Dallas Jury awards $21M for anoxic brain injury under anesthesia at BUMC

[Ronin786]

This is a young patient who is permanently disabled and will need expensive care for the remainder of what could still be a very long life. How much are good nursing homes nowadays? How much will it cost to provide 24/7 nursing care for 30-50yrs? How much will his medical bills be? And mom has relocated to take care of her son. What did she do for a living? What did the patient do before his injury? Economic damages can be huge.

Tort reform states have caps on noneconomic damages (like pain and suffering) but there are no limits on economic damages. California is a tort reform state with a cap of $250k for noneconomic damages. However, there have been 8 figure settlements and jury awards when a child or young professional becomes permanently disabled by malpractice. When a patient dies, the settlements tend to be smaller. But when they survive and need lifetime care, the amounts can be very high.

Edit:

In rereading the article, it says $8mil of the award was for medical care. Of the remaining $13mil, I’m sure some of it was for lost income, some for pain and suffering, and some to send a message.

You misunderstood me. My point is, failure to be notified of the option of an MD was not the reason this occurred. I'm obviously not a lawyer, but that doesn't seem like an incriminating piece of evidence.

That's like me going to dinner and not being told that there's an option to have a chef or an associate prepare my food. Except the associate serves me raw chicken because he put it in the oven, didn't turn the oven on and then covered it with gravy to make it appear cooked while taking a 12 minute smoke break.

The incriminating piece here isn't my failure to be notified. It's the ******* associate.

If anyone has this and can share, I would sincerely appreciate it.

Anesthesiologist Staffing Ratio and Surgical Patient Morbidity and Mortality

This cohort study uses data from the Multicenter Perioperative Outcomes Group database to examine the association between intraoperative anesthesiologist staffing ratio and surgical patient morbidity and mortality across 23 hospitals in 18 states.

jamanetwork.com

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[doc123456]

Wait until everyone figures out that USAP regularly staffs at radios higher than 1:4 especially in the Houston market…these articles don’t even address “medical supervision” at 1:6 and 1:8…

 

[ERRES2288]

This case is very strange. If there was hypoxic event for a prolonged period of time it’s likely surgeons and RNs would have been aware but something obviously happened. Maybe pushed a bunch of propofol, threw in LMA and patient apneic for some time without a working pulse ox? We have so many alarms it’s tough for me to imagine others weren’t aware of something so catastrophic to lead to a 27 yo having anoxic brain injury.

 

[dannyboy1]

Bottom line: There is nothing in the lawsuit that I have seen that is malpractice. No mention of any problem with intubation or extubation, no documented allergic reaction. Ect…
This may be the one in a million case where mild hypotension causes problems. Literally the only mechanism of injury that the PLAINTIFF put forward was hypotension. I wouldn’t convict based on this evidence but I’m sure they found an “expert” who claimed that this was gross malpractice…,,

 

[aneftp]

Let’s not make of any patient injury or death here. Even MD only practice can have brain injury leading to death. Aka Ron springs former running back for Dallas cowboys MD only outpatient has anoxic brain injury for what probably was routine vascular graft for his dialysis. They sued cause of the cap on medical malpractice.

Joan rivers gi procedure/death was MD only as well

At Least Ron Springs' Family Will Be Compensated For His Tragic Death. Right?

Ron Springs' fight is dead. His litigation, however, lives on. While former Cowboys teammates Roger Staubach and Everson Walls prepare to speak at Springs' funeral in Carrollton on Thursday, the ex-running back, who died of a heart attack while in a 3 1/2-year coma last week, is still being...

www.dallasobserver.com

 

[Xman5678]

Bottom line: There is nothing in the lawsuit that I have seen that is malpractice. No mention of any problem with intubation or extubation, no documented allergic reaction. Ect…
This may be the one in a million case where mild hypotension causes problems. Literally the only mechanism of injury that the PLAINTIFF put forward was hypotension. I wouldn’t convict based on this evidence but I’m sure they found an “expert” who claimed that this was gross malpractice…,,

Something smells bad about this case. I googled the doc and CRNA. Both recent grads when the event happened. Giving pressors with normal vital signs charted. The CRNA appears to have relocated to another state.

