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and it has to do with a massive vascular injury during a hip revision.
holy cow. what kind of access did you have? maybe they should have called the trauma service for damage control.
Well that is a nightmare. I can think of very few reasons to place central access during a hip case unless your access is absolutely terrible to begin with so nobody can fault you for that. I have done double redos a few times and haven't used any special access for them. WHat is concerning as well is possible conversion to GA. Did you start out w/ a spinal?
The good news is that this type of complications only happens in academia and you almost never see it in private practice.
2 good peripheral IV's is a reasonable access for hip revision, and as Arch said, unless the patient had terrible veins I would not place a central line.
and me handing off the resuscitation 4 hours later. and me not placing a central line before the case. and the lateral position with no neck. and something dumb like 22 liters through the belmont.
I said it was a hip where they shredded the common femoral with a retractor. and no, I don't think he had 22 liters of loss- it was hard to tell because only a fraction of it was going to the canister. he needed volume and got volume, then needed pressors and got volume. in retrospect.Another example of academia providing "skewed reality" to a resident.
Dude, that s hit doesnt even come close to happening in private practice.
You said this was for a hip?
Twenty two liters?
I've seen better animal studies.
The surgeon you've been given the "opportunity" to work with needs to consider psychiatry.
I said it was a hip where they shredded the common femoral with a retractor. and no, I don't think he had 22 liters of loss- it was hard to tell because only a fraction of it was going to the canister. he needed volume and got volume, then needed pressors and got volume. in retrospect.
private practice wouldn't do the case. sent him up to be a statistic on our books instead.
I said it was a hip where they shredded the common femoral with a retractor. and no, I don't think he had 22 liters of loss- it was hard to tell because only a fraction of it was going to the canister. he needed volume and got volume, then needed pressors and got volume. in retrospect.
private practice wouldn't do the case. sent him up to be a statistic on our books instead.[/quote]
Really!
A private practice surgeon refused to do a hip revision??
I said it was a hip where they shredded the common femoral with a retractor. and no, I don't think he had 22 liters of loss- it was hard to tell because only a fraction of it was going to the canister. he needed volume and got volume, then needed pressors and got volume. in retrospect.
private practice wouldn't do the case. sent him up to be a statistic on our books instead.[/quote]
Really!
A private practice surgeon refused to do a hip revision??
CONCUR.
We've gotta ROKKSTAR orthopedist who does revisions almost every operative day.
OH, AND BY THE WAY, I'VE NEVER SEEN HIM COMPROMISE A VESSEL WITH A RETRACTOR.
thank god, no. we placed an epidural for POP but due to his size and the fact that the case was posted for like 6 hours we tubed him right off.
I don't doubt private practice ortho does revisions. I'm not sure what made this one especially difficult, just that it was discussed as being more technically challenging and posted for longer than our standard revisions.
The vascular note said artery, and they angio and repaired it. The pressure went from 106/70 to 40/20 literally in the space of seconds, so...