Private equity buys anesthesia - Dr. Glaucomflecken

[anaesthetic]

My threshold for postponing is potassium of 6.0. Why? Idk. That’s my rule. Below that, usually I’ll proceed. No rhyme or reason for 6.0 specifically, but at some point, you have to make the decision as a board-certified anesthesiologist.

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[Twiggidy]

sinema must have serious funding from private equity fund managers.

Sinema……I think it’s the glasses for me 😆

 

[ERRES2288]

Last year I had Anes cancel an SCS revision for K+=5.7, stat repeat and it was 5.5. Still Cx.

who ordered the labs and why? I certainly wouldn’t order labs for this procedure and only for the patient if indicated.

 

[lobelsteve]

who ordered the labs and why?

Anesthesia. To try and cancel the case.
SCS implant, trial in office in prior month no issue.
45 min skin to skin. 2x2" incisions. Blood loss typically 5ml.

 

[DocVapor]

Anesthesia. To try and cancel the case.
SCS implant, trial in office in prior month no issue.
45 min skin to skin. 2x2" incisions. Blood loss typically 5ml.

I have a sneaking feeling we're not being told the whole story here.

 

[TheLoneWolf]

I have a sneaking feeling we're not being told the whole story here.

If I am drawing a BMP for an SCS implant day of surgery then I would have had serious concerns to justify this testing.

 

[GassYous]

Anesthesia. To try and cancel the case.
SCS implant, trial in office in prior month no issue.
45 min skin to skin. 2x2" incisions. Blood loss typically 5ml.

 

[anbuitachi]

Last year I had Anes cancel an SCS revision for K+=5.7, stat repeat and it was 5.5. Still Cx.

this is easy cancellation . potassium is high. cancel. this gets cancelled 100% of teh time at my institution for elective cases
the surgeons know this. if you want your cases to be done, dont bring in patients with elevated potassium.

Anesthesia. To try and cancel the case.
SCS implant, trial in office in prior month no issue.
45 min skin to skin. 2x2" incisions. Blood loss typically 5ml.

its 45 min skin to skin 2x2 incision. minimal ebl. why do u even need anesthesia. proceed under local. who cares what the potassium is

 

[lobelsteve]

this is easy cancellation . potassium is high. cancel. this gets cancelled 100% of teh time at my institution for elective cases
the surgeons know this. if you want your cases to be done, dont bring in patients with elevated potassium.



its 45 min skin to skin 2x2 incision. minimal ebl. why do u even need anesthesia. proceed under local. who cares what the potassium is

If patient experiences unexpected pain with a 14G Tuohy in their spine over their cord and wiggles, they can be injured. MAC not used because I do not know who I am getting and many of the CRNA, AA/PA people go light and patient not sedated, just disinhibited becoming a danger to themselves. I have done SCS case implants under local and it goes much smoother under general. If you cancelled my cases all the time at 5.5, I would file complaint through admin and work to get you fired. If normal range is 5.5 and literature says do not change anesthetic plan if K+ <6.

 

[lobelsteve]

I have a sneaking feeling we're not being told the whole story here.

I am an employee of the hospital. Anesthesia is contracted services. They have a separate pain clinic. We compete for cases, but they do all their cases in their own ASC and not in the hospital. As far as clinical picture: Anesthesia pre-op had her hold all meds except her K+. She was taking that as she was on Lasix. Per Cards clearance, stratifies as low risk.

 

[crash2500]

I am an employee of the hospital. Anesthesia is contracted services. They have a separate pain clinic. We compete for cases, but they do all their cases in their own ASC and not in the hospital. As far as clinical picture: Anesthesia pre-op had her hold all meds except her K+. She was taking that as she was on Lasix. Per Cards clearance, stratifies as low risk.

Doesn't make sense to hold lasix but not k+...

 

[lobelsteve]

Doesn't make sense to hold lasix but not k+...

I am PMR/Pain. I stay out of med mgmt.

