Peds airway foreign body

[epidural man]

Background -
I rarely do peds. I work at a place that has peds backup 24/7.

Call is for an 18 month old with airway foreign body. I have a CA-3 and a brand new OMFS rotator.

My credentials say I can do anesthesia down to 1 month old.

But I’m calling the backup on this.

Would you?

Also, it should be noted that sometimes the backup is a contractor so they get paid a bunch to come in. Sometimes it is active duty so they get screwed, and sometimes it is a government employee so they get screwed. Also, some of the peds folks are awesome and don’t complain. Others, they whine and whine and think I should be capable of doing NICU kids. I know these factors shouldn’t figure in to when I call in backup- but to be honest…they kinda do.

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[Justice4all]

Call back up as you rarely do these cases and age group.The surgeon and patient will appreciate it.
I recall in residency that age 2 was the cutoff for the peds attending to be called in. Might need to revisit the age cutoff even if you credentialed for age 1 month up.

 

[deleted875186]

High risk case, relatively young kid, you could do the case but honestly this case benefits from a peds anesthesiologist, and also would greatly benefit from a peds anesthesiologist and ENT surgeon that work together often.

 

[Arch Guillotti]

Background -
I rarely do peds. I work at a place that has peds backup 24/7.

Call is for an 18 month old with airway foreign body. I have a CA-3 and a brand new OMFS rotator.

My credentials say I can do anesthesia down to 1 month old.

But I’m calling the backup on this.

Would you?

Also, it should be noted that sometimes the backup is a contractor so they get paid a bunch to come in. Sometimes it is active duty so they get screwed, and sometimes it is a government employee so they get screwed. Also, some of the peds folks are awesome and don’t complain. Others, they whine and whine and think I should be capable of doing NICU kids. I know these factors shouldn’t figure in to when I call in backup- but to be honest…they kinda do.

Call backup.

I don’t have a peds guy to call so my hand would be forced. But if I had someone to call zero chance I am doing the case.

 

[Beeftenderloin]

I would call peds person in. Wouldn’t think twice. When peds person is on call they won’t hesitate calling my @$$ in for the middle of the night chest washout. But more importantly, if that was my kid, I would want them taken care of by someone who anesthetizes small children all the time.

 

[Robby3]

I would call the peds backup. If you do not call them and you do the case and everything happens to luckily go smooth then you will have an increased number of peds backup people whining for you to do the next peds emergency case since everything went well this time. If things do not go well then you will take 100% of the blame for not calling your backup. So you are in a lose-lose situation by not calling them.

 

[patriot6]

Background -
I rarely do peds. I work at a place that has peds backup 24/7.

Call is for an 18 month old with airway foreign body. I have a CA-3 and a brand new OMFS rotator.

My credentials say I can do anesthesia down to 1 month old.

But I’m calling the backup on this.

Would you?

Also, it should be noted that sometimes the backup is a contractor so they get paid a bunch to come in. Sometimes it is active duty so they get screwed, and sometimes it is a government employee so they get screwed. Also, some of the peds folks are awesome and don’t complain. Others, they whine and whine and think I should be capable of doing NICU kids. I know these factors shouldn’t figure in to when I call in backup- but to be honest…they kinda do.

I would definitely call backup.

 

[PpfSuxTube]

100% call backup...

 

[DocVapor]

This is a potentially complicated peds case. YOU are THEIR backup/second set of hands.

 

[Katheudontas parateroumen]

These cases are pretty complicated. If I have backup peds, then I’d probably call too. At my place we are credentialed for 1 year old. But we are encouraged to call peds anesthesia for anything under 2.

Inhalation induction then Propofol and precedex drips to keep them spontaneous.

 

[nimbus]

I rarely do peds.

I have a CA-3 and a brand new OMFS rotator.

Enough said. You have 3 amateur pediatric anesthesiologists to take care of a high risk case. (No offense, I’m an amateur too.)


Additionally how many of these cases are done at your hospital? Send them to Children’s.


It is not just about anesthesia but also the ENT, scrub tech, nursing, instruments, supplies and equipment, PACU, wards, pharmacy, code team, etc. They take care of this age group and do these cases routinely. It would be a crime not to use this resource since it is available. Every other place in town (except perhaps Kaiser) sends these cases to Children’s. That’s where I’d want my 18mo airway FB to go.