 

[gasdoc77]

-per the WFAA article
"Despite written policies by U.S. Anesthesia Partners, the suit alleged, Rojas was not informed that he had “the right to choose” whether to have an anesthesiologist or CRNA."

If that is, indeed, a written USAP policy, then they (and any medical direction/supervision group that offers patients an option) should send a reminder bulletin to their providers of said policy. In fact, failure to do so in light of this would be (intentionally?) neglectful to the physician(s) as well as the patients. This could set a precedent while increasing demand for physicians to be available and/or offered as an option.

 

[greatnt249]

Let’s not make of any patient injury or death here. Even MD only practice can have brain injury leading to death. Aka Ron springs former running back for Dallas cowboys MD only outpatient has anoxic brain injury for what probably was routine vascular graft for his dialysis. They sued cause of the cap on medical malpractice.

Joan rivers gi procedure/death was MD only as well

At Least Ron Springs' Family Will Be Compensated For His Tragic Death. Right?

Ron Springs' fight is dead. His litigation, however, lives on. While former Cowboys teammates Roger Staubach and Everson Walls prepare to speak at Springs' funeral in Carrollton on Thursday, the ex-running back, who died of a heart attack while in a 3 1/2-year coma last week, is still being...

www.dallasobserver.com

Take x number CRNAs and an equal x number MD/DO anesthesiologists...which group, as a whole, has a higher probability of having an adverse outcome? Don't sell yourselves short just because "anyone" could have a bad outcome.

 

[Status Sciaticus]

Maybe the patients gown was tight around the neck for a prolonged time impeding carotid/jugular? Has to be something. It’s certainly not MAPs in the 50-60’s in an otherwise healthy patient.

Perhaps the CRNA who was giving loads of pressors and charting perfect vitals was in fact not charting the true vitals, and it was way worse than it looked

 

[TheLoneWolf]

Let’s not make of any patient injury or death here. Even MD only practice can have brain injury leading to death. Aka Ron springs former running back for Dallas cowboys MD only outpatient has anoxic brain injury for what probably was routine vascular graft for his dialysis. They sued cause of the cap on medical malpractice.

Joan rivers gi procedure/death was MD only as well

At Least Ron Springs' Family Will Be Compensated For His Tragic Death. Right?

Ron Springs' fight is dead. His litigation, however, lives on. While former Cowboys teammates Roger Staubach and Everson Walls prepare to speak at Springs' funeral in Carrollton on Thursday, the ex-running back, who died of a heart attack while in a 3 1/2-year coma last week, is still being...

www.dallasobserver.com

Anoxic brain injury for an elbow cyst? This is very sad.

 

[coffeebythelake]

Perhaps the CRNA who was giving loads of pressors and charting perfect vitals was in fact not charting the true vitals, and it was way worse than it looked

Yes I'm suspicious how the charting takes place. Is it automatically pulled or was it manually put in?

 

[coffeebythelake]

Anesthesiologist Staffing Ratio and Surgical Patient Morbidity and Mortality

This cohort study uses data from the Multicenter Perioperative Outcomes Group database to examine the association between intraoperative anesthesiologist staffing ratio and surgical patient morbidity and mortality across 23 hospitals in 18 states.

jamanetwork.com

Yep this is the one i was talking about. I knew it was recent sometime but didn't think it was from 2022. Retrospective study but certainly compelling especially when thinking that more complex higher risk cases should preferentially lean to lower staff ratios.

 

[marr65]

Anoxic brain injury for an elbow cyst? This is very sad.

Second hand story but Ron Springs was a known difficult airway. Surgeon and patient decided to do case at a stand alone ASC with a brand new anesthesiologist. Pt became the unable to ventilate/intubate scenario right after induction.

As for the 27 year old, I think pt might have gone into a PEA from a fat embolism.

 

[nimbus]

From previous posts, y'all know we're pretty much 99%+ medically directed ACT. Not here to debate the pros and cons.

