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It takes 5 seconds to draw up a med
Patient Nearly Dies After CRNA Mishap
Started by zizzer
It takes 5 seconds to draw up a med
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deleted87051
Off topic but curious. How much opioid did that patient receive? Sinus endoscopy is not a painful procedure.
Disagree
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deleted87051
Personal experience?
I do these with 50-100mcg fentanyl. They often go home with nothing more in PACU. Maybe it depends on how much local the surgeon injects.
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deleted641888
Same, if not less. Some stimulating portions that can be controlled by non-opioids. Otherwise, once that scope comes out… well, you’ll be giving a lot more medications than intended as above. I’ve seen some headaches afterwards which acetaminophen/fluids usually takes care of.
I agree it doesn’t take much during the case but these always seem to be age 30 something gorillas that get coked up by surgeon and wake up spitting blood ready to put staff in headlocks when I do them.
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deleted87051
Our ents usually use lidocaine with epi. Also in my experience, a little precedex (16-20mcg) during the case usually makes them very chill in PACU.
Maybe 15 seconds but yeah i get your point. We had propofol in line already
I dont remember. It was less than 1 mg dilaudid.
Crazy to listen to. I wonder when legislation will finally change to prevent this loophole of supervision... Also, as the legislation stands it does not seem appropriate to have a surgeon as a supervisor to a CRNA. What does a surgeon know about anesthesia? They are two completely different fields of medicine and in addition to this how can a surgeon adequately supervise a CRNA while they are doing surgery?
We all know that it comes down to profitability and that is the sole reason for employing as many CRNAs as possible and as little anesthesiologists as possible, but I wonder if instances like these will change this paradigm. Are examples like this costly enough to the business model after being sued? This I don't know. Not sure how much he would be awarded and how much the surgery center is liable for since they wanted to push everything on the surgeon.
We all know that it comes down to profitability and that is the sole reason for employing as many CRNAs as possible and as little anesthesiologists as possible, but I wonder if instances like these will change this paradigm. Are examples like this costly enough to the business model after being sued? This I don't know. Not sure how much he would be awarded and how much the surgery center is liable for since they wanted to push everything on the surgeon.
I know as much about surgery as the surgeon knows about anesthesia. Not enough. Some surgeons think supervision of a CRNA means yelling that the "patient is waking up" when they move.
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deleted1133676
My personal “favorite” is the demand for “anesthesia” coverage in the ICU so that GI can do an EGD on an intubated patient on a propofol infusion at 1800. Yeah, I am not available.
I never understand why they need us for this. They have an icu nurse and the patient is already on sedation
It's an all too common law in the US. I heard about it initially from my dad (ortho) when he was doing locums in critical access hospitals back when I was in residency. He said when he was told he had to sign the anesthetic record, he said he had no idea what the CRNA was doing, and couldn't vouch for them. I think he eventually signed, but they didn't tell him before the case that he was supervising. He then did only the smallest cases on healthy patients in the tiny hospitals and transferred everything else out. I bet the hospitals didn't like it, but he didn't want to be in charge of the anesthesia as well as the operation. He's since retired from locums.
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deleted875186
My personal experience is that nearly everyone pulls an ETT before the patient has truely emerged because they don’t want to watch the patient buck. Which in most cases is fine, so long as the CRNA is aware of this and is vigilant, and the patient is maskable and you can manage the airway. In this case patient probably coughed once, tube came out, patient still emerging and breath holding or apnic ….
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Our group has drawn a hard line on these. First question asked when called about an ICU patient for a scope, “are they intubated?” If the answer is yes the conversation stops there. ICU manages sedation.
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deleted875186
I remember in residency intubating a sick ICU patient. Induced, tube goes in, ventilation ok, immediate hemodynamics are ok, then about 60 seconds after the tubes in, my attending and I are standing at the foot watching the vitals and the ICU nurse proceeds to disconnect all the monitors to “tidy up” the lines and monitors, and commences to leave them all disconnect while they untangle things for a couple mins ….