 

[anbuitachi]

If patient experiences unexpected pain with a 14G Tuohy in their spine over their cord and wiggles, they can be injured. MAC not used because I do not know who I am getting and many of the CRNA, AA/PA people go light and patient not sedated, just disinhibited becoming a danger to themselves. I have done SCS case implants under local and it goes much smoother under general. If you cancelled my cases all the time at 5.5, I would file complaint through admin and work to get you fired. If normal range is 5.5 and literature says do not change anesthetic plan if K+ <6.

normal k is up to 5.2 here
why are so many of your patients at 5.5. i think you should stop checking potassium hahaha

 

[anbuitachi]

I am an employee of the hospital. Anesthesia is contracted services. They have a separate pain clinic. We compete for cases, but they do all their cases in their own ASC and not in the hospital. As far as clinical picture: Anesthesia pre-op had her hold all meds except her K+. She was taking that as she was on Lasix. Per Cards clearance, stratifies as low risk.

why did this patient need a cardiology evaluation preop?

 

[coffeebythelake]

Anesthesia pre-op had her hold all meds except her K+. She was taking that as she was on Lasix. Per Cards clearance, stratifies as low risk.

Hyperkalemia and cardiac risk stratification are two separate issues here.

 

[lobelsteve]

normal k is up to 5.2 here
why are so many of your patients at 5.5. i think you should stop checking potassium hahaha

Serum Potassium - Clinical Methods - NCBI Bookshelf

Hyperkalemia

Hyperkalemia is when you have high potassium levels in your blood. You may not have symptoms in mild cases, but severe cases can damage your heart.

my.clevelandclinic.org

Hyperkalemia: Practice Essentials, Background, Pathophysiology

Hyperkalemia is defined as a serum potassium concentration higher than the upper limit of the normal range; the range in infants and children is age-dependent, whereas the range for adults is approximately 3.5-5.

emedicine.medscape.com

And Mayo agrees w you:

High potassium (hyperkalemia)

What does it mean if you have high potassium? Learn about the role potassium plays in your body and the possible causes of this blood test result.

www.mayoclinic.org

 

[lobelsteve]

Case was 6 mo ago. Will pull chart in office. Usually requested by preop NP for anes services.

 

[anbuitachi]

Serum Potassium - Clinical Methods - NCBI Bookshelf

Hyperkalemia

Hyperkalemia is when you have high potassium levels in your blood. You may not have symptoms in mild cases, but severe cases can damage your heart.

my.clevelandclinic.org

Hyperkalemia: Practice Essentials, Background, Pathophysiology

Hyperkalemia is defined as a serum potassium concentration higher than the upper limit of the normal range; the range in infants and children is age-dependent, whereas the range for adults is approximately 3.5-5.

emedicine.medscape.com

And Mayo agrees w you:

High potassium (hyperkalemia)

What does it mean if you have high potassium? Learn about the role potassium plays in your body and the possible causes of this blood test result.

www.mayoclinic.org

yes . i dont know why , if its based on some paper id idnt read or something. but potassium at 2 of the places i worked for changed from 5.5 to 5.2 for abnormal in the past few years =\

 

[pgg]

45 min skin to skin. 2x2" incisions. Blood loss typically 5ml.

Did anyone else read this in a robotic orthopedic voice? TheRe WilL bE miNIMal BlOOd loSS.




Edit - that's what I get for posting before reading the thread. @GassYous beat me to it by about 8 hours.

 

[DocMcCoy]

why did this patient need a cardiology evaluation preop?

Probably some cardiac cripple that very well could be done with MAC but jerk surgeon “needs” a prone general for his bs SCS placement.

 

[coffeebythelake]

If you cancelled my cases all the time at 5.5, I would file complaint through admin and work to get you fired.

You'll file a complaint to get someone fired? This is the type of bravado that get you labeled as a d-bag.
Your hospital admin must have eager anesthesia staff lined up, ready to be hired at a moments notice, to serve you, and be at your beck and call..
Face it nobody is going to get fired by your whining.
😂😂😂

 

[Clean7795]

yes . i dont know why , if its based on some paper id idnt read or something. but potassium at 2 of the places i worked for changed from 5.5 to 5.2 for abnormal in the past few years =\

Lab values are usually based on the range for ~95% of the population.

