn't present.

 

[lvspro]

Just curious - how many of you are doing diagnostic LPs? When there are neurology/medicine residents in house? Asking because I was consulted a short time ago for a 'STAT Lumbar Puncture' on a L&D patient. I was consulted by the 'neurology service' who had not even seen the patient, had just phoned in verbal orders. I did the LP, but was a little disgusted when I learned why none of the neuro/medicine residents/attendings would do it.

We had a guy w/an INR of 3-ish, and the neurologist I was working for wouldn't touch him. He consulted anesthesiology, who, of course, did it w/o any complications.
Weak

 

[jetproppilot]

We had a guy w/an INR of 3-ish, and the neurologist I was working for wouldn't touch him. He consulted anesthesiology, who, of course, did it w/o any complications.
Weak

Sorry.

I wouldnt put a needle in the back of a dude with an INR of "three-ish."

 

[KluverBucy]

Sorry.

I wouldnt put a needle in the back of a dude with an INR of "three-ish."

fuk. that's what i was thinking. but who am i...just a lowly ms-4 about to get killed starting 7/1.

 

[DenRock]

fuk. that's what i was thinking. but who am i...just a lowly ms-4 about to get killed starting 7/1.

As an aside, I think we can ?safely do diagnostic LPs on anticoagulated patients. The problem comes with neuraxial anesthesia in the anticoagulated patient. They won't develop the neurologic symptoms of spinal/epidural hematoma due to the blockade, and then it's too late. Without neuraxial anesthesia the patient can be closely monitored, detecting and intervening on any complication in a timely fashion. That's if the dude really needed the puncture in the first place. Can't think of any real STAT LP situations.

Back to my original post - when I finally contacted the neurology attending and resident (from medicine) their response was that they "don't do LPs on pregnant patients". Lame. I was totally apalled.

 

[lvspro]

Sorry.

I wouldnt put a needle in the back of a dude with an INR of "three-ish."

Yeah, they were a little hesitant, but he was afraid an infectious process was causing the encephalopathy. It was quite the tough situation.

 

[CanGas]

Very, very rare. Only happens at one of the 3 sites I work at. Usually from the ER doc who does not have the experience. I figure I am in house anyways and simply bring a 25 whitacer with me (try and avoid giving the dude a worse headache than the one he already has).

My bigger problem is with the "Difficult IV" patients. I'm not an IV service but as a resident I figure I am in house anyways, the patient would benifit and if I don't go do it now they are going to blow every single possible accessable vein with their crappy attempts and I will have to put in a line. Still bugs me though, particularily if I just got to bed.

I guess it could be worse, those poor Urology suckers get called all night long for "difficult foley's". I'll take IV's any day.

Just curious - how many of you are doing diagnostic LPs? When there are neurology/medicine residents in house? Asking because I was consulted a short time ago for a 'STAT Lumbar Puncture' on a L&D patient. I was consulted by the 'neurology service' who had not even seen the patient, had just phoned in verbal orders. I did the LP, but was a little disgusted when I learned why none of the neuro/medicine residents/attendings would do it.

 

[bigeyedfish]

As an MS3 on neuro service we had a possible new Dx of MS and the attending wanted an LP but said the patient was too obese for him to tap. (That's cool, I'm not into fat chicks either. )

Me: But the anesthesiologists do spinals on obese patients all the time. Why dont' you guys?

Attending: Hey, that's a good idea, let's call them.