constant high risk cases

  • Thread starter Thread starter deleted59964
  • Start date Start date
Healthcare jobs with pay you can see.
This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
D

deleted59964

Members don't see this ad.
My current gig is full of challenges.

a very sick local population - that refuses to look after themselves and frequently does stupid self destructive ****.

we're the only game in town - and we're VERY geographically isolated - almost nothing gets transferred out.
I do a bit of everything - from neonates to multi trauma, to high risk obstetrics and thoracics -sometimes all in one day.

it's a lot of fun, but logic tells me if I constantly do high risk cases eventually I'm going to have a death on the table.
I think I'd be bored with simple cases in healthy people, but I do feel like my work is taking a toll on me.

any of you feel this way?
thoughts of when to slow it down?
 
I'm on the other boat working with overall ASA 1-3, rare 4 in community hospital setting. I feel bad sometimes that I'm not doing high level cases like you to avoid the brain drain but then again it's nice to not be stressed out like crazy
 
JobsFan said:
My current gig is full of challenges.

a very sick local population - that refuses to look after themselves and frequently does stupid self destructive ****.

we're the only game in town - and we're VERY geographically isolated - almost nothing gets transferred out.
I do a bit of everything - from neonates to multi trauma, to high risk obstetrics and thoracics -sometimes all in one day.

it's a lot of fun, but logic tells me if I constantly do high risk cases eventually I'm going to have a death on the table.
I think I'd be bored with simple cases in healthy people, but I do feel like my work is taking a toll on me.

any of you feel this way?
thoughts of when to slow it down?
Click to expand...

The hospital I work at is like this. Very busy and acuity is high and it can be stressful.

These days are balanced for me with an occasional mindless day in an ASC supervising eye cases / GI / bread and butter stuff.

Is your practice solely based out of the stressful hospital?
 
Hoya11 said:
The hospital I work at is like this. Very busy and acuity is high and it can be stressful.

These days are balanced for me with an occasional mindless day in an ASC supervising eye cases / GI / bread and butter stuff.

Is your practice solely based out of the stressful hospital?
Click to expand...
I’m there 95% of the time and do about 5% of my work in the associated private hospital ... which is more low key
 
2Fast2Des said:
I'm on the other boat working with overall ASA 1-3, rare 4 in community hospital setting. I feel bad sometimes that I'm not doing high level cases like you to avoid the brain drain but then again it's nice to not be stressed out like crazy
Click to expand...
Grass is always greener
 
JobsFan said:
Grass is always greener
Click to expand...

Which grass is more greener? Thankfully I felt I did some good cases in residency so I still feel like I "got it" if I'm in a new job that needs that. Even routine stuff on some bad sickies still keeps the wheels turning, but honestly I get super bored sitting in long cases now so I prefer the faster paced rooms overall. But being the new and fresh guy I get assigned to the sicker or longer cases when they're scheduled anyway
 
Last edited:
Encourage you to find some balance. Some people can do that stuff all day every day for 40 years with no consequence. But many of us burn out from it. You are getting a cortisol bolus several times per week whenever things get hairy. You are dealing with inevitable bad outcomes that instill guilt and perseveration. Unless you are one of those “give zero fuks” types, you need to balance it.

What is your physical and mental health worth to you? What is the the economic value of your emotional ability and willingness to do your work? That’s what’s at stake.
 
Last edited:
caligas said:
Encourage you to find some balance. Some people can do that stuff all day every day for 40 years with no consequence. But many of us burn out from it. You are getting a cortisol bolus several times per week whenever things get hairy. You are dealing with inevitable bad outcomes that instill guilt and perseveration. Unless you are one of those “give zero fuks” types, you need to balance it.

What is your physical and mental health worth to you? What is the the economic value of your emotional ability and willingness to do your work? That’s what’s at stake.
Click to expand...
Agreed about getting balance and the stakes, I got particularly slammed my last on call - hence the thread. I found my last on call more stressful than usual, hence the thread.