What I don't get is CRNAs that don't call for help. I've never understood this attitude. We drum this into all of our anesthetists, CRNA and CAA, from day one, or even earlier if they've rotated through our hospitals as students. Got a problem? Call for help. You can't call? Tell your circulator, loudly and clearly, to call for you, or hit the emergency button in the OR if there is one. Absolutely nobody in my department is going to criticize anyone that calls for help for anything, whether it's something minor or something catastrophic, because we don't want anyone to think they're being wimpy or a poor anesthetist or doc just because they call for help. Rather, calling for help is a sign of a professional that puts the patient's wellbeing before ego.

Don't call for help? You'll have a private conversation later with the attending doc or chairman. It will be very blunt and one-sided.

Calling for help is something we drill in our all MD practice too.

 

[nimbus]

You misunderstood me. My point is, failure to be notified of the option of an MD was not the reason this occurred. I'm obviously not a lawyer, but that doesn't seem like an incriminating piece of evidence.

That's like me going to dinner and not being told that there's an option to have a chef or an associate prepare my food. Except the associate serves me raw chicken because he put it in the oven, didn't turn the oven on and then covered it with gravy to make it appear cooked while taking a 12 minute smoke break.

The incriminating piece here isn't my failure to be notified. It's the ******* associate.

Anesthesiologist Staffing Ratio and Surgical Patient Morbidity and Mortality

This cohort study uses data from the Multicenter Perioperative Outcomes Group database to examine the association between intraoperative anesthesiologist staffing ratio and surgical patient morbidity and mortality across 23 hospitals in 18 states.

jamanetwork.com

I was just addressing the size of the award, not the reason why they found malpractice.

 

[nimbus]

Let’s not make of any patient injury or death here. Even MD only practice can have brain injury leading to death. Aka Ron springs former running back for Dallas cowboys MD only outpatient has anoxic brain injury for what probably was routine vascular graft for his dialysis. They sued cause of the cap on medical malpractice.

Joan rivers gi procedure/death was MD only as well

At Least Ron Springs' Family Will Be Compensated For His Tragic Death. Right?

Ron Springs' fight is dead. His litigation, however, lives on. While former Cowboys teammates Roger Staubach and Everson Walls prepare to speak at Springs' funeral in Carrollton on Thursday, the ex-running back, who died of a heart attack while in a 3 1/2-year coma last week, is still being...

www.dallasobserver.com

It is odd that the story says the anesthesiologist was “working under the supervision” of the plastic surgeon. Probably just the usual journalist cluelessness.

 

[deleted875777]

Second hand story but Ron Springs was a known difficult airway. Surgeon and patient decided to do case at a stand alone ASC with a brand new anesthesiologist. Pt became the unable to ventilate/intubate scenario right after induction.

As for the 27 year old, I think pt might have gone into a PEA from a fat embolism.

Per court record, CT/MRI read said fat embolism unlikely

 

[teacher2md]

Who pays in this situation?
Certainly doc/and CRNA don’t have that $$. Malpractice insurance has a cap (usually 1 million).
We have no details about what went on in the case but I’m assuming lost airway. Pretty hard to fu(k up a 27 year old without involvement of the airway, and a lost airway is pretty much indefensible these days….

Typically the case is litigated in a way to put the employer/hospital on the hook for much of it. I haven’t read the details of the case, but I bet they argued that NAPA is liable due to its staffing practices.

If a doc is found liable for more than $1M, the plaintiff usually settles at $1M and does does not go after personal assets. The reason is that it would be bad optics for the plaintiff industry to have headlines about a doctor being homeless due to a lawsuit.

The only times when plaintiffs have gone after personal assets are apparently when the doc was intentional under-insured, as a way of punishing him/her.

Could a malpractice mega-verdict wipe you out?

In theory, yes. But in reality, doctors rarely lose their personal assets.

www.medicaleconomics.com

 

[vector2]

This is very strange. Mild hypotension in a 27 year old causing anoxic encephalopathy? No way…

I've had a couple cases throughout the years where I had refractory hypotension in otherwise healthy ppl getting balanced anesthetics. No obvious rash, wheezing, high peak pressures. Maybe slightly decreased ETCO2 like the pt in question. Not responding to fluids and ounces of neo, norepi and vaso. Start giving epi boluses, benadryl, pepcid, solumedrol and all of a sudden they snap out of it.

Assuming he wasn't on an ace/arb and it wasn't PE/fat embolus, subclinical anaphylaxis is certainly high up on my list.

