In office procedures

[paindoctor2014]

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Just started doing them. Are you:

Checking blood sugars
Pregnancy tests
Keeping intralipid

 

[BobBarker]

No.

 

[Laryngospasm]

Why would you need intralipid? I do check sugars on diabetics. Hospital policy. Probably not necessary.

 

[lobelsteve]

None of the above.

 

[Baron S]

No. For diabetic pts I just make sure their most recent A1C isn't super high before doing a steroid injection or considering implanted devices.

 

[bedrock]

No one does pregnancy tests??

 

[lobelsteve]

No one does pregnancy tests??

Only if you think it is yours.

 

[SSdoc33]

No one does pregnancy tests??

xray tech whispers in patient's ear "any chance of pregnancy?"

patient laughs

we carry on with our lives....

 

[Ducttape]

I don't test.

However, I have seen at least 10 cases of immaculate conceptions in my ER career, none as a pain doctor.

Suggestion - if you see fingers and toes in your scout film, abort the procedure.

 

[Ducttape]

You do not need intralipid if you are doing bread and butter injections (esi, Mbb, rfa).


If you do sympathetic blocks, then you should probably have some, along with a rescue box.

 

[callmeanesthesia]

Patient signs on consent form that there is no chance they could be pregnant. If they’re not sure, either they take a pregnancy test or delay procedure.

For diabetics, we ask their most recent blood sugar and A1C for steroid injections. We check it if they don’t know or if no recent check, especially if history do poor glycemic control.

 

[cowboydoc]

I've been the bearer of surprising news x2 in the pre-procedure area. One was shocked in a happy way, the other...not so much. Both procedures canceled.

Hospital requires test or signing a refusal form noting risk.

 

[MD87]

SIS fact finder suggests possibly postponing ESI if blood glucose >200.

 

[Baron S]

SIS fact finder suggests possibly postponing ESI if blood glucose >200.

Yeah, I use a1c > 9 as a hard cut off and want a fingerstick that day if between 8 and 9.

 

[CleanUp]

I've been the bearer of surprising news x2 in the pre-procedure area. One was shocked in a happy way, the other...not so much. Both procedures canceled.

Hospital requires test or signing a refusal form noting risk.

Should have stimmed the fetus.

Dark humor y’all…

 

[sdnuser001]

No. For diabetic pts I just make sure their most recent A1C isn't super high before doing a steroid injection or considering implanted devices.

What's your cutoff?

 

[Ducttape]

not sure about Baron's -

my cut off is 8.5, unless doing MBB or RFA as Baron alluded to.

 

[Baron S]

Yeah, I use a1c > 9 as a hard cut off and want a fingerstick that day if between 8 and 9.

What's your cutoff?

Sorry, added that in a separate response.

 

[drrosenrosen]

Do you count on pts to know their A1C and report it reliably? We do fingersticks, and sometimes that does result in day of cancellations/reschedules because "oh, it must have been that 32oz sweet tea I had on the way over"

 

[Ducttape]

in this area, all the major health systems and labs use Epic.

i find that there is an inverse relationship between an individual knowing what their A1C number is and how well they are actually controlling their diabetes.

 

[drrosenrosen]

One of the few things I loved working at a large hospital/academic center was having Epic and being able to read all of the notes from PCPs, other specialists. Made things so streamlined. Now I've got 5 different imaging portals to look things up on, and if records aren't faxed to us, I don't know what surgery they had, what new med their PCP put them on, etc.

 

[PainMD23]

Yes to all. We've had 2 positive pregancy tests which were true positives over the past 7 years. I postpone patients with FSBS >300 all the time. I typically will do a 250-300 if non-steroid procedure.