how many mistakes?

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ryanjmy

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How many mistakes do you see during this induction? Are you outpt center guys really this lax?

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Induction took about 30 seconds too long. But I get it, the kid is a rookie.
 
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That sort of patient care is not for me. I certainly wouldn’t film it if I did do.
 
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well obviously the patient should have pushed lidocaine first
 
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GassYous said:
Induction took about 30 seconds too long. But I get it, the kid is a rookie.
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Ill never understand why someone would think it makes sense to take a blood pressure in holding and take off the cuff...”when seconds count” ‍
 
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The biggest problem I have is they cannulated the patient, which as we all know is a complete waste of time. Normally I just palpate for the carotid and then inject everything in one go via a 50mL syringe. They never even need a cannula this way. At the start of the day I get a bucket and fill it with a Chef's Blend of Propofol, Fentanyl, Abx, Dexamethasone, and Ondansetron. Each case can then be induced with a 50mL dip into the bucket and then switch them to volatile once asleep.
 
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Obviously this isn’t the safest way of doing things, and if anything goes wrong it’s hard to defend (skipping preoxygenation, not checking a BP in the OR prior to propofol, etc). That being said.... C’mon guys. This looks like a healthy teenager. Pretty hard to mess things up so badly. I’ve let healthy teens push their own propofol before- if it makes them less nervous because it makes the experience novel, or gives them a “challenge” to focus on (‘bet you can’t push the whole syringe before you fall asleep’), who cares? The biggest mistake here as far as I’m concerned, and the only one that reflects a SERIOUS lapse in judgement, was letting this be filmed.
 
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Young healthy patient. Doc looks like he could save himself from the common things that might go wrong. Shouldnt have filmed it given the number of Karen’s and clipboard nurses in the world, but really don’t think this induction is an issue...
 
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sigrhoillusion said:
So did that guy lose his job...?
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Why would he? He's an experienced anesthesiologist working in a surgicenter who knows what he can and can't get away with. I know he didn't do things "by the book" but once you aquire enough skill/experience/confidence, you don't need to.
 
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1. You can argue no face mask whatever, hasn't been shown to protect anyone. But no gloves and gross cross contamination is worrisome.
2. No preoxygenatjon. Indefensible if something happened to pt.
3. No ekg leads?
4. But At least he had a pulse ox on...
5. Having a kid push his own propofol is beyond what I would ever allow a patient to do and contributes to the idea that anesthesia isn't a big deal.
 
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They should be fired for the camera work alone.
 
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woopedazz said:
The biggest problem I have is they cannulated the patient, which as we all know is a complete waste of time. Normally I just palpate for the carotid and then inject everything in one go via a 50mL syringe. They never even need a cannula this way. At the start of the day I get a bucket and fill it with a Chef's Blend of Propofol, Fentanyl, Abx, Dexamethasone, and Ondansetron. Each case can then be induced with a 50mL dip into the bucket and then switch them to volatile once asleep.
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I know a guy, very senior dude, who actually makes 50cc sticks like this at the start of the day for all of his outpatient cases. Scares the **** out of me but he’s been in the game for going on 30 years.
 
woopedazz said:
The biggest problem I have is they cannulated the patient, which as we all know is a complete waste of time. Normally I just palpate for the carotid and then inject everything in one go via a 50mL syringe. They never even need a cannula this way. At the start of the day I get a bucket and fill it with a Chef's Blend of Propofol, Fentanyl, Abx, Dexamethasone, and Ondansetron. Each case can then be induced with a 50mL dip into the bucket and then switch them to volatile once asleep.
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repititionition said:
I know a guy, very senior dude, who actually makes 50cc sticks like this at the start of the day for all of his outpatient cases. Scares the **** out of me but he’s been in the game for going on 30 years.
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One must be sure the syringe is properly labeled “ANESTHESIA”.
 
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Consigliere said:
Why would he? He's an experienced anesthesiologist working in a surgicenter who knows what he can and can't get away with. I know he didn't do things "by the book" but once you aquire enough skill/experience/confidence, you don't need to.
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I'm not sure I agree with your thinking on this. I understand that in an experienced provider's hands, the chances of having a serious airway issue in a patient who looks like this is extremely low, maybe one in 10,000. But... If you're doing thousands of cases a year, it could happen. And when it does, it's not going to look good if you skipped steps for no good reason, like not pre-oxygenating, which is unquestionably the standard of care.
 
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He would not be taking care of my child. Who is this guy?
 
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coffeebythelake said:
5. Having a kid push his own propofol is beyond what I would ever allow a patient to do and contributes to the idea that anesthesia isn't a big deal.
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I disagree. I am thinking about trying it. What an idea. And the patient probably loved it.
 
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epidural man said:
I disagree. I am thinking about trying it. What an idea. And the patient probably loved it.
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Just showing him how to do it for when he tries it at home.



But in reality I was very intrigued by this idea and add in appropriate ASA monitors and pre-oxygenation, that kid probably thought it was so cool.
 