Similar situation when I did locums briefly. I had access to both a surgery center located at outpatient medical office building or main OR at the regional hospital. I was told I would be "supervising" the CRNAs at the surgery center ("Who are all amazing and super experienced!") and that in case of emergency they would have to call the anesthesiologists from the main hospital (a two-mile drive down the road).
I told them in no uncertain terms that I thought asking surgeons to supervise anesthesia while also performing surgery was unconscionable and that I would not be doing any cases at the surgery center as a result. Bunch of clipboard nurses and supervisors at the surgery center were stunned.
It's my experience, speaking as an anesthesiologist, opioid missteps also occur with physicians.
Why didn't you or your attending say something? (When you say they had them disconnected for a couple minutes, it sounds like you guys let them finish whatever untangling they were doing). I feel like that would have been a perfect educational opportunity.
Working in Phoenix is very weird. There is an over abundance and a mishmash of groups or contractors (AMCs, physician groups, midlevel-only groups, etc.) dispersed across the valley. Most cities and regions have 2-4 established groups for hospitals and surgery centers to select from.
Phoenix area hospitals and facilities have too many options resulting in a paradox of choices. The over abundance and decentralization of groups leads to driving down prices/rates allowing the lowest bidder new AMC to come in and enter the Phoenix market. Yet due to shortages, the locum market is good.
It is not unusual in Phoenix to have 2 or more anesthesia groups to simultaneously staff a hospital or surgery center which means no group has a truly "exclusive contract" with the hospital and can be terminated at any point. Bottom line is there is no real stability in Phoenix.
This happens about weekly at our institution. It's pretty normal to be called into the room after extubation with sats in the 50-60s and you have to clean up their mess when they are befuddled with what to do. CRNAs think it's super slick to arbitrarily pull the ETT early and hope they continue to breathe post-extubation. Hope for the best, call overhead when things don't work out. CRNA mantra.
Especially with the climate
Eh, tried (Midwest academic institution) this at a visiting professor lecture, was not appreciated. No humor in this field
Tons of humor in this field. Gotta bring actual jokes.
I made an attending laugh when I told him I wanted to do elective retrograde wires. He gave me a monologue about them. And I just said, "Nah, I really want to do lightwands." He said I was like his kids making him think they had done something bad when really they hadn't done their homework.
"an anesthesiologist from another group helped with resuscitation in PACU"
how does this work, is that anesthesiologist required to fix the messes of this independent CRNA? What happens when they intervene with patient care, do they now have some liability because they helped out?
are they required to rescue someone else mess when that person has not required supervision by an anesthesiologist but rather by a surgeon?
how does this work, is that anesthesiologist required to fix the messes of this independent CRNA? What happens when they intervene with patient care, do they now have some liability because they helped out?
are they required to rescue someone else mess when that person has not required supervision by an anesthesiologist but rather by a surgeon?
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Good question and point. This is and will be an issue when hospitals and ASCs use multiple anesthesia groups.
Anyone know what anesthesia group this CRNA belonged to or what anesthesia group contracted out this independent CRNA?
I doubt they would be required. There is no established relationship to the patient. Where is the CRNA? In my mind the anesthesiologist who responded to this emergency did so as a good Samaritan.
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It's mentioned in the podcast. It's AZAS Arizona Anesthesia Solutions they have a few ads hiring for doctors on gasworks.
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deleted87051
Can u elaborate.. what does that mean..?
Who?
He’s the TikTok star of the independent CRNA movement, so that’s hilarious that that was his group
How ironic. Wonder if he fired the CRNA from his group because of this adverse event.
There’s a shortage so they probably dumped him at another ASC or something kind of like what the CC did with “problematic” clergy
Independent CRNA movement... but when **** hit the fan patient needed to be bailed out by an anesthesiologist. That Rodriguez clown probably blood boiling from that. He would rather the patient die than admit a CRNA couldn't handle it.
On a related note, saw this gem littered around our anesthesia areas today.
AANA is just so toxic.
Honestly surprised your group would stand for these type of flyers.
Ya I would say that ish needs to be addressed in a group meeting.
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deleted87051
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Barbers, the original surgeons...
I wouldn’t know… 😉 🌝