For more specialized tests the assays/technique can differ leading to different results and lab ranges.

 

[Twiggidy]

Now, I take care of plenty of renal failure disasters who often have a K above 5 but less than 6. I’m not 100% sure a less than hour case with a K of 5.5 warrants cancellation unless if maybe the week or even month before it was
4. I don’t want to turn this into an oral boards thread (what if it’s 5.7? 5.8? 5.9?). As DocVapor said above, why are labs even being ordered and I don’t buy for a second it was “just to cancel the case”. That’s a response from someone who didn’t want to discuss with the anesthesiologist their concern and probably stormed away when they found out the lab was ordered.

Being a douche won’t win you any “maybe I take a chance here” points. It doesn’t matter what a cardiologist or medicine doctor has said in a chart. Always know that the anesthesiologist is the final clearance. If canceling a case for attempting to be safe earns me a trip to the principal’s office then it may be some place I don’t want to work and definitely a surgeon/proceduralist I don’t want to work with. If it make them sleep better to fire me, do so. There are jobs everywhere and I’m licensed in like 6 states……I won’t starve.

 

[nimbus]

I don’t know about other parts of the country but the chance that a proceduralist/surgeon can get an anesthesiologist fired around here is zero. It’s always been that way even before the shortage. They can say stuff like “I don’t want to work with Dr X” but they usually end up paying the price when Dr X is the only one available. Then they cave and work with Dr X or they sit on their ass and wait.

 

[GravelRider]

I’m wondering if the potassium thing has to do with planned use of succinylcholine. It sounds like general was requested for this short procedure. Before the widespread availability of sugammadex, I often used sux for short procedures. Some hospitals even limit usage of sugammadex due to cost (which is the dumbest thing ever). A patient with cardiac comorbidities is someone you probably want to avoid the neostigmine/glyco combos if you can, which inevitably lead to tachycardias in pacu. When I’m planning on using succinylcholine, I definitely pay more attention to K…especially in someone with cardiac comorbidities. If I was planning to use succinylcholine here, I would have cancelled.

 

[pgg]

You'll file a complaint to get someone fired? This is the type of bravado that get you labeled as a d-bag.
Your hospital admin must have eager anesthesia staff lined up, ready to be hired at a moments notice, to serve you, and be at your beck and call..
Face it nobody is going to get fired by your whining.
😂😂😂

Check out the PMR guy who thinks he's as important as a surgeon!

 

[MirrorTodd]

I’m wondering if the potassium thing has to do with planned use of succinylcholine. It sounds like general was requested for this short procedure. Before the widespread availability of sugammadex, I often used sux for short procedures. Some hospitals even limit usage of sugammadex due to cost (which is the dumbest thing ever). A patient with cardiac comorbidities is someone you probably want to avoid the neostigmine/glyco combos if you can, which inevitably lead to tachycardias in pacu. When I’m planning on using succinylcholine, I definitely pay more attention to K…especially in someone with cardiac comorbidities. If I was planning to use succinylcholine here, I would have cancelled.

As always, I'm sure there is more to the story. Personally, I wouldn't have cancelled (like many others for a K of 5.7) even if I was going to give succinylcholine, which I very likely wouldn't have been giving anyway. There are many different ways to get the case done (which is what I love about anesthesia to begin with) so I'm not sure why a K of 5.7 with a repeat of 5.5 resulted in cancellation. To me this highlights the importance of the anesthesiologist being vocal about their plan and not just doing a general because the surgeon says they want it done that way.

 

[GravelRider]

As always, I'm sure there is more to the story. Personally, I wouldn't have cancelled (like many others for a K of 5.7) even if I was going to give succinylcholine, which I very likely wouldn't have been giving anyway. There are many different ways to get the case done (which is what I love about anesthesia to begin with) so I'm not sure why a K of 5.7 with a repeat of 5.5 resulted in cancellation. To me this highlights the importance of the anesthesiologist being vocal about their plan and not just doing a general because the surgeon says they want it done that way.

