Eye Opening

[NightNight]

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Surgery centers don't have to report deaths in 17 states

Why the nurses think (and can get away with saying) “there’s no difference in outcomes”

Cause nobody’s reporting their clean kills!

 

[Man o War]

We had to take propofol away from our GIs because they were causing so many airway emergencies. Much like here, bad patient selection too.
This is just greed, it’s pathetic.
Add unsupervised CRNAs to that mix, and this does not surprise me. It’s sad and unnecessary. In this era of regulating everything, it’s unreal that we have patients dying after colonoscopies.
I always beat it into residents’ heads that Endo and off site anesthesia suites are among the most dangerous places to be assigned in my experience. Especially if you’re supervising nurses. You’ve got to keep your guard up.

 

[Twiggidy]

Surgery centers don't have to report deaths in 17 states

Why the nurses think (and can get away with saying) “there’s no difference in outcomes”

Cause nobody’s reporting their clean kills!

So the nurses are out here getting all philosophical on us now? If a patient dies in an ASC and no one has to report it, did the patient really die?

 

[TheLoneWolf]

We had to take propofol away from our GIs because they were causing so many airway emergencies. Much like here, bad patient selection too.
This is just greed, it’s pathetic.
Add unsupervised CRNAs to that mix, and this does not surprise me. It’s sad and unnecessary. In this era of regulating everything, it’s unreal that we have patients dying after colonoscopies.
I always beat it into residents’ heads that Endo and off site anesthesia suites are among the most dangerous places to be assigned in my experience. Especially if you’re supervising nurses. You’ve got to keep your guard up.

Wow

I thought that might come up elsewhere. I was doing TAVRs and ablations a few months back and the circulator told me about the cardiologists and gastros were being 'in trained' on propofol. It made no sense to me. We have almost daily airway emergencies, often in the very same neurosurgery, GI, cardiac, vascular suites. Its obscene that some conscious sedation nurses and interventionalists think that 2mg versed and 100-200 mcg fentanyl wont cause apnea.

Anesthesia group doesn't want to step on any toes so no changes were implemented. They pretty much were complacent, citing rarity of bad outcomes. Happily turned down their partnership and locums offers.

 

[coffeebythelake]

Wow

I thought that might come up elsewhere. I was doing TAVRs and ablations a few months back and the circulator told me about the cardiologists and gastros were being 'in trained' on propofol. It made no sense to me. We have almost daily airway emergencies, often in the very same neurosurgery, GI, cardiac, vascular suites. Its obscene that some conscious sedation nurses and interventionalists think that 4mg versed and touch and go fentanyl wont cause apnea.

Anesthesia group doesn't want to step on any toes so no changes were implemented. They pretty much were complacent, citing rarity of bad outcomes. Happily turned down their partnership and locums offers.

Scary and dangerous.

 

[Man o War]

Wow

I thought that might come up elsewhere. I was doing TAVRs and ablations a few months back and the circulator told me about the cardiologists and gastros were being 'in trained' on propofol. It made no sense to me. We have almost daily airway emergencies, often in the very same neurosurgery, GI, cardiac, vascular suites. Its obscene that some conscious sedation nurses and interventionalists think that 2mg versed and 100-200 mcg fentanyl wont cause apnea.

Anesthesia group doesn't want to step on any toes so no changes were implemented. They pretty much were complacent, citing rarity of bad outcomes. Happily turned down their partnership and locums offers.

We tracked the number of times someone had to go rescue the patient, it was obscene. We did not have the man power to come running every time they almost killed someone.
It was to the point that when it was brought to the med exec, they were so appalled it was an easy decision to cut them off. The policy was actually that nobody could use propofol except anesthesia.

 

[TheLoneWolf]

We tracked the number of times someone had to go rescue the patient, it was obscene. We did not have the man power to come running every time they almost killed someone.
It was to the point that when it was brought to the med exec, they were so appalled it was an easy decision to cut them off. The policy was actually that nobody could use propofol except anesthesia.

Makes sense. I’m sure even the manufacturer says nonanesthetists shouldnt touch it than that should end this behavior:

Diprivan product insert from the FDA website:
For general anesthesia or monitored anesthesia care (MAC) sedation, DIPRIVAN Injectable Emulsion should be administered only by persons trained in the administration of general anesthesia and not involved in the conduct of the surgical/diagnostic procedure.

 

[Psai]

Wow

I thought that might come up elsewhere. I was doing TAVRs and ablations a few months back and the circulator told me about the cardiologists and gastros were being 'in trained' on propofol. It made no sense to me. We have almost daily airway emergencies, often in the very same neurosurgery, GI, cardiac, vascular suites. Its obscene that some conscious sedation nurses and interventionalists think that 2mg versed and 100-200 mcg fentanyl wont cause apnea.

Anesthesia group doesn't want to step on any toes so no changes were implemented. They pretty much were complacent, citing rarity of bad outcomes. Happily turned down their partnership and locums offers.

I don't care if people want to do things they shouldn't be but that stops when they're calling us in to fix their mistakes.

 

[Arch Guillotti]

Its obscene that some conscious sedation nurses and interventionalists think that 2mg versed and 100-200 mcg fentanyl wont cause apnea.

They don't if given carefully and incrementally.

 

[deleted697535]

It really is crazy.
I did a rotation with a gi friend a couple years ago, observer only. He's way more senior than me in years but not in airway.

He asked his nurse to push '2 and 100 as usual'. No way I would've done that to his first patient. He was about to crump

But give them their dues, they are fast!! The gi guys don't think so much about sedation and get thru a lot of scopes in a day. Yeah they might kill the odd person but our meddling would vastly slow them down. Safety is slow unfortunately. Who knew eh?

 

[WholeLottaGame7]

During training, my wife had a colonoscopy at my residency program. 60kg, got 6mg midaz and 150mcg of propofol, was a first start case, "woke up" at 230 that afternoon. Was talking to one of the good CRNAs who was over there (was a mix of RN sedation and ACT anesthesia at that time), said before anesthesia was involved, they would constantly be rescuing "moderate" sedations. He said his record that he saw was 32mg of midaz. Unbelievable.

 

[Psai]

During training, my wife had a colonoscopy at my residency program. 60kg, got 6mg midaz and 150mcg of propofol, was a first start case, "woke up" at 230 that afternoon. Was talking to one of the good CRNAs who was over there (was a mix of RN sedation and ACT anesthesia at that time), said before anesthesia was involved, they would constantly be rescuing "moderate" sedations. He said his record that he saw was 32mg of midaz. Unbelievable.

Maybe the patient was in status