For you old hands - I’m interested in your experiences and advice if you’re willing. It’d be helpful to me and it’s an issue for others too I’m sure


Edited for honesty
 
Last edited by a moderator:
I can sympathize somewhat with you. The majority of cases I do trend towards the high risk side, and I also do CT and transplants which adds a bit to it. I do not feel especially worn down by the case complexity compared to how worn down I would be just showing up to a job and working the same hours and going home. I personally find the transition of home to work and the time spent at work to be my main fatigue determinants and not as much the content of the work. However, I am also not sure how I will react when I have my inevitable death on the table, so far I have been lucky about not taking work home with me, but whenever that occurs it may change things.
 
JobsFan said:
My current gig is full of challenges.

a very sick local population - that refuses to look after themselves and frequently does stupid self destructive ****.

we're the only game in town - and we're VERY geographically isolated - almost nothing gets transferred out.
I do a bit of everything - from neonates to multi trauma, to high risk obstetrics and thoracics -sometimes all in one day.

it's a lot of fun, but logic tells me if I constantly do high risk cases eventually I'm going to have a death on the table.
I think I'd be bored with simple cases in healthy people, but I do feel like my work is taking a toll on me.

any of you feel this way?
thoughts of when to slow it down?
Click to expand...


I work in a similar high risk environment. And yes, you will have people die occasionally. That's the nature of doing high risk stuff. I mitigate the burnout by having plenty of vacation time to destress.
 
You will def. have a death on the table. It’s only a matter of time.

Your current gig will also offer you the experience to become a great anesthesiologist... so good that you will save a lot of people from death.

You can only do your best and some deaths are unavoidable (penetrating traumas, crush injuries, GSWs, emergent hearts, CO2 embolus come to mind in my practice).
 
caligas said:
Reminds me of the time I was doing a pre-op on an inmate that had 3 teardrop tattoos below his eye and I said “Hey! That’s how many people I’ve killed at my job too!”
Click to expand...

U said that..?
 
caligas said:
Reminds me of the time I was doing a pre-op on an inmate that had 3 teardrop tattoos below his eye and I said “Hey! That’s how many people I’ve killed at my job too!”
Click to expand...

God I hope that’s a true story. :=|:-):
 
caligas said:
Reminds me of the time I was doing a pre-op on an inmate that had 3 teardrop tattoos below his eye and I said “Hey! That’s how many people I’ve killed at my job too!”
Click to expand...

Did you actually kill them or were you taking care of them while they were in the process of dying? It’s semantics, but still an important difference. I understand your comment was probably meant to be a joke, but this distinction often gets blurred in the real world among doctors...especially young doctors. The guilt a doctor feels when a patient dies under his care can be a real burden when it shouldn’t be.

The same psychology that makes us feel guilt when an already sick or dying patient dies also makes us offer futile treatments. Death happens. Unless you are really bad, it’s almost never your fault.
 
GravelRider said:
Did you actually kill them or were you taking care of them while they were in the process of dying? It’s semantics, but still an important difference. I understand your comment was probably meant to be a joke, but this distinction often gets blurred in the real world among doctors...especially young doctors. The guilt a doctor feels when a patient dies under his care can be a real burden when it shouldn’t be.

The same psychology that makes us feel guilt when an already sick or dying patient dies also makes us offer futile treatments. Death happens. Unless you are really bad, it’s almost never your fault.
Click to expand...

Agree. Definitely “care in the process of dying” (Shock trauma patients).
 
JobsFan said:
For you old hands - I’m interested in your experiences and advice if you’re willing. It’d be helpful to me and it’s an issue for others too I’m sure


Edited for honesty
Click to expand...
I don’t typically respond to “old” but you struck a cord with me here. My job for the first 3 yrs was much like you describe. I loved it. It was intense as hell. But it prepared me better than anything I could imagine. Way better than residency. Then I moved to another job with less frequency of high acuity but still plenty of it. Luckily for me I have not had a death on the table in a pt that we didn’t expect. They still can get to you and you never know when it will come through the OR doors and land on your table. The worst one I had was a 13yo girl who hit a tree skiing. That one stuck with me for years and I would start to cry whenever I thought of it for at least 2yrs. I would even shed tears on the lift that passed over the tree she hit. I was a mess when I got home that evening after the case. But I learned to deal with it on my own somehow. Time was a huge part of it. And I began to realize how much we bring to our pts every day. Just think of all the pts you have saved or improved their lives or relieved their suffering. The list goes forever. And there are many more of these pts than the ones that didn’t fair well.