 

[nimbus]

Who pays in this situation?
Certainly doc/and CRNA don’t have that $$. Malpractice insurance has a cap (usually 1 million).
We have no details about what went on in the case but I’m assuming lost airway. Pretty hard to fu(k up a 27 year old without involvement of the airway, and a lost airway is pretty much indefensible these days….

Probably the deepest pockets, USAP and Baylor. Both those organizations(if they are self insured) or their insurers may have reinsurance for amounts beyond their primary insurance limits. I know of a case from 2 decades ago where the University of California paid an 8 figure sum.

 

[dannyboy1]

Probably the deepest pockets, USAP and Baylor. Both those organizations(if they are self insured) or their insurers may have reinsurance for amounts beyond their primary insurance limits. I know of a case from 2 decades ago where the University of California paid an 8 figure sum.

Typically the jury assigns percentage of blame to each defendant based on the nature of the case. One defendant is not liable for the other defendants inability to pay.

 

[dannyboy1]

I've had a couple cases throughout the years where I had refractory hypotension in otherwise healthy ppl getting balanced anesthetics. No obvious rash, wheezing, high peak pressures. Maybe slightly decreased ETCO2 like the pt in question. Not responding to fluids and ounces of neo, norepi and vaso. Start giving epi boluses, benadryl, pepcid, solumedrol and all of a sudden they snap out of it.

Assuming he wasn't on an ace/arb and it wasn't PE/fat embolus, subclinical anaphylaxis is certainly high up on my list.

You would have to be profoundly hypotensive for a prolonged time to have global anoxic injury. Especially in a healthy 27 year old. Maybe he was, but the complaint only mentioned systolic’s in the 80’s. I know everyone likes to $hit on ACT and CRNA’s but the reality is what happened here is kind of a mystery. Could happen to any of us….

 

[vector2]

You would have to be profoundly hypotensive for a prolonged time to have global anoxic injury. Especially in a healthy 27 year old. Maybe he was, but the complaint only mentioned systolic’s in the 80’s. I know everyone likes to $hit on ACT and CRNA’s but the reality is what happened here is kind of a mystery. Could happen to any of us….

Prolonged time? Nah, one can sustain a devastating hypoxic brain injury with like ~5-8 min of significant hypotension.

Fraudulent paper charting +- possible monitor error (cuff size/fit/compression) +- CRNAs not infrequently running young people at 1.5-2 MAC for painful Ortho cases (and thus disrupting autoregulatory curves) makes hypotensive hypoxic injury definitely possible.


You are right that this could happen to any of us, but the ACT model makes it infinitely more likely that the mystery diagnosis was not acted upon quickly enough. Time and time and time again I see CRNAs who, despite their big egos, know they're not on the surgeons' level and thus are terrified of 1. Calling for help, 2. telling the surgeon to stop when the pt is doing poorly.

 

[amyl]

Who pays in this situation?
Certainly doc/and CRNA don’t have that $$. Malpractice insurance has a cap (usually 1 million).
We have no details about what went on in the case but I’m assuming lost airway. Pretty hard to fu(k up a 27 year old without involvement of the airway, and a lost airway is pretty much indefensible these days….

This was not it

 

[Southpaw]

You would have to be profoundly hypotensive for a prolonged time to have global anoxic injury. Especially in a healthy 27 year old. Maybe he was, but the complaint only mentioned systolic’s in the 80’s. I know everyone likes to $hit on ACT and CRNA’s but the reality is what happened here is kind of a mystery. Could happen to any of us….

Paper charting. What reason do you have to believe any of it?

 

[vector2]

CRNA practice I see often enough it sticks in my memory:

-Not having a phenylephrine stick immediately available at induction
-Giving way too much propofol to everyone
-Giving way too much fentanyl to everyone
-Running everyone on 2+ of sevo even if they're an 89yo dementor
-Letting pts be hypotensive for 10-15 min because incision was coming "at any moment"
-Moving the cuff to 7 different locations if they don't like the reading
-Hyperventilating pts to way too low ETCO2s
-Presuming every instance of hypotension in a normalish pt is because the pt is "dry"
-Presuming every pt with a hx of ESRD or CHF can never be "dry"

 

[amyl]

Something smells bad about this case. I googled the doc and CRNA. Both recent grads when the event happened. Giving pressors with normal vital signs charted. The CRNA appears to have relocated to another state.