We’re obviously missing a lot of information here that comes in piecemeal…request for general on a short case when moderate to deep sedation is more typical, cardiac consultations, elevated potassium, a holding of lasix (why is this patient on lasix? does this patient have a significant cardiomyopathy?) As more information comes to light, this is sounding less like the “quick easy case” as originally billed. In a vacuum, I wouldn’t have cancelled for a K of 5.7, but the more the details emerge here, the more I can’t fault someone who did. We also don’t know if the anesthesiologist presented alternatives like moderate sedation and that option was refused.

 

[Southpaw]

If patient experiences unexpected pain with a 14G Tuohy in their spine over their cord and wiggles, they can be injured. MAC not used because I do not know who I am getting and many of the CRNA, AA/PA people go light and patient not sedated, just disinhibited becoming a danger to themselves. I have done SCS case implants under local and it goes much smoother under general. If you cancelled my cases all the time at 5.5, I would file complaint through admin and work to get you fired. If normal range is 5.5 and literature says do not change anesthetic plan if K+ <6.

You're probably a nice guy, Steve. But your post illustrates one of my biggest problems in medicine as an anesthesiologist. And it'll make me retire earlier than I would've otherwise. The issue is respect. Example, your patient could rotate between their primary care and a cardiologist for months/years, with you uninvolved, and you don't care. It's not your patient. As you say, you're PMR/pain and you don't deal with med management. But the second you get involved, and consult anesthesiology for services, anything other than doing what you want when you want it done results in you bad mouthing anesthesiology or looking askew at that particular anesthesiologist.

I have no idea what occurred. I think you said it was a year ago, or 6 months ago maybe. It obviously left a bad taste in your mouth. I'm sorry it occurred. My guess is though if you had a professional conversation with the anesthesiologist a lot of the drama or ill feelings could've been avoided. Maybe you two would have decided the case could be done under a MAC. Yeah, when patients are disinhibited, and 'light', they move to stimulation. It's natural and intentional. Most here access the epidural space using landmarks in wiggling, squirmy unsedated pregnant women routinely. Certainly one can do it using fluoro guidance and a 14g needle with some local and sedation. It may not be ideal for you, but it can be done. The most stimulating part of your procedure should be the tunneling of the leads, not accessing the space.

I don't really have an opinion on the particular patient aside from saying that a patient on lasix and K+ supplementation with a note from cardiology maybe isn't as straightforward medically as you think they are. I'd encourage you to rethink the relationship with you and the anesthesiologist when you consult them for their service. It isn't just 'provide general anesthesia' when and where you want it done.

 

[ERRES2288]

We’re obviously missing a lot of information here that comes in piecemeal…request for general on a short case when moderate to deep sedation is more typical, cardiac consultations, elevated potassium, a holding of lasix (why is this patient on lasix? does this patient have a significant cardiomyopathy?) As more information comes to light, this is sounding less like the “quick easy case” as originally billed. In a vacuum, I wouldn’t have cancelled for a K of 5.7, but the more the details emerge here, the more I can’t fault someone who did. We also don’t know if the anesthesiologist presented alternatives like moderate sedation and that option was refused.

I’d rather control the ventilation with high K. Last thing I want is patient getting hypercarbic with moderate sedation and acidotic leading to higher K. I likely wouldn’t have cancelled either unless there were EKG changes but there are things we are missing from story.

 

[GravelRider]

I’d rather control the ventilation with high K. Last thing I want is patient getting hypercarbic with moderate sedation and acidotic leading to higher K. I likely wouldn’t have cancelled either unless there were EKG changes but there are things we are missing from story.