My current gig is less stressful but it still comes and the girls case I mentioned came at this site, not the one with the super high acuity. But that first job prepared me well. Just yesterday I had a AAA pt who had a stent placed 10yrs ago and it had fractured completely in half and separated. We had to run another one up and stent the stent. When we finished the guy’s wife said, “wait, are you telling me he survived?” And when I woke him up he said the same thing. He was a wreck with comorbidities. But I felt very comfortable with the case and therefore, very little stress. Thanks to my past experiences and to my personality as well. I’m not a high stress individual. Emotional at times though. 😉

So I think your gig is a fantastic place for young (less old in your case) doc’s to practice and get comfortable with all kinds of crap. Plus those pts need someone like you. Just think about how many lives you are impacting favorably. And then some people just get burnt out doing high acuity cases all the time. Those people need to be honest with themselves and remedy the situation.
 
www.kevinmd.com

The powerful phrase that's ruining medicine

Within the clinics, hospital corridors, and halls of medicine, a new phrase has emerged and taken hold of the practice of medicine.
www.kevinmd.com www.kevinmd.com

I'm not a fan of KevinMD at all, but this article (written by a neurosurgeon) might help you a bit. Take solace in the fact that you feel comfortable taking care of the sickest patients that come your way. And take solace in the fact that you do what the majority of the population and quite a few docs are unwilling/unable to.
 
Thanks for the responses and suggestions - frequent vacations definitely help me to cope, and stay enthusiastic. I find exercise really important for my mood too.
 
caligas said:
Reminds me of the time I was doing a pre-op on an inmate that had 3 teardrop tattoos below his eye and I said “Hey! That’s how many people I’ve killed at my job too!”
Click to expand...

60FF251D-6045-45C5-BBF9-B507CD0B0FED.jpeg
 
Noyac said:
I don’t typically respond to “old” but you struck a cord with me here. My job for the first 3 yrs was much like you describe. I loved it. It was intense as hell. But it prepared me better than anything I could imagine. Way better than residency. Then I moved to another job with less frequency of high acuity but still plenty of it. Luckily for me I have not had a death on the table in a pt that we didn’t expect. They still can get to you and you never know when it will come through the OR doors and land on your table. The worst one I had was a 13yo girl who hit a tree skiing. That one stuck with me for years and I would start to cry whenever I thought of it for at least 2yrs. I would even shed tears on the lift that passed over the tree she hit. I was a mess when I got home that evening after the case. But I learned to deal with it on my own somehow. Time was a huge part of it. And I began to realize how much we bring to our pts every day. Just think of all the pts you have saved or improved their lives or relieved their suffering. The list goes forever. And there are many more of these pts than the ones that didn’t fair well.

My current gig is less stressful but it still comes and the girls case I mentioned came at this site, not the one with the super high acuity. But that first job prepared me well. Just yesterday I had a AAA pt who had a stent placed 10yrs ago and it had fractured completely in half and separated. We had to run another one up and stent the stent. When we finished the guy’s wife said, “wait, are you telling me he survived?” And when I woke him up he said the same thing. He was a wreck with comorbidities. But I felt very comfortable with the case and therefore, very little stress. Thanks to my past experiences and to my personality as well. I’m not a high stress individual. Emotional at times though. 😉

So I think your gig is a fantastic place for young (less old in your case) doc’s to practice and get comfortable with all kinds of crap. Plus those pts need someone like you. Just think about how many lives you are impacting favorably. And then some people just get burnt out doing high acuity cases all the time. Those people need to be honest with themselves and remedy the situation.
Click to expand...
Thank you noyac,takes guts to even revisit things like this let alone post them.

there is a lot of bravado on this board (mine too usually ) - I think when things like this don’t get to you - you need to think “why not? “ I’m fairly hardened but I don’t want to be the ‘give zero fuks guy”. I’d like to walk away from this job one day still feeling human.
 
