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Cervical Spine Fracture Before ERCP by
Started by NumTacos
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Better than cervical fx after ERCP. Supine ERCP.
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Read this case the other day. I think the anesthesiologist was on the right track but just should have held firm. If the GI doc COULDN'T do it should then send the guy to another hospital where they can.
We had a locums interventional GI doc who was very subpar and my partner cancelled a complex case, telling the patient they need to come back next week when a better and more qualified gastroenterologist would be there to do the procedure. I kid you not!
We had a locums interventional GI doc who was very subpar and my partner cancelled a complex case, telling the patient they need to come back next week when a better and more qualified gastroenterologist would be there to do the procedure. I kid you not!
Did not realize it was a Mal case. Thought it was Numtaco's case, lol. Feel really bad for the anesthesiologist.
Haha! It exactly sure how I would have handled this, if I anticipate having to do crazy stuff like in line stabilization for a neck that could snap any moment, I probably would just cancel the case.
It's scary because I've heard neck cracking sounds when turning patients (usually for spine cases) and patients have always been okay but I always worry about this kind of thing.
Oof. The GI guy clearly sucks.
I had an AS patient in the last couple years where his chin was practically fused to his chest who needed me to peel a 5 micron thick membrane that can only be safely visualized with our systems if he’s looking straight at the ceiling. Of course he’s pushing 3 bills as well. Somehow managed to rig it so he was Trendelenburg enough that I could also rotate the eye enough to make it work. Multiple belts were involved. No neck was manipulated, and given the positioning and his OSA, he was blocked with nothing on board.
Moral of the story, work around the patient, don’t have the patient work around you.
I had an AS patient in the last couple years where his chin was practically fused to his chest who needed me to peel a 5 micron thick membrane that can only be safely visualized with our systems if he’s looking straight at the ceiling. Of course he’s pushing 3 bills as well. Somehow managed to rig it so he was Trendelenburg enough that I could also rotate the eye enough to make it work. Multiple belts were involved. No neck was manipulated, and given the positioning and his OSA, he was blocked with nothing on board.
Moral of the story, work around the patient, don’t have the patient work around you.
Last year I took over an ERCP for a guy with ankylosing spondylitis. He had been an awake nasal intubation and the new “super duper advanced interventional” GI doc was doing it supine. In handoff, other anesthesiologist tells me “yeah about 10 min ago his ventilator mechanics got worse and his belly started getting bigger”. The GI doc had taken an angiocath and done a needle decompression of the patients ABDOMEN. She balked when I suggested leaving him intubated at the end of the case, but I figured she’d perforated something and the guy would be getting an ex lap in the next few hours.
Arch Guillotti
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Can you elaborate? I can’t quite picture this?
Normal BMI patient develops massively distended abdomen pretty acutely while supine. GI doc takes 14g angiocath, enters perpendicular to the skin at probably T8-T10 dermatome on the right, somewhere between midclavicular line and mid axillary line. A few inches north of McBurney’s point. Pulls needle, orange catheter stays hubbed, belly loosens up. I read about it later (googled abdominal needle decompression) and an old attending I had in residency told me a story about something similar that happened in her practice.
Guy went intubated to the ICU, got an abdominal CT. I think during the procedure the stomach/small bowel became super distended (idk why the co2 wouldn’t suck out through the scope) and the needle just went straight into the lumen of the GI tract and evacuated the co2. Didn’t have free air or evidence of perforation.
you’re a great colleague, I can’t believe you took this over!
Why would you hand this case off?
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Everybody has a partner at one point or another who will dump and run any case no holds barred.
But…but… it was my turn to go home. That takes priority.
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Randomnly shoving a big angiocath into the belly hoping it decompresses the area you’re hoping to seems wild. Never heard of that. But I’ve also seen desufflation with the scope work all the time.
It was a newer grad, prob 6 months in the practice. The boardrunner just told me “go get xxx out”. Part of why I felt ok taking over was I was concerned the newer guy would get coerced into extubating the guy (potentially screwing someone later in 2-3 hours when he needs another nasal intubation for an ex lap) and that he wouldn’t necessarily have the foresight to document in the record and as a progress note the objective events and reasoning for our medical decision making to protect ourselves and our department if this went to peer review and/or medmal.
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Never heard of this before. I have seen a patient blow up like the michelin man with subq emphysema everywhere due to CO2 tracking through presumably a tic. Also went to the ICU intubated.
Yeah saw one guy get this so bad it went up to his face and he couldn’t open his eyes for a few days.
When I went back and reviewed everything, there was a fluoro image from the ERCP files of the guy having an enormously dilated upper GI tract (mid procedure image, pre procedure everything looked normal sized). Idk why the normal suction on the scope didn’t suffice.
Yep had one person dump an egd on me. The signout was "patient is waiting for platelets to get here and be transfused" I was like nope took them right to the gi suite, done 5 minutes later.
Yepp.. seems to me exchanging the scope and desufflating would be a much easier and much less invasive thing for the gi doc to have done...
I've seen this once with a bowel perf during a double balloon colonoscopy. The immediate change was impressive. Pt went intubated to the icu then to the OR. We started intubated because the first procedure was a double balloon enteroscopy.
Tryna go home!
Don't get it though because they were sitting there for an hour
Just do the 5 minute case, collect your 6 units and be on your way
Some of us are paid on availability as opposed to productivity. So the incentive is to do as little as possible.
cittykat
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How does that work? Im available to work but only if you can find me?
You mean like taking a long break btwn cases and dragging out all case starts etc?
Ha! Have you even been to the ORs at a VA?
LOL
There are a whole lot of things in medicine that are semi-elective and/or of dubious clinical value, that are disproportionately rewarded by insurance or cash payments.
Some people are more aggressive, shady, or lazy than others in optimizing their paycheck and minimizing the effort they expend.
You know that's how staff - particularly underpaid or undervalued staff - behave. Some doctors do too.
People perform to the incentives they're given. So it goes. No one should be too surprised.
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