Ventilation is adequate with moderate sedation. Once the patient is hypoventilating then you have crossed into deep sedation or general anesthesia. I know we’re getting into the weeds now, but these are the discussions and expectations you have to set with your surgeon when coming up with a plan. “Hey, I can do this with moderate sedation, but they’re going to jump when you give the local. Use more local than usual. If you’d rather her have general then let’s bring her back next week when her potassium is normal.”

Again, a lot of missing information, but I’m not looking down on anyone who is postponing this case.

 

[Twiggidy]

You're probably a nice guy, Steve. But your post illustrates one of my biggest problems in medicine as an anesthesiologist. And it'll make me retire earlier than I would've otherwise. This issue is respect. Example, your patient could rotate between their primary care and a cardiologist for months/years, with you uninvolved, and you don't care. It's not your patient. As you say, you're PMR/pain and you don't deal with med management. But the second you get involved, and consult anesthesiology for services, anything other than doing what you want when you want it done results in you bad mouthing anesthesiology or looking askew at that particular anesthesiologist.

I have no idea what occurred. I think you said it was a year ago, or 6 months ago maybe. It obviously left a bad taste in your mouth. I'm sorry it occurred. My guess is though if you had a professional conversation with the anesthesiologist a lot of the drama or ill feelings could've been avoided. Maybe you two would have decided the case could be done under a MAC. Yeah, when patients are disinhibited, and 'light', they move to stimulation. It's natural and intentional. Most here access the epidural space using landmarks in wiggling, squirmy unsedated pregnant women routinely. Certainly one can do it using fluoro guidance and a 14g needle with some local and sedation. It may not be ideal for you, but it can be done. The most stimulating part of your procedure should be the tunneling of the leads, not accessing the space.

I don't really have an opinion on the particular patient aside from saying that a patient on lasix and K+ supplementation with a note from cardiology maybe isn't as straightforward medically as you think they are. I'd encourage you to rethink the relationship with you and the anesthesiologist when you consult them for their service. It isn't just 'provide general anesthesia' when and where you want it done.

Exactly all of this

 

[coffeebythelake]

Ventilation is adequate with moderate sedation. Once the patient is hypoventilating then you have crossed into deep sedation or general anesthesia.

That depends on how much opioid was given with moderate sedation. You can have a patient still responsive but the ventilation may be inadequate when you leave them alone. Quite a lot of grey area from moderate sedation to deep sedation.

 

[GravelRider]

That depends on how much opioid was given with moderate sedation. You can have a patient still responsive but the ventilation may be inadequate when you leave them alone. Quite a lot of grey area from moderate sedation to deep sedation.

Continuum of Depth of Sedation: Definition of General Anesthesia and Levels of Sedation/Analgesia

www.asahq.org

I didn’t make up the definition. If the patient “may be ventilating inadequately” then by definition the patient is in deep sedation. Obviously there is a fine line and a continuum, but these are the discussions you have with surgeons about setting expectations.

 

[coffeebythelake]

Continuum of Depth of Sedation: Definition of General Anesthesia and Levels of Sedation/Analgesia

www.asahq.org

I didn’t make up the definition. If the patient “may be ventilating inadequately” then by definition the patient is in deep sedation. Obviously there is a fine line and a continuum, but these are the discussions you have with surgeons about setting expectations.

actually the biggest part of the definition is response to stimulation. that is the most apparent clinical aspect of it.
that's why i said you can have someone who is apparently responsive but who might also be hypoventilating significantly.

 

[pgg]

You're probably a nice guy, Steve. But your post illustrates one of my biggest problems in medicine as an anesthesiologist. And it'll make me retire earlier than I would've otherwise. This issue is respect. Example, your patient could rotate between their primary care and a cardiologist for months/years, with you uninvolved, and you don't care. It's not your patient. As you say, you're PMR/pain and you don't deal with med management. But the second you get involved, and consult anesthesiology for services, anything other than doing what you want when you want it done results in you bad mouthing anesthesiology or looking askew at that particular anesthesiologist.