I had a sweet old guy that came in with his wife for a colon cancer resection. Did great during the case. Ended up going bradycardic and into asystole in PACU more than 60 minutes postop. We coded him for 30+ minutes and never got him back. I still remember his wife talking about how guilty she felt for talking him into having the surgery.
 
2Fast2Des said:
I'm on the other boat working with overall ASA 1-3, rare 4 in community hospital setting. I feel bad sometimes that I'm not doing high level cases like you to avoid the brain drain but then again it's nice to not be stressed out like crazy
Click to expand...

This is my job, take care of patient from about 2 years old to 100 years old plus Obstetrics. See the ASA 4s a few times a week. I do about 70 or 80 percent of my own cases. I like it but sometimes I wonder about some of the skills I have lost since residency. On the other hand some of the folks who work at the tertiary hospital haven't done Peds or Obstetrics for 20 years, even though they are doing one lung and cardiac regularly.
 
I am definitely considered old. Staring down retirement....I have cases from decades ago that still bother me. The amniotic fluid embolism deaths always bugged me. You show up for what is presumably one of the happiest days of your life, and it turns out the complete opposite. For those, I exercise. I spend time alone to recharge my battery. I talk it out with my wife, who is a saint and excellent at putting things into perspective for me.
I never did peds during my career because I know I cannot handle it emotionally. I just can’t, as much as I tried. So my advice is know yourself and when the burden is just too much to bear.
I do mostly high acuity cardiac these days, and while it bothers me when we have a loss, most of our patients are older and I know they’ve had a chance to live life. The other portion are IV drug abusers or morbidly obese people. For some reason these just feel different than a kid or a young person with terrible luck.
The surgeons I work with are awesome people, and we talk about these cases that bother us so they don’t eat us alive. I think just talking it through with another person who gets it is helpful for me. Don’t ever be afraid to see a counselor either if needed, that is an under utilized resource IMO.
 
JobsFan said:
My current gig is full of challenges.

a very sick local population - that refuses to look after themselves and frequently does stupid self destructive ****.

we're the only game in town - and we're VERY geographically isolated - almost nothing gets transferred out.
I do a bit of everything - from neonates to multi trauma, to high risk obstetrics and thoracics -sometimes all in one day.

it's a lot of fun, but logic tells me if I constantly do high risk cases eventually I'm going to have a death on the table.
I think I'd be bored with simple cases in healthy people, but I do feel like my work is taking a toll on me.

any of you feel this way?
thoughts of when to slow it down?
Click to expand...

This is my job without OB and peds.

All sick trauma, thoracic, vascular, ortho, neuro, endo, heavy IR, strokes, etc. Every day, all day. No easy days, no breaks at a surgery center. Always 3:1 to start, often 4:1 and always end up at 4:1 by mid/end of day. It’s exhausting, but I have a lot of time off and I feel prepared to do anything. Been out of residency here for two years, and I’ve had multiple deaths on table or immediately post op. Happens.

Helps I have great partners, very good CRNAs, and a great chief.

I have hobbies and things I love outside of work, and I don’t feel burnout yet. That might be difficult to do without the time off, but I love the gig.
 
Shimmy8 said:
This is my job without OB and peds.

All sick trauma, thoracic, vascular, ortho, neuro, endo, heavy IR, strokes, etc. Every day, all day. No easy days, no breaks at a surgery center. Always 3:1 to start, often 4:1 and always end up at 4:1 by mid/end of day. It’s exhausting, but I have a lot of time off and I feel prepared to do anything. Been out of residency here for two years, and I’ve had multiple deaths on table or immediately post op. Happens.

Helps I have great partners, very good CRNAs, and a great chief.

I have hobbies and things I love outside of work, and I don’t feel burnout yet. That might be difficult to do without the time off, but I love the gig.
Click to expand...
Talking about 7 figure jobs...
 
With our patient population and payer mix...:laugh:

Lots of call but lots of time off and plenty of short days makes up for it.
 
