Thora/Para's? I do them.
It's not that much work and the patient feels much much better afterwards. Part of our job is to relieve suffering and trying to breathe with 12liters pushing up on your diaphragm sounds like suffering. Same with 2-3 liters of malignant effusion filling your chest. Sure I could admit them and have IR do it in the morning but that's 14 more hours of suffering. They don't take me much time
For a para you could train a chimp to do it on someone who has massive ascites. Put in the catheter. As Shockindex said hook it to wall suction. Tell the nurse to change canisters and shut off the suction when they get to however many liters you are shooting for. Leave and come back when they are done. If that isn't an option you can even, as Rendar5 said, just leave it draining to gravity into a bucket and come back an hour or two later. I'm only in the room for 10 minutes
I once had a patient flown by fixed wing from a CAH hospital so I could do a therapeutic para because "no one here will do one". Imagine that, ambulance ride to CAH, ambulance ride to airport, 1 hour airplane flight, ambulance ride to my ER from airport all so I could do a therapeutic para. An hour later when we were all done I asked him, "how you getting home?" He said, "damned if I know". Ended up admitting him just so they could figure out how to get him home.
For a thora I only do it if they are obviously suffering but again it doesn't take that long. Probably wouldn't let the chimp do this one. Use ultrasound, put in the catheter. Show the nurse how to pump the 60cc syringe. Tell them to call you when it stops flowing and go see another patient. If my mom couldn't breath and was told to tough it out for 14 hours until IR comes back in that is what I would want. A lot of patients can just go home after you are done. Most cancer patients would rather spend the days they have left at home.
I think they are only worth 2-2.5 RVU's but that doesn't really enter into the equation for me.
It's not that much work and the patient feels much much better afterwards. Part of our job is to relieve suffering and trying to breathe with 12liters pushing up on your diaphragm sounds like suffering. Same with 2-3 liters of malignant effusion filling your chest. Sure I could admit them and have IR do it in the morning but that's 14 more hours of suffering. They don't take me much time
For a para you could train a chimp to do it on someone who has massive ascites. Put in the catheter. As Shockindex said hook it to wall suction. Tell the nurse to change canisters and shut off the suction when they get to however many liters you are shooting for. Leave and come back when they are done. If that isn't an option you can even, as Rendar5 said, just leave it draining to gravity into a bucket and come back an hour or two later. I'm only in the room for 10 minutes
I once had a patient flown by fixed wing from a CAH hospital so I could do a therapeutic para because "no one here will do one". Imagine that, ambulance ride to CAH, ambulance ride to airport, 1 hour airplane flight, ambulance ride to my ER from airport all so I could do a therapeutic para. An hour later when we were all done I asked him, "how you getting home?" He said, "damned if I know". Ended up admitting him just so they could figure out how to get him home.
For a thora I only do it if they are obviously suffering but again it doesn't take that long. Probably wouldn't let the chimp do this one. Use ultrasound, put in the catheter. Show the nurse how to pump the 60cc syringe. Tell them to call you when it stops flowing and go see another patient. If my mom couldn't breath and was told to tough it out for 14 hours until IR comes back in that is what I would want. A lot of patients can just go home after you are done. Most cancer patients would rather spend the days they have left at home.
I think they are only worth 2-2.5 RVU's but that doesn't really enter into the equation for me.
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