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epidural man said:
I disagree. I am thinking about trying it. What an idea. And the patient probably loved it.
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This guy probably builds rapport in the blink of an eye. I would trust him to do my anesthetic. I would love to push my own prop! Though I would prbly wanna preoxygenate myself
 
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Anyone who is stupid enough to allow themselves to be filmed doing this in this day and age deserves to have their medical license taken away.
 
Really must have 0 skills if this is a big deal. Young healthy person has plenty of reserve for any experienced provider to fix any problems.

Pushing the propofol what a medial task. Kid pushed it fell asleep. Is that any different than me or you pushing the propofol empty the syringe and go to sleep. There is only 20cc in the syringe not like he could go crazy and overdose himself.

This guy is someone who probably has 0 problems getting paid for his service as he makes great rapport with his patients and doesn’t act like a robot like the rest of you sound.

The only issue is the video. More than likely the kid and his family requested it. Letting it escape where people can critique and complain is the only problem.
 
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When he went from bare hand on patient's face to bare hand on his face I gagged.
 
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My pain rotation attending was finishing up his injections at the ASC when he had heard enough from one of the nurses about his constant back pain. Told him to get on the table and did a MBB. This was while the CRNA and other staff were watching and cheering on. It’s no way near as bad as what happened here, but from what I remember the attending just got a talking to from the ASC director, and that was it.
 
Like it or not, we live in a hyper judgmental and litigious society. While “no harm no foul” is how things should work, I would not be surprised if videos like these in the wrong hands could be misconstrued as unethical or dangerous. Want to let your ASA 1 outpatient procedure patient push his own prop? Who cares tbh.

now fast forward in time and imagine a real malpractice case against this anesthesiologist and this video surfaces. Lawyers (and the media) will use it to frame him as reckless or to say he isn’t providing the standard of care in the video so who’s to say he did in the malpractice case.

maybe I’m overreacting but you really need to think twice about things like this these days.
 
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Obvoiusly i wouldnt le tmyself be filmed..

But it's not that uncommon to push 200mg on a young otherwise healthy patient. Ive certainly done it before, without oxygenating... in endo! I dont preoxygenate majority of my patients in Endo. I slug them with prop and run an infusion..
 
anbuitachi said:
Obvoiusly i wouldnt le tmyself be filmed..

But it's not that uncommon to push 200mg on a young otherwise healthy patient. Ive certainly done it before, without oxygenating... in endo! I dont preoxygenate majority of my patients in Endo. I slug them with prop and run an infusion..
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theres nothing wrong with 200 of
Prop without preoxygenating if you know what you’re doing.

My argument is just about the judgement call of being filmed.
 
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Propofool123 said:
Like it or not, we live in a hyper judgmental and litigious society. While “no harm no foul” is how things should work, I would not be surprised if videos like these in the wrong hands could be misconstrued as unethical or dangerous. Want to let your ASA 1 outpatient procedure patient push his own prop? Who cares tbh.

now fast forward in time and imagine a real malpractice case against this anesthesiologist and this video surfaces. Lawyers (and the media) will use it to frame him as reckless or to say he isn’t providing the standard of care in the video so who’s to say he did in the malpractice case.

maybe I’m overreacting but you really need to think twice about things like this these days.
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Honestly. I just want him to put his mask over his face and wear gloves. To me that's the more egregious offense. The would also be my reaction pre-Covid having seen all sorts of drool and smelled all sorts of funk breath.
 
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I don't understand the "healthy, young patient what's the problem" attitude. the problem isn't the patient - it's the routine we rely on for every patient; a routine that can potentially save the pt and your a**. Not to mention, every patient is my family when they're on the table and they've placed their trust in me to (at the very least) not be sloppy, ever.
 
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Reminds me of the video of the dentist treating his patient's standing on one of those hoverboard things; he was just sentenced to 12 years in prison for medical fraud :) Im sure that video didn't hold up well at his trial. Not the same here, but video will follow this dude wherever he goes...
 
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Consigliere said:
R_etard logic
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You can think whatever you want. The signs are all around us, like the dentist on the hoverboard. You need to take these videos and instances not at face value but think one step ahead.
 
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Tramadeezy said:
Reminds me of the video of the dentist treating his patient's standing on one of those hoverboard things; he was just sentenced to 12 years in prison for medical fraud :) Im sure that video didn't hold up well at his trial. Not the same here, but video will follow this dude wherever he goes...
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Yeah but he didn't go to jail BECAUSE of the hoverboard incident from how I understood it.
 
True, but im sure it didnt help his cause. Much like if this doc has a bad outcome at some point and his video resurfaces.
 
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I agree with above... this promotes the idea that a monkey could do it and we are not true professionals.

Regardless of whether I would let a patient do this or not, I would make sure monitors were on, preoxygenation, etc. And I definitely would not film it!

If you knew your pilot was bypassing safety features and going cowboy b/c he was "that good", what would you think? I mean as long as the plane doesn't crash, "no harm, no foul".

We are better than this (to induce this carelessly). And we are smarter than this (to be filmed).
 
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abolt18 said:
Yeah but he didn't go to jail BECAUSE of the hoverboard incident from how I understood it.
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That was the funny part! Put patients' lives at risk-->slap on the wrist. Defraud the government of money--> Decades in prison!!!
 
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