JobsFan said:
My current gig is full of challenges.

a very sick local population - that refuses to look after themselves and frequently does stupid self destructive ****.

we're the only game in town - and we're VERY geographically isolated - almost nothing gets transferred out.
I do a bit of everything - from neonates to multi trauma, to high risk obstetrics and thoracics -sometimes all in one day.

it's a lot of fun, but logic tells me if I constantly do high risk cases eventually I'm going to have a death on the table.
I think I'd be bored with simple cases in healthy people, but I do feel like my work is taking a toll on me.

any of you feel this way?
thoughts of when to slow it down?
Click to expand...

how old are you and where are you in with your career?
i'm a fairly new attending and something like this i would jump for
gotta keep the skills up
 
I think I compartmentalize pretty well and these things rarely seem to affect me a lot in the moment. But later ...

Even when I'm sure I couldn't have done anything better the helplessness can be painful. The Navy gave me plenty of these cases in Afghanistan. Last year I spent a few months working in a hospital in a developing country, where there was a lot of excess M&M - not having enough authority to fix broken systems and undertrained doctors was another kind of helplessness.

Occasionally I can't shake the feeling that I could have or should have averted a complication or death. I had a patient abruptly PEA arrest and die after we moved her from the OR table to the gurney to go to PACU after a trivial MAC case. The autopsy concluded PE but there's a part of me that thinks maybe I missed a respiratory arrest in those minutes and the pathologist found a clot that formed later in a dead person. She was in her 50s and had ovarian cancer and plenty of reasons to have clots, but still, I'll never know. That was 8 or 9 years ago and I think about it literally every single time I do "just a MAC" for a port-a-cath.

Cardiac cases with bad outcomes don't get to me the same way. Part of it is everyone's expectations - nearly everyone (patient, family, staff) implicitly understands that heart surgery is a big deal, and the people who need it are sick. Young people who need it are invariably EXTRA sick. Old people who need it have mostly lived long lives, and the often self-inflictedness of the disease tempers the tragedy of a bad outcome. Complete opposite of pediatrics.

If none of it ever gets to you, you're a psychopath. But if it gets to you all the time, a practice change may be in order.
 
pgg said:
Occasionally I can't shake the feeling that I could have or should have averted a complication or death. I had a patient abruptly PEA arrest and die after we moved her from the OR table to the gurney to go to PACU after a trivial MAC case. The autopsy concluded PE but there's a part of me that thinks maybe I missed a respiratory arrest in those minutes and the pathologist found a clot that formed later in a dead person. She was in her 50s and had ovarian cancer and plenty of reasons to have clots, but still, I'll never know. That was 8 or 9 years ago and I think about it literally every single time I do "just a MAC" for a port-a-cath.

If none of it ever gets to you, you're a psychopath. But if it gets to you all the time, a practice change may be in order.
Click to expand...
Wow, I had the exact same case my first or second year out of training. ICU Pt brought to the OR for something. Don’t remember what it was. We moved the Pt from the ICU bed to the OR table and then PEA. Never got him back. Huge PE was the post mortum. I think about it every time we move a Pt from an ICU bed to the OT table. Sheet sticks with you.
The funny thing is that I didn’t recall how this case stuck with me until you posted this.
 
eikenhein said:
how old are you and where are you in with your career?
i'm a fairly new attending and something like this i would jump for
gotta keep the skills up
Click to expand...
Mid 40’s late starter so also a fairly new attending (3 years) - agree the gig and experience is great and I’m keen to stick at it, but recognise the toll it’s taking and that I need to manage that.
 
By death on the table in my OP - I mean a death that I contribute to, while trying to help a high risk patient.
 
JobsFan said:
By death on the table in my OP - I mean a death that I contribute to, while trying to help a high risk patient.
Click to expand...

I guess the question is what do you mean by "contribute to"? There is a distinct difference morally and emotionally to me between high risk patients that your care met standard of care compared to something like losing an airway or making a medication error. Bad stuff happens to high risk patients even when you provide perfect care. Does it take an emotional toll? It can but I think we all need to have strategies for decompressing from that stuff. I like to talk it out with my partners and then go home and hug the wife and kids and try to take my mind off it.
 
pgg said:
I think I compartmentalize pretty well and these things rarely seem to affect me a lot in the moment. But later ...