This crna has not relocated to another state

 

[abolt18]

CRNA practice I see often enough it sticks in my memory:

-Not having a phenylephrine stick immediately available at induction
-Giving way too much propofol to everyone
-Giving way too much fentanyl to everyone
-Running everyone on 2+ of sevo even if they're an 89yo dementor
-Letting pts be hypotensive for 10-15 min because incision was coming "at any moment"
-Moving the cuff to 7 different locations if they don't like the reading
-Hyperventilating pts to way too low ETCO2s
-Presuming every instance of hypotension in a normalish pt is because the pt is "dry"
-Presuming every pt with a hx of ESRD or CHF can never be "dry"

You just summed up much of my first year of practice! People always say "you learn more in your first year of practice than all of residency." And I have to say that was NOT my experience. At least, not about actual anesthesia. I did learn a lot about 1) carefully choosing my battles and which hills to die on, 2) trusting (almost) no one, even the crnas with a good reputation (few seemed immune from stupidity) 3) getting a crna to buy-into my anesthetic plan, and 4) trusting the "confident" crnas even less than all others.

We have some great crnas, but the burden and stress and frustration of working with the not-great ones is too much for me.

 

[amyl]

When the crna left the room for 12 minutes it is because he was given a break by another crna. There was always a crna in the room. This article has a lot of missing information and a huge bias. I would really like to post the facts of the case but I can’t…. When the appeals are settled and I can I will.

Let me ask all of you this- would anyone order a preop echo on a 27 year old with a tibial fracture?
Would anyone suspect embolism in this case?

 

[coffeebythelake]

When the crna left the room for 12 minutes it is because he was given a break by another crna. There was always a crna in the room. This article has a lot of missing information and a huge bias. I would really like to post the facts of the case but I can’t…. When the appeals are settled and I can I will.

Let me ask all of you this- would anyone order a preop echo on a 27 year old with a tibial fracture?
Would anyone suspect embolism in this case?

No. Not for the description of global anoxic brain injury. It ain't an embolism.

Plain and simple. This was hypoxemia or hypotension. Hypoxemia should be easily detected by that blaring alarm unless the patient didn't even have a pulse ox. Like most of you guys here I agree profound hypotension is most likely the reason, consistent with the nurse dosing of vasopreasors despite "normal" falsely documented BPs. Compared to EMR, these paper charts have a statistically higher chance of showing train track vitals...🤔

While bad outcomes can and do happen to anyone, what should NOT happen is falsifying medical records or pretending that everything is fine and ignoring the problem instead of asking for help. You can blame the anesthesiologist for not being omnipresent but realistically this is on the nurse playing doctor.

 

[BLADEMDA]

In the ACT model the anesthesiologist will be sued for the actions or inactions of the crna. The burden of proof that the crna was solely at fault Will need to be proven by you. That’s the price you pay for the ACT model.

 

[aneftp]

When the crna left the room for 12 minutes it is because he was given a break by another crna. There was always a crna in the room. This article has a lot of missing information and a huge bias. I would really like to post the facts of the case but I can’t…. When the appeals are settled and I can I will.

Let me ask all of you this- would anyone order a preop echo on a 27 year old with a tibial fracture?
Would anyone suspect embolism in this case?

We had a very similar case recently. Briefly lost all end tidal. Pressures tanked. So I’m not sure how well the documentation was in the Dallas case . Echo was brought into the room and tee intraop done 15 min after event. Whatever it was. Got dislodged. Didn’t see anything peculiar that would show PE Patient went for to IR. IR docs couldn’t find anything either.

Patient remarkably did ok. So got lucky.

So while I don’t know the specific detail about this particular case. If they are on paper. They should switch to emr. We all know how messy paper can be.

 

[Xman5678]

In the ACT model the anesthesiologist will be sued for the actions or inactions of the crna. The burden of proof that the crna was solely at fault Will need to be proven by you. That’s the price you pay for the ACT model.

Sometimes only one will take a hit in the event of a settlement or verdict. Sometimes both.

