Noyac's Clinical Post Back Atcha

[Noyac]

68 yo male s/p Sm Bowel resection with epidural in place and working very well. 11pm floor nurse pages me (and I am not even on call). I politely return the page and the nurse says the pt is complaining of an erection. Yes an erection. At first I thought this was a joke and someone was screwing with me but it wasn't. This nurse seriously wanted me to do something about it and wanted to know if the epidural could be causing it. After a few seconds, I realized that it wasn't a joke and that the nurse was serious so I asked if the erection was painful. He said no, the pt has had no pain all day. Then I said, " Well then, call his wife in and see if she can do anything about it" I'm sure this is the first erection this guy has had in a long time.

Nurses like this just scare the crap out of me.

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[rmh149]

68 yo male s/p Sm Bowel resection with epidural in place and working very well. 11pm floor nurse pages me (and I am not even on call). I politely return the page and the nurse says the pt is complaining of an erection. Yes an erection. At first I thought this was a joke and someone was screwing with me but it wasn't. This nurse seriously wanted me to do something about it and wanted to know if the epidural could be causing it. After a few seconds, I realized that it wasn't a joke and that the nurse was serious so I asked if the erection was painful. He said no, the pt has had no pain all day. Then I said, " Well then, call his wife in and see if she can do anything about it" I'm sure this is the first erection this guy has had in a long time.

Nurses like this just scare the crap out of me.

OMG....lol, please tell me it was at least 3am in the morning.

 

[Planktonmd]

I see a potential for making money here.

Epidurals for erectile dysfunction, we are talking big money here.

 

[Planktonmd]

oops

 

[Mman]

You should've asked the nurse to fax a picture of herself over and then you could judge whether or not she could help him out.

side note: I also wonder a little about the patient's motive behind "complaining" about this to the nurse. Did he want her to examine it? Was it bothering him?

 

[toughlife]

68 yo male s/p Sm Bowel resection with epidural in place and working very well. 11pm floor nurse pages me (and I am not even on call). I politely return the page and the nurse says the pt is complaining of an erection. Yes an erection. At first I thought this was a joke and someone was screwing with me but it wasn't. This nurse seriously wanted me to do something about it and wanted to know if the epidural could be causing it. After a few seconds, I realized that it wasn't a joke and that the nurse was serious so I asked if the erection was painful. He said no, the pt has had no pain all day. Then I said, " Well then, call his wife in and see if she can do anything about it" I'm sure this is the first erection this guy has had in a long time.

Nurses like this just scare the crap out of me.

How would he know if the erection was painful with an epidural in place?

 

[dhb]

How would he know if the erection was painful with an epidural in place?

if the epidural is thoracic you'd have to run it pretty high to get a pudendal nerve block (S2-4)

 

[Noyac]

You should've asked the nurse to fax a picture of herself over and then you could judge whether or not she could help him out.

side note: I also wonder a little about the patient's motive behind "complaining" about this to the nurse. Did he want her to examine it? Was it bothering him?

The nurse was a "murse".

 

[Noyac]

How would he know if the erection was painful with an epidural in place?

Its a thoracic epidural at 10cc/hr. He has full sensation in this area.

 

[jetproppilot]

Its a thoracic epidural at 10cc/hr. He has full sensation in this area.

Noy, that takes the cake for the stupidest page ever.

 

[VolatileAgent]

How would he know if the erection was painful with an epidural in place?

toughlife, you are spouting off some hot rhetoric on the other thread about "the future of anesthesiology" as you perceive it. the fact that you don't even know that an epidural for abdominal surgery is placed thoracically (roughly t10 level) and does not cover the sacral area therefore missing the dermatomes in question speaks volumes.

i suggest you cool down and focus on learning anesthesiology for now. there'll be plenty of time later in your career to figure out how the real world works.

 

[zippy2u]

Give the guy a GETA and at end of case tell the surgeon to throw him a PCA. All that high fallutin' epidural cath crap does is potentially creates more HAs for you. Nurses call at all hours saying the pump is beeping, the fluid's out, the pt's. dropped the pump on the floor, the pt's kid disconnected the tubing, yada, yada, yada. At the end of the day ya want to go home, play with the kids, keep the wife happy and sleep well at night. Regards, ----Zip

 

[The_Sensei]

Give the guy a GETA and at end of case tell the surgeon to throw him a PCA. All that high fallutin' epidural cath crap does is potentially creates more HAs for you. Nurses call at all hours saying the pump is beeping, the fluid's out, the pt's. dropped the pump on the floor, the pt's kid disconnected the tubing, yada, yada, yada. At the end of the day ya want to go home, play with the kids, keep the wife happy and sleep well at night. Regards, ----Zip

I've been saying this for years...no post-op epidurals for the kid. Remember this equation:

#headaches is directly proportion to #post-op epidurals

 

[Noyac]

I agree that # of post op epidurals has something to do with the # of stupid ass pages but our nurses are pretty good with the post op epidurals and rarely call about anything unless it comes disconnected or is no longer working. This was some new or traveling murse that I never met. When I told the day staff what happened the next day they laughed so hard that i have a feeling this murse will get ridiculed relentlessly. Honestly, the calls we get regarding the epidurals are very low. I get tired of just putting them to sleep, waking them up, starting pca's. And a well placed epidural is magic to the pt.

I agree jet, STUPIDEST page ever.

 

[Planktonmd]

toughlife, you are spouting off some hot rhetoric on the other thread about "the future of anesthesiology" as you perceive it. the fact that you don't even know that an epidural for abdominal surgery is placed thoracically (roughly t10 level) and does not cover the sacral area therefore missing the dermatomes in question speaks volumes.

i suggest you cool down and focus on learning anesthesiology for now. there'll be plenty of time later in your career to figure out how the real world works.

Sorry, but this generalization is simply inaccurate.
I would say that the majority of epidurals placed for abdominal surgery, in the real world, are actually lumbar.

 

[Noyac]

This was and still is a T10 thoracic epidural. I should have stated this in the initial post. The reason for this post was not to debate epidurals for abd surgery so with the direction this thread is taking and since it is my thread I am closing it.