I have no idea what occurred. I think you said it was a year ago, or 6 months ago maybe. It obviously left a bad taste in your mouth. I'm sorry it occurred. My guess is though if you had a professional conversation with the anesthesiologist a lot of the drama or ill feelings could've been avoided. Maybe you two would have decided the case could be done under a MAC. Yeah, when patients are disinhibited, and 'light', they move to stimulation. It's natural and intentional. Most here access the epidural space using landmarks in wiggling, squirmy unsedated pregnant women routinely. Certainly one can do it using fluoro guidance and a 14g needle with some local and sedation. It may not be ideal for you, but it can be done. The most stimulating part of your procedure should be the tunneling of the leads, not accessing the space.

I don't really have an opinion on the particular patient aside from saying that a patient on lasix and K+ supplementation with a note from cardiology maybe isn't as straightforward medically as you think they are. I'd encourage you to rethink the relationship with you and the anesthesiologist when you consult them for their service. It isn't just 'provide general anesthesia' when and where you want it done.

Very well said. Thanks for writing that.

 

[GravelRider]

actually the biggest part of the definition is response to stimulation. that is the most apparent clinical aspect of it.
that's why i said you can have someone who is apparently responsive but who might also be hypoventilating significantly.

Ok.

I guess for the purposes of this discussion, if you are sedating enough where hypoventilation is causing a respiratory acidosis worsening the already present hyperkalemia then we can safely say we are in deep sedation range. No? Or is the patient so tenuous that even a mild hypoventilation is going to put them into hypercarbic respiratory failure?

My initial response regarding levels of sedation was to the comment that there was a preference for general anesthesia and a controlled airway for this outpatient pain procedure in the setting of hyperkalemia to
avoid respiratory acidosis. This comment doesn’t make sense to me because if you’d rather have a controlled airway to prevent a respiratory acidosis in the setting of hyperkalemia then you shouldn’t be doing this very elective procedure.

We have fully entered the weeds…that wasn’t really the point I was trying to make. I was merely trying to point out the need to discuss rationale and set expectations with your surgeon. Cancelling a case is as much of an art as administering an anesthetic. Sometimes you see a patient and your “spidey sense” goes off. There is not one big reason to cancel, but a lot of little reasons that on their own would be fine, but together paint a picture that something is off and the patient is not optimized.

 

[BLADEMDA]

I’d rather control the ventilation with high K. Last thing I want is patient getting hypercarbic with moderate sedation and acidotic leading to higher K. I likely wouldn’t have cancelled either unless there were EKG changes but there are things we are missing from story.

FYI, patients who take potassium supplements on a regular basis may have a serum K of 5.3-5.5 routinely. I have seen this many times including one patient who had a K of 5.5 for the previous 5 years. This is perfectly "normal" for that person and poses no increased risk for surgery IMHO. In fact, I would be more concerned if the K dropped to 3.5 in someone who for the past 5 years was at 5.5.

I do not cancel cases for K of 5.5 and certainly not if the patient takes potassium supplements on a routine basis.

 

[BLADEMDA]

Here’s the answer: Per Miller’s Anesthesia, p. 1107, “As a rule, all patients undergoing elective surgery should have normal serum potassium levels. However, we do not recommend delaying surgery if the serum potassium level is above 2.8 mEq/L or below 5.9 mEq/L, if the cause of the potassium imbalance is known, and if the patient is in otherwise optimal condition.”

SHOULD YOU CANCEL SURGERY FOR A LOW POTASSIUM LEVEL OF 3.4 mEq/L?

anesthesiaexperts.com

 

[anbuitachi]

Here’s the answer: Per Miller’s Anesthesia, p. 1107, “As a rule, all patients undergoing elective surgery should have normal serum potassium levels. However, we do not recommend delaying surgery if the serum potassium level is above 2.8 mEq/L or below 5.9 mEq/L, if the cause of the potassium imbalance is known, and if the patient is in otherwise optimal condition.”

SHOULD YOU CANCEL SURGERY FOR A LOW POTASSIUM LEVEL OF 3.4 mEq/L?

anesthesiaexperts.com

which