 

[ERRES2288]

Realistically how low would the MAP have to go and for how long before you would get such profound global hypoxic injury in a healthy 27yo ? I would say <50 for at least 10 min or so and even then.. @amyl your pre op echo question makes me think he had HCOM or some other undiagnosed heart condition

 

[nimbus]

Realistically how low would the MAP have to go and for how long before you would get such profound global hypoxic injury in a healthy 27yo ? I would say <50 for at least 10 min or so and even then.. @amyl your pre op echo question makes me think he had HCOM or some other undiagnosed heart condition

She also mentioned embolus so may be alluding to a septal defect.

 

[dannyboy1]

No. Not for the description of global anoxic brain injury. It ain't an embolism.

Plain and simple. This was hypoxemia or hypotension. Hypoxemia should be easily detected by that blaring alarm unless the patient didn't even have a pulse ox. Like most of you guys here I agree profound hypotension is most likely the reason, consistent with the nurse dosing of vasopreasors despite "normal" falsely documented BPs. Compared to EMR, these paper charts have a statistically higher chance of showing train track vitals...🤔

While bad outcomes can and do happen to anyone, what should NOT happen is falsifying medical records or pretending that everything is fine and ignoring the problem instead of asking for help. You can blame the anesthesiologist for not being omnipresent but realistically this is on the nurse playing doctor.

1). Seems it was not an airway event. Those can’t be covered up (room nurses are involved)
2) so we are looking at hypotension. This is a healthy 27 year old. Do we know the dosages and meds used for induction/maintenance? Would have to be a lot to tank a 27 year old and keep him down long enough for encephalopathy. (Remember, the more you give, the more CMRO2 decreases). I do a lot of neuro cases with monitoring and the monitoring doesn’t change much even with pretty significant hypotension.
We do alot of cerebral angiography at my shop as well and the brain seems to perfuse regardless of the BP. the only explanation I can think of is that there was something tight around the neck (gown, EKG cable) which compressed carotid or jugular
3. Paper records are all bull$hit. Everyone who uses a paper record is guilty of “train tracking” (some more than others) Every anesthesia lawsuit I have seen accuses the providers of coverup with regard to charting. It’s an easy target for attorneys when things go bad, but we all know it is widespread and prevalent. It is what it is.

 

[dannyboy1]

In the ACT model the anesthesiologist will be sued for the actions or inactions of the crna. The burden of proof that the crna was solely at fault Will need to be proven by you. That’s the price you pay for the ACT model.

Yup. Besides, your defense attorney is likely representing the CRNA as well if you are employed by the same entity and covered by the same malpractice carrier. Gets tricky. Unfortunately, the best thing to do is to get on the same page with your CRNA and only discuss the case with your attorney. DONT start pointing fingers during/after the event. It will likely backfire. The less said, the better.

 

[nimbus]

1). Seems it was not an airway event. Those can’t be covered up (room nurses are involved)
2) so we are looking at hypotension. This is a healthy 27 year old. Do we know the dosages and meds used for induction/maintenance? Would have to be a lot to tank a 27 year old and keep him down long enough for encephalopathy. (Remember, the more you give, the more CMRO2 decreases). I do a lot of neuro cases with monitoring and the monitoring doesn’t change much even with pretty significant hypotension.
We do alot of cerebral angiography at my shop as well and the brain seems to perfuse regardless of the BP. the only explanation I can think of is that there was something tight around the neck (gown, EKG cable) which compressed carotid or jugular
3. Paper records are all bull$hit. Everyone who uses a paper record is guilty of “train tracking” (some more than others) Every anesthesia lawsuit I have seen accuses the providers of coverup with regard to charting. It’s an easy target for attorneys when things go bad, but we all know it is widespread and prevalent. It is what it is.

The electronic record can also help protect you in the event of a bad outcome. I find myself running a lot more low dose phenylephrine or norepinephrine infusions since we’ve gone electronic.

 

[dannyboy1]

The electronic record can also help protect you in the event of a bad outcome. I find myself running a lot more low dose phenylephrine or norepinephrine infusions since we’ve gone electronic.

Maybe. Can also hurt you if the VS are not looking that great and something happens….

