Managing conflict

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maverickdoc

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I have a contentious working relationship with a trauma surgeon at work . He operated on a 90 yo pt who went into ARDS . She had a small pleural effusion that he insisted needed to be tapped and was the reason she was still on the vent . I politely said no . She obviously ended up dying
Since then he has stopped talking/ ignoring me which I find amusing . He is 20 yrs older than me and pretty high up in the administration. I finished fellowship last yr .
Should I try to talk to him to clear this out ? Any suggestions ?
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Wait until he retires/dies?
Jk.
It happens, nothing on you, you did what you thought was best for her and that should be it.
Give it time, he's probably projecting on you and do try to talk/reach to him within reason but I would not bend over to do so.


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maverickdoc said:
I have a contentious working relationship with a trauma surgeon at work . He operated on a 90 yo pt who went into ARDS . She had a small pleural effusion that he insisted needed to be tapped and was the reason she was still on the vent . I politely said no . She obviously ended up dying
Since then he has stopped talking/ ignoring me which I find amusing . He is 20 yrs older than me and pretty high up in the administration. I finished fellowship last yr .
Should I try to talk to him to clear this out ? Any suggestions ?
Click to expand...

To be fair, sometimes removing a small amount of pleural fluid can make a big difference. But it's tough to say without knowing the rest of the details.
 
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TimesNewRoman said:
To be fair, sometimes removing a small amount of pleural fluid can make a big difference. But it's tough to say without knowing the rest of the details.
Click to expand...
Anesthesiology. 2017 Mar 24. doi: 10.1097/ALN.0000000000001621. [Epub ahead of print]
Prevalence and Impact on Weaning of Pleural Effusion at the Time of Liberation from Mechanical Ventilation: A Multicenter Prospective Observational Study.
Dres M1, Roux D, Pham T, Beurton A, Ricard JD, Fartoukh M, Demoule A.
Author information

Abstract
BACKGROUND:
Pleural effusion is frequent in intensive care unit patients, but its impact on the outcome of weaning remains unknown.

METHODS:
In a prospective study performed in three intensive care units, pleural ultrasound was performed at the first spontaneous breathing trial to detect and quantify pleural effusion (small, moderate, and large). Weaning failure was defined by a failed spontaneous breathing trial and/or extubation requiring any form of ventilatory support within 48 h. The primary endpoint was the prevalence of pleural effusion according to weaning outcome.

RESULTS:
Pleural effusion was detected in 51 of 136 (37%) patients and was quantified as moderate to large in 18 (13%) patients. As compared to patients with no or small pleural effusion, their counterparts were more likely to have chronic renal failure (39 vs. 7%; P = 0.01), shock as the primary reason for admission (44 vs. 19%; P = 0.02), and a greater weight gain (+4 [0 to 7] kg vs. 0 [-1 to 5] kg; P = 0.02). The prevalence of pleural effusion was similar in weaning success and weaning failure patients (odds ratio, 1.23; 95% CI, 0.61 to 2.49; P = 0.56), as was the prevalence of moderate to large pleural effusion (odds ratio, 0.89; 95% CI, 0.33 to 2.41; P = 1.00). Duration of mechanical ventilation and intensive care unit length of stay were similar between patients with no or small pleural effusion and those with moderate to large pleural effusion.

CONCLUSIONS:
Significant pleural effusion was observed in 13% of patients at the time of liberation from mechanical ventilation and was not associated with an alteration of weaning outcome
 
TimesNewRoman said:
To be fair, sometimes removing a small amount of pleural fluid can make a big difference. But it's tough to say without knowing the rest of the details.
Click to expand...

I drain large effusions. Never seen any benefit of draining the small ones but have seen it's complications
 
maverickdoc said:
Anesthesiology. 2017 Mar 24. doi: 10.1097/ALN.0000000000001621. [Epub ahead of print]
Prevalence and Impact on Weaning of Pleural Effusion at the Time of Liberation from Mechanical Ventilation: A Multicenter Prospective Observational Study.
Dres M1, Roux D, Pham T, Beurton A, Ricard JD, Fartoukh M, Demoule A.
Author information

Abstract
BACKGROUND:
Pleural effusion is frequent in intensive care unit patients, but its impact on the outcome of weaning remains unknown.

METHODS:
In a prospective study performed in three intensive care units, pleural ultrasound was performed at the first spontaneous breathing trial to detect and quantify pleural effusion (small, moderate, and large). Weaning failure was defined by a failed spontaneous breathing trial and/or extubation requiring any form of ventilatory support within 48 h. The primary endpoint was the prevalence of pleural effusion according to weaning outcome.

