- Joined
- Apr 5, 2005
- Messages
- 1,528
- Reaction score
- 349
A little reminder of the importance of checking your own set-up, if your hospital provides the luxury of anesthesia techs.
I just returned from two weeks of reservist active duty at a middle-size Navy hospital. The Navy assigns a corpsman (enlisted medical specialist, equivalent of an EMT or LPN) to each anesthesia department to be in charge of supplies, anesthesia set-up (to include drawing up meds, which made me nervous), and anesthesia room turnover. This particular hospital had two anesthesia techs.
This brand-new tech had supposedly been shown the ropes by the senior tech, who then left on vacation.
When I reported in, we discovered my privileges hadn't been signed yet by the Chief of Staff, so all I could do my first day in the OR was pre-ops and start IVs. One room that day was booked for pedi ENT cases, so the department head asked me to assist him in that room (which, again, had supposedly been set-up correctly by the new and unsupervised tech).
First case: 1 year old for T+A. Department head starts to attempt N20/02/Sevo breathe-down. Nothing happens. Hmmm. Then I notice the red stripe peering from the soda lime cannister, indicating the outer celophane wapper had never been removed by the tech from the cassette.
Wrapper quickly removed. Breathe-down commenced. No ETCO2 registers. Airway obviously under control with easy chest excursion, stable VS, pt gently falling asleep. Oh, look, the tech unknowingly screwed the ETCO2 tubing into the monitor wrong port on the machine.
Then the circulator RN gets an easy IV start and starts to hook up the IV line. Right as she was about to open the clamp, I noticed the line had never been primed by the tech. The drip chamber and buretrol are both bone-dry. The new tech didn't know how to operate a buretrol. Jesus, what next?
Line gets primed, and a little fent goes in. Easy laryngoscopy, and the department head attempts to insert a way-too-big cuffed ETT (selected by and handed to him by the newbie tech), which the tyke's cords didn't appreciate. Cords slam shut, SAO2 starts to plummet, oh great the sux and atropine were not re-stocked on the pedi supply cart.
Department head is literally praying out loud to God to help him.
Fast-forward, we manged to emerge from that alligator-infested swamp with our asses intact, but it was not a pretty sight.
Lesson learned: everyone's human and mistakes happen. But the person on the witness stand being grilled by the plaintiff's attorney is not going to be the tech; it's going to be you. So, be grateful if you have techs to help keep your ORs stocked and set-up, but always remember who has the ultimate responsibility for everything.
I just returned from two weeks of reservist active duty at a middle-size Navy hospital. The Navy assigns a corpsman (enlisted medical specialist, equivalent of an EMT or LPN) to each anesthesia department to be in charge of supplies, anesthesia set-up (to include drawing up meds, which made me nervous), and anesthesia room turnover. This particular hospital had two anesthesia techs.
This brand-new tech had supposedly been shown the ropes by the senior tech, who then left on vacation.
When I reported in, we discovered my privileges hadn't been signed yet by the Chief of Staff, so all I could do my first day in the OR was pre-ops and start IVs. One room that day was booked for pedi ENT cases, so the department head asked me to assist him in that room (which, again, had supposedly been set-up correctly by the new and unsupervised tech).
First case: 1 year old for T+A. Department head starts to attempt N20/02/Sevo breathe-down. Nothing happens. Hmmm. Then I notice the red stripe peering from the soda lime cannister, indicating the outer celophane wapper had never been removed by the tech from the cassette.
Wrapper quickly removed. Breathe-down commenced. No ETCO2 registers. Airway obviously under control with easy chest excursion, stable VS, pt gently falling asleep. Oh, look, the tech unknowingly screwed the ETCO2 tubing into the monitor wrong port on the machine.
Then the circulator RN gets an easy IV start and starts to hook up the IV line. Right as she was about to open the clamp, I noticed the line had never been primed by the tech. The drip chamber and buretrol are both bone-dry. The new tech didn't know how to operate a buretrol. Jesus, what next?
Line gets primed, and a little fent goes in. Easy laryngoscopy, and the department head attempts to insert a way-too-big cuffed ETT (selected by and handed to him by the newbie tech), which the tyke's cords didn't appreciate. Cords slam shut, SAO2 starts to plummet, oh great the sux and atropine were not re-stocked on the pedi supply cart.
Department head is literally praying out loud to God to help him.
Fast-forward, we manged to emerge from that alligator-infested swamp with our asses intact, but it was not a pretty sight.
Lesson learned: everyone's human and mistakes happen. But the person on the witness stand being grilled by the plaintiff's attorney is not going to be the tech; it's going to be you. So, be grateful if you have techs to help keep your ORs stocked and set-up, but always remember who has the ultimate responsibility for everything.