 

[nimbus]

Maybe. Can also hurt you if the VS are not looking that great and something happens….

But at least the recorded vitals are less likely to be fictitious.

 

[abolt18]

But at least the recorded vitals are less likely to be fictitious.

I had an attending during residency that would chart ahead vitals while I was on a break. Come back and he's already charted perfect vitals for the next 30 minutes...

 

[dannyboy1]

I had an attending during residency that would chart ahead vitals while I was on a break. Come back and he's already charted perfect vitals for the next 30 minutes...

It’s called “planning ahead “

 

[chocomorsel]

Second hand story but Ron Springs was a known difficult airway. Surgeon and patient decided to do case at a stand alone ASC with a brand new anesthesiologist. Pt became the unable to ventilate/intubate scenario right after induction.

As for the 27 year old, I think pt might have gone into a PEA from a fat embolism.

PEA? And no code called? So… no BP, No sats, an EKG rhythm, ashen patient, brought back to life with phenylephrine and no compressions and no one notices?
This one sounds very, very, highly unlikely. I don’t know what happened but it’s probably not this.

 

[chocomorsel]

Calling for help is something we drill in our all MD practice too.

It’s something that is drilled in us in residency. Is this something that is drilled into CRNA school?

 

[chocomorsel]

Prolonged time? Nah, one can sustain a devastating hypoxic brain injury with like ~5-8 min of significant hypotension.

Fraudulent paper charting +- possible monitor error (cuff size/fit/compression) +- CRNAs not infrequently running young people at 1.5-2 MAC for painful Ortho cases (and thus disrupting autoregulatory curves) makes hypotensive hypoxic injury definitely possible.


You are right that this could happen to any of us, but the ACT model makes it infinitely more likely that the mystery diagnosis was not acted upon quickly enough. Time and time and time again I see CRNAs who, despite their big egos, know they're not on the surgeons' level and thus are terrified of 1. Calling for help, 2. telling the surgeon to stop when the pt is doing poorly.

Big egos but scared of the surgeon? Doesn’t compute. Lol
Do ACT practices drill it to their nurses to call for help? I mean we docs do it all the time in my experience without any issue. F what the surgeon thinks. Are all y’all workijf jn these models preaching this to the nurses? And having ramifications if they don’t and something bad happens?

 

[chocomorsel]

You just summed up much of my first year of practice! People always say "you learn more in your first year of practice than all of residency." And I have to say that was NOT my experience. At least, not about actual anesthesia. I did learn a lot about 1) carefully choosing my battles and which hills to die on, 2) trusting (almost) no one, even the crnas with a good reputation (few seemed immune from stupidity) 3) getting a crna to buy-into my anesthetic plan, and 4) trusting the "confident" crnas even less than all others.

We have some great crnas, but the burden and stress and frustration of working with the not-great ones is too much for me.

And what are you planning on doing about it? It’s not gonna get any better. Their egos continue to grow with each new class.

 

[coffeebythelake]

It’s something that is drilled in us in residency. Is this something that is drilled into CRNA school?

Perhaps not if means a militant CRNA have to show inferiority to the anesthesiologist who comes to rescue the patient. It's right there in the AANA "nurse anesthesiologist" guide book next to the chapters on "fake it until you make it" and "its hard to kill a patient"

 

[chocomorsel]

Perhaps not if means a militant CRNA have to show inferiority to the anesthesiologist who comes to rescue the patient. It's right there in the AANA "nurse anesthesiologist" guide book next to the chapters on "fake it until you make it" and "its hard to kill a patient"

Hahahah.

 

[linkin06]

Big egos but scared of the surgeon? Doesn’t compute. Lol
Do ACT practices drill it to their nurses to call for help? I mean we docs do it all the time in my experience without any issue. F what the surgeon thinks. Are all y’all workijf jn these models preaching this to the nurses? And having ramifications if they don’t and something bad happens?

They call for help too late. The most dangerous thing is when you don’t know that you don’t know

 

[chocomorsel]

They call for help too late. The most dangerous thing is when you don’t know that you don’t know

I really dislike working with CRNAs. I have a met a few who are very physician friendly and respectful, without ego and run everything by you and are very approachable, but the bad, egotistical batch just makes it so not worth the pain.