RESULTS:
Pleural effusion was detected in 51 of 136 (37%) patients and was quantified as moderate to large in 18 (13%) patients. As compared to patients with no or small pleural effusion, their counterparts were more likely to have chronic renal failure (39 vs. 7%; P = 0.01), shock as the primary reason for admission (44 vs. 19%; P = 0.02), and a greater weight gain (+4 [0 to 7] kg vs. 0 [-1 to 5] kg; P = 0.02). The prevalence of pleural effusion was similar in weaning success and weaning failure patients (odds ratio, 1.23; 95% CI, 0.61 to 2.49; P = 0.56), as was the prevalence of moderate to large pleural effusion (odds ratio, 0.89; 95% CI, 0.33 to 2.41; P = 1.00). Duration of mechanical ventilation and intensive care unit length of stay were similar between patients with no or small pleural effusion and those with moderate to large pleural effusion.

CONCLUSIONS:
Significant pleural effusion was observed in 13% of patients at the time of liberation from mechanical ventilation and was not associated with an alteration of weaning outcome
Click to expand...

That study doesn't address the point I made - its related, but distinctly different.
 
maverickdoc said:
Anesthesiology. 2017 Mar 24. doi: 10.1097/ALN.0000000000001621. [Epub ahead of print]
Prevalence and Impact on Weaning of Pleural Effusion at the Time of Liberation from Mechanical Ventilation: A Multicenter Prospective Observational Study.
Dres M1, Roux D, Pham T, Beurton A, Ricard JD, Fartoukh M, Demoule A.
Author information

Abstract
BACKGROUND:
Pleural effusion is frequent in intensive care unit patients, but its impact on the outcome of weaning remains unknown.

METHODS:
In a prospective study performed in three intensive care units, pleural ultrasound was performed at the first spontaneous breathing trial to detect and quantify pleural effusion (small, moderate, and large). Weaning failure was defined by a failed spontaneous breathing trial and/or extubation requiring any form of ventilatory support within 48 h. The primary endpoint was the prevalence of pleural effusion according to weaning outcome.

RESULTS:
Pleural effusion was detected in 51 of 136 (37%) patients and was quantified as moderate to large in 18 (13%) patients. As compared to patients with no or small pleural effusion, their counterparts were more likely to have chronic renal failure (39 vs. 7%; P = 0.01), shock as the primary reason for admission (44 vs. 19%; P = 0.02), and a greater weight gain (+4 [0 to 7] kg vs. 0 [-1 to 5] kg; P = 0.02). The prevalence of pleural effusion was similar in weaning success and weaning failure patients (odds ratio, 1.23; 95% CI, 0.61 to 2.49; P = 0.56), as was the prevalence of moderate to large pleural effusion (odds ratio, 0.89; 95% CI, 0.33 to 2.41; P = 1.00). Duration of mechanical ventilation and intensive care unit length of stay were similar between patients with no or small pleural effusion and those with moderate to large pleural effusion.

CONCLUSIONS:
Significant pleural effusion was observed in 13% of patients at the time of liberation from mechanical ventilation and was not associated with an alteration of weaning outcome
Click to expand...

I dont drain small pleural effusion on intubated patients because I believe the harm (high risk of Pneumothorax) outweighs benefit, but this study fails to demonstrate the real question of if drainage changes outcome.

Either way, I think your should just continue to act professional and be the "bigger" person. It is impossible for you both not to need each other help in the future. So act like nothing happened and give it time.
 
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Let time heal things. Be cordial and polite. Even if he is brusque and standoff-ish continue to show respect and maturity. He will eventually get over it and will see that your work speaks for itself. I wouldn't try to bring things up unless you know that this is necessary (i.e. purposely retaliating and making the workplace inhospitable). Best wishes.
 
Hernandez said:
This sacred cow needs to be BBQ'd and eaten. I do thora on vent all the time and my ptx numbers are very low. And then you have this observational study.

Thoracentesis outcomes: a 12-year experience | Thorax
Click to expand...

Read what I said. I DON'T DO THORA ON SMALL PLEURAL EFFUSIONS. I did not say I don't do thora's. I also do them on moderate-large effusions on intubated patient. Also that observation study talked about all thora's, not the odds of a pneumothorax in a intubated patient.
 
mochief2000 said:
Read what I said. I DON'T DO THORA ON SMALL PLEURAL EFFUSIONS. I did not say I don't do thora's. I also do them on moderate-large effusions on intubated patient. Also that observation study talked about all thora's, not the odds of a pneumothorax in a intubated patient.
Click to expand...

You're right, I breezed over the word small. the study does talk about nppv and vents in the body but I can't out my hand on an on-subscription access link at the moment, they don't separate bipap vs vents but note no increase in ptx
 
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