Even when I'm sure I couldn't have done anything better the helplessness can be painful. The Navy gave me plenty of these cases in Afghanistan. Last year I spent a few months working in a hospital in a developing country, where there was a lot of excess M&M - not having enough authority to fix broken systems and undertrained doctors was another kind of helplessness.

Occasionally I can't shake the feeling that I could have or should have averted a complication or death. I had a patient abruptly PEA arrest and die after we moved her from the OR table to the gurney to go to PACU after a trivial MAC case. The autopsy concluded PE but there's a part of me that thinks maybe I missed a respiratory arrest in those minutes and the pathologist found a clot that formed later in a dead person. She was in her 50s and had ovarian cancer and plenty of reasons to have clots, but still, I'll never know. That was 8 or 9 years ago and I think about it literally every single time I do "just a MAC" for a port-a-cath.

Cardiac cases with bad outcomes don't get to me the same way. Part of it is everyone's expectations - nearly everyone (patient, family, staff) implicitly understands that heart surgery is a big deal, and the people who need it are sick. Young people who need it are invariably EXTRA sick. Old people who need it have mostly lived long lives, and the often self-inflictedness of the disease tempers the tragedy of a bad outcome. Complete opposite of pediatrics.

If none of it ever gets to you, you're a psychopath. But if it gets to you all the time, a practice change may be in order.
Click to expand...

Same case last month. Assume PE as well. ****ty feeling as it was as case was over moving to stretcher, but not much else to do. Still sucks.
 
FYI: about 30% of people who die in the ICU have previously undiagnosed (i.e. asymptomatic) PEs on autopsy (not necessarily as cause of death).
 
Mman said:
I guess the question is what do you mean by "contribute to"? There is a distinct difference morally and emotionally to me between high risk patients that your care met standard of care compared to something like losing an airway or making a medication error. Bad stuff happens to high risk patients even when you provide perfect care. Does it take an emotional toll? It can but I think we all need to have strategies for decompressing from that stuff. I like to talk it out with my partners and then go home and hug the wife and kids and try to take my mind off it.
Click to expand...

high risk patients push you into a corner - and force you to make judgement calls.
If you make enough of them, then surely - eventually you'll make an error of judgement.

high risk patients also make demands of your technical (and non technical) skills, if you push your skills to the limit often enough, eventually you'll fail (though of course it's great for skill development otherwise).

these patients need someone with great skill and judgement to pull them from the brink, or to get them through an operation.
I feel like I treat a lot of these patients - don't get me wrong, I love doing it - but I know the stress is taking a toll, and I know eventually I'll fall short.


for example
what if you loose the airway on a patient that has a massive fungating glottic tumor, while trying to do an awake fibre optic - maybe you should have done the awake trache instead.

what if you give 50mg of propofol and some pressor to a shocked patient to induce them, and they get cardiovascular collapse - maybe you should have used ketamine after all.
 
JobsFan said:
high risk patients push you into a corner - and force you to make judgement calls.
If you make enough of them, then surely - eventually you'll make an error of judgement.

high risk patients also make demands of your technical (and non technical) skills, if you push your skills to the limit often enough, eventually you'll fail (though of course it's great for skill development otherwise).

these patients need someone with great skill and judgement to pull them from the brink, or to get them through an operation.
I feel like I treat a lot of these patients - don't get me wrong, I love doing it - but I know the stress is taking a toll, and I know eventually I'll fall short.


for example
what if you loose the airway on a patient that has a massive fungating glottic tumor, while trying to do an awake fibre optic - maybe you should have done the awake trache instead.

what if you give 50mg of propofol and some pressor to a shocked patient to induce them, and they get cardiovascular collapse - maybe you should have used ketamine after all.
Click to expand...

high risk patients usually don't die because you had an error in judgment or technical skill, they died because their disease process killed them and you just couldn't stop it.

