Clinical case for Jet (and others)
Started by Noyac
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No I am not. A few people here have shown understanding of the issue at hand. and Im not chasing academic dogma. I am chasing "I dont wanna kill anyone" dogma. Sure anyone can get lucky. But for the residents reading. You mess with the wrong patient... and your judgement is a little off one day and choose an anesthetic that is not appropriate. You WILL have some splainin to do. And it wont be to the patient.you're alone on a boat
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deleted171991
Again, this study is done in left lateral position. You place the patient in the position awake, and then slowly give propofol (preferably by pump, after a few appropriately small boluses) while maintaining spontaneous ventilation. If there is trouble, this is where it starts showing. And if it does, you stop.
As long as one is not a cowboy, one is always less than a minute away from recovering spontaneous ventilation. There is a reason many people consider this MAC: it's basically deep sedation, except the few cases where one needs to manage the airway to maintain deep enough (for the procedure) sedation. It's scary until you do a few hundred of these solo.
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Place him prone?
Oops. I see others have touched on this.
you're right - the trick is to know when you can do the same ol same ol and when you need to do something special to prevent death (residents are residents to learn this and the first few years out of residency can be pretty tricky - asking older partners if unsure is never a bad idea - whether you end up taking their advice or not).
however - this is a same ol same ol case. recumbent cough doesn't get my hackles up at all. postnasal drip will give ya a recumbent cough - so will run o' the mill gerd. ask a few other questions to be sure - examine the pt.
anterior mediastinal mass is one of those things we all fear and it gets drilled into your head cuz it should cuz you can kill someone with anesthesia quickly. but don't start seeing it everywhere. i've had a few patients with big nasty life threatening masses - and all of em had scary symptoms. ie noisy breathing or positional syncope or something pretty gloomy.
you can think all you want (and i think everyone on here understands the issue at hand - there were just varying degrees of concern about it) so long as you don't delay this case or do something weird for the anesthetic. if you do that you will be in a lonesome boat with a select few who are overly cautious and unpopular with their partners and surgeons.
don't be a cowboy - but on the flip side don't be a mental spider monkey.
I am still waiting for the retrograde intubationWell $hit Noy... I expected a full McDonalds stomach with a partial SBO that aspirated on induction and then subsequently went into PEA from some massive ant. mediastinal mass case...
Sneaky Ninja Mofo.
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deleted171991
It was just an EGD, no colonoscopy. 😀
Sorry I did miss that part... after all... it is the AW tool of choice for someone who is actively vomiting dark brown stool.
So yeah... I figured you guys would pick up great vessel obstruction with induction. It is a zebra, but one that residents and private/academic docs should keep stored somewhere in the back of their minds. It is very impressive when you see it and it happens fast. If you don't recognize it and the patient keeps on getting pressors/volume/PALS, you've already thrown in the towel.
Prone positioning and discontinuation of anesthesia/resumption of spontaneous ventilation brought him back.
Nice to actually see it and not just read about it.
Prone positioning and discontinuation of anesthesia/resumption of spontaneous ventilation brought him back.
Nice to actually see it and not just read about it.