 

[nimbus]

High risk case, relatively young kid, you could do the case but honestly this case benefits from a peds anesthesiologist, and also would greatly benefit from a peds anesthesiologist and ENT surgeon that work together often.

☝️

 

[MirrorTodd]

What is the point of having peds call if you don't call them to come in? They are on call specifically for this patient population.

 

[anbuitachi]

Background -
I rarely do peds. I work at a place that has peds backup 24/7.

Call is for an 18 month old with airway foreign body. I have a CA-3 and a brand new OMFS rotator.

My credentials say I can do anesthesia down to 1 month old.

But I’m calling the backup on this.

Would you?

Also, it should be noted that sometimes the backup is a contractor so they get paid a bunch to come in. Sometimes it is active duty so they get screwed, and sometimes it is a government employee so they get screwed. Also, some of the peds folks are awesome and don’t complain. Others, they whine and whine and think I should be capable of doing NICU kids. I know these factors shouldn’t figure in to when I call in backup- but to be honest…they kinda do.

change your credentials. here we credent 2yo +. under is peds anes

 

[BobLoblaw78]

And to reframe it another way: if Pediatric Anesthesiologists are trying to keep general Anesthesiologists from doing simple and routine pediatrics at many places because they are not experienced enough, then this case definitely needs a more experienced Anesthesiologist

 

[Beeftenderloin]

change your credentials. here we credent 2yo +. under is peds anes

Our group has taken it even further. 10 and under or any non-adult ASA 3+, we are encouraged to not do the case and call peds in. Most of the time I don’t even get notified. OR charge just knows to call the peds doc in.

 

[DrOwnage]

Our group has taken it even further. 10 and under or any non-adult ASA 3+, we are encouraged to not do the case and call peds in. Most of the time I don’t even get notified. OR charge just knows to call the peds doc in.

Amazing. Where is this magical place?

 

[nimbus]

Our group has taken it even further. 10 and under or any non-adult ASA 3+, we are encouraged to not do the case and call peds in. Most of the time I don’t even get notified. OR charge just knows to call the peds doc in.

Except newborns from L&D, there are no kids under 14 at our hospital. We have a peds hospital 10min away. If the newborns need anything, they get shipped off to the children’s hospital.

 

[dannyboy1]

What is the question here. This is a peds case and should go to the peds anesthesiologist.

 

[nimbus]

What is the question here. This is a peds case and should go to the peds anesthesiologist.

It’s not just a peds case like an elective hernia or tonsillectomy, it’s a peds board exam case.

 

[dizzy21]

Peds anesthesiologist… would be very critical of an adult anesthesiologist who did this without calling in peds anesthesiologist. Would be equally critical of peds anesthesiologist that whined about being called in for this case.

 

[kidthor]

I’m a peds anesthesiologist and I definitely would want to be called in for this. Depending on where you are it might even warrant transfer.

For what it’s worth I’d gladly come in for just about any peds case within reason.

 

[kidthor]

I’m a peds anesthesiologist and I definitely would want to be called in for this. Depending on where you are it might even warrant transfer.

For what it’s worth I’d gladly come in for just about any peds case within reason, and this case isn’t even close to debatable.

 

[kidthor]

Our group has taken it even further. 10 and under or any non-adult ASA 3+, we are encouraged to not do the case and call peds in. Most of the time I don’t even get notified. OR charge just knows to call the peds doc in.

I think that’s a good system!

 

[Beeftenderloin]

Amazing. Where is this magical place?

Except newborns from L&D, there are no kids under 14 at our hospital. We have a peds hospital 10min away. If the newborns need anything, they get shipped off to the children’s hospital.

We’re a non-academic referral center for everything but level 1 trauma and transplant. About an hour outside of a large Midwest city. I don’t have any numbers, but we have what appears to be a fairly robust pediatric and neonatal surgery program. We’re affiliated with a big regional player but the freestanding children’s hospital downtown is a solid hour drive by ambulance. We occasionally ship out to the mothership, but far more often getting shipped too by one of our many OSHs.

 

[IlDestriero]

These cases can be a chip shot or a huge pain. You are absolutely correct to call in the pediatric specialist. There are many ways to skin a cat, but a peds airway foreign body will absolutely benefit from an experienced pediatric trained anesthesiologist as well as someone used to working with the ENT surgeon regularly.

 

[epidural man]

Funny thing - I didn't even have to worry about it.

They punted the case to the morning (must have not been that big of a deal).