(as an aside, it's hard to lose an airway while doing an awake intubation. That's the "awake" part of it)
 
FFP said:
FYI: about 30% of people who die in the ICU have previously undiagnosed (i.e. asymptomatic) PEs on autopsy (not necessarily as cause of death).
Click to expand...
Yep

Which is why I dwell on that case. Seems more likely the proximate cause of death was something I did in the OR (maybe she wasn't breathing as well as I thought she was when I took her off monitors for transport and clicked the all-important EMR pixels) ... not the seemingly unlikely chance that a DVT broke loose as we moved her and caused a fatal PE.
 
Periop cancer patient, American sedentary lifestyle, cardiac arrest when moving to/from OR table -> PE is way more likely than you'd think. The rest is between you and your conscience. Nobody's perfect.

Also, many deep venous thrombi are produced in the pelvic veins (what are the chances in ovarian cancer? 😉), hence they never get detected before PE.

There is a differential between ante- and post-mortem clots. Believe the pathologist.

I would let you take care of my loved ones.
 
Last edited by a moderator:
pgg said:
Yep

Which is why I dwell on that case. Seems more likely the proximate cause of death was something I did in the OR (maybe she wasn't breathing as well as I thought she was when I took her off monitors for transport and clicked the all-important EMR pixels) ... not the seemingly unlikely chance that a DVT broke loose as we moved her and caused a fatal PE.
Click to expand...

I know what you mean and I have the same thoughts from time to time. I haven’t lost anyone yet since becoming an attending either in transport, OR, or PACU but I know it will happen eventually. I am certain I will decide that I missed something somehow.

I was called to help with a ruptured AAA recently and entered a chaotic OR with CPR and attempts at hemostasis in progress. At the head of the bed I noticed PEA but also that the ventilator was not on. I slammed it on as fast as I could. Did the ventilator not get turned on in the chaos of transfer from the ED bed to OR table and the patient suffered asphyxial arrest because it was missed? I don’t know. But I wonder how many deaths occur because of things like that. And I’m NOT being overly critical. It’s an easy thing to miss, especially if there any many people in the room and everyone wrongly assumes that someone else alrewary took care of something so basic
 
T-burglar said:
I know what you mean and I have the same thoughts from time to time. I haven’t lost anyone yet since becoming an attending either in transport, OR, or PACU but I know it will happen eventually. I am certain I will decide that I missed something somehow.

I was called to help with a ruptured AAA recently and entered a chaotic OR with CPR and attempts at hemostasis in progress. At the head of the bed I noticed PEA but also that the ventilator was not on. I slammed it on as fast as I could. Did the ventilator not get turned on in the chaos of transfer from the ED bed to OR table and the patient suffered asphyxial arrest because it was missed? I don’t know. But I wonder how many deaths occur because of things like that. And I’m NOT being overly critical. It’s an easy thing to miss, especially if there any many people in the room and everyone wrongly assumes that someone else alrewary took care of something so basic
Click to expand...

That should not happen.

I get it... chaos and all....but who ever was in charge of anesthesia should have known better.

That is the kind of stuff that would eat away at my core if it ever happened to me.
 
FFP said:
Periop cancer patient, American sedentary lifestyle, cardiac arrest when moving to/from OR table -> PE is way more likely than you'd think. The rest is between you and your conscience. Nobody's perfect.

Also, many deep venous thrombi are produced in the pelvic veins (what are the chances in ovarian cancer? 😉), hence they never get detected before PE.

There is a differential between ante- and post-mortem clots. Believe the pathologist.

I would let you take care of my loved ones.
Click to expand...
Thanks.

I had an elective, same-day admit CABG scheduled last week that was cancelled because the patient had a stroke the night before surgery. I couldn't help but think, if she'd had that stroke 12 hours later we'd probably have found a way to blame ourselves.
 
You must log in or register to reply here.

Similar threads

M
How different are big cases from little cases?
Replies
21
Views
3K
We'llBeDoneIn15Minutes
W
V
Share your cool TEE / echo cases
Replies
4
Views
869
medicine2wallstreet
M
P
Would you risk your license?
Replies
9
Views
3K
IMGASMD
I
T
  • Question Question
Reimbursement for same day return to OR cases
Replies
10
Views
2K
nimbus
nimbus
G
Methadone for ERAS Spine Cases
Replies
42
Views
4K
MirrorTodd
MirrorTodd
Top