Blood Patch by EM Docs?

[pagemmapants]

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Just curious. Are there any shops out there where EM docs are doing their own blood patches?

I guess I kind of figure if you can do an LP you can do a blood patch... Not that I necessarily WANT them and I do certainly appreciate the help from our anesthesia colleagues.

 

[b-real]

Muck around the spine more than I have to? No thanks. I know of no places where credentialing is offered for blood patches.

 

[WilcoWorld]

People come to the ED for them, but they're not an emergency.

We shouldn't do them.

 

[emergentmd]

Just curious. Are there any shops out there where EM docs are doing their own blood patches?

I guess I kind of figure if you can do an LP you can do a blood patch... Not that I necessarily WANT them and I do certainly appreciate the help from our anesthesia colleagues.

I try to do the least amount of procedures as possible. Did much more in residency. Definitely not blood patch

 

[dotcb]

Heck no. I've never heard of an emergency physician doing a blood patch.

 

[Hercules]

No.

 

[UnderwaterDoc]

I see your "no" and I will raise you to "not in a million years".

 

[dchristismi]

Never, ever, ever.

Not my circus, not my monkeys.
(And FWIW, I have never seen this procedure listed in any credentialling application for any EP...and there is still some weird-ass stuff on some of them.)

 

[RustedFox]

 

[Birdstrike]

Just curious. Are there any shops out there where EM docs are doing their own blood patches?

I guess I kind of figure if you can do an LP you can do a blood patch... Not that I necessarily WANT them and I do certainly appreciate the help from our anesthesia colleagues.

No reason to do a blood patch in the ED. Rest, drink fluids, oral caffeine. Follow up with anesthesia for elective blood patch in 10 days if fails conservative care.

 

[B-Bone]

No reason to do a blood patch in the ED. Rest, drink fluids, oral caffeine. Follow up with anesthesia for elective blood patch in 10 days if fails conservative care.

Holy hell can you come work at my hospital? I'm an anesthesiologist and our ED calls us at any hour of the day or night to get a blood patch STAT for any suspected PDPH. My favorite is when IR (who also does blood patches) caused the headache doing an LP with an 18g cutting needle and the ED calls me because the radiologists works bankers hours (bbbbbbbut they won't do it til Monday!!!).

 

[WilcoWorld]

Holy hell can you come work at my hospital? I'm an anesthesiologist and our ED calls us at any hour of the day or night to get a blood patch STAT for any suspected PDPH. My favorite is when IR (who also does blood patches) caused the headache doing an LP with an 18g cutting needle and the ED calls me because the radiologists works bankers hours (bbbbbbbut they won't do it til Monday!!!).

It is ridiculous indeed. My only contention is that it's probably not the docs in the ED who are the problem. They know that PDPH is NOT an emergency, but the hospital has decided that patient satisfaction IS an emergency. In fact, it is THE emergency.

The tail is wagging the dog and, unfortunately, the docs are going along for the ride.

 

[LaBusqueda]

It is ridiculous indeed. My only contention is that it's probably not the docs in the ED who are the problem. They know that PDPH is NOT an emergency, but the hospital has decided that patient satisfaction IS an emergency. In fact, it is THE emergency.

The tail is wagging the dog and, unfortunately, the docs are going along for the ride.

So true!

 

[Docinthetrenches]

No I would not do it. I'm sure we could learn to but I don't think our malpractise would cover it. It's out of the scope of our practise like lipoma removals and other minor non-emergent procedures.

 

[Rendar5]

No reason to do a blood patch in the ED. Rest, drink fluids, oral caffeine. Follow up with anesthesia for elective blood patch in 10 days if fails conservative care.

Well I do have two issues here. One how does one refer a patient to an anesthesiologist. Two: since when is care of a painful condition not to treat it for a week and a half. I don't send someone with a broken wrist home without a splint and some percocets. If there is a treatment to cure something I don't see the point in just saying go home and figure it out in a couple weeks. Now if my anesthesiologist that I call says to go to ambulatory care center and they'll do it in the morning then sure that's great. I would prefer it. But I've never worked in a setting where I can always can arrange that. So is it an emergency? No less than most things that come my way, but I'm stuck treating it if I can't refer someone to an appropriate outpatient provider and for once I'm not sure PMD can handle it.

 

[Birdstrike]

It is ridiculous indeed. My only contention is that it's probably not the docs in the ED who are the problem. They know that PDPH is NOT an emergency, but the hospital has decided that patient satisfaction IS an emergency. In fact, it is THE emergency.

The tail is wagging the dog and, unfortunately, the docs are going along for the ride.

True. Patient satisfaction is given precedence over good medicine. What if the immediate demand for a blood patch is caved in to, the procedure gets done, and there's a complication, such as the blood injected gets infected and converts to a epidural abscess, in a patient who likely would have had spontaneous resolution in 10 days?

Does the patient and the hospital get punished for their desire for instant gratification (patient) and greed (hospital profits tied to high sat scores)?

No.

The doctor gets punished for the complication; goes to M&M, gets sued, and is blamed for it.

On the other hand, if the doctor sticks to his guns, practices good medicine and does the right thing, he also gets punished with the patient complaint, low Press Ganey score and subsequent threats to his job or contract. This is just one of many examples of where doctors are punished for trying to do the right thing, regardless of what they do. Patient satisfaction centered medicine drives poorer quality care and higher rates of morbidity and mortality.

http://archinte.jamanetwork.com/Mobile/article.aspx?articleid=1108766

 

[Birdstrike]

Well I do have two issues here. One how does one refer a patient to an anesthesiologist. Two: since when is care of a painful condition not to treat it for a week and a half. I don't send someone with a broken wrist home without a splint and some percocets. If there is a treatment to cure something I don't see the point in just saying go home and figure it out in a couple weeks. Now if my anesthesiologist that I call says to go to ambulatory care center and they'll do it in the morning then sure that's great. I would prefer it. But I've never worked in a setting where I can always can arrange that. So is it an emergency? No less than most things that come my way, but I'm stuck treating it if I can't refer someone to an appropriate outpatient provider and for once I'm not sure PMD can handle it.

1-If the anesthesiologists at your group don't allow the outpatient referral option, then you call them ASAP and they have to deal with it. If they want this pathway, and it makes sense to have it, they have to work with you to make it accessible. If not, then you call at 3 am.

2-I never said "Don't treat." Rest, oral fluids and caffeinated analgesics are the first line treatment for PDPH. If you want to skip to the PDPH, fine, just know that the majority would not have been needed. This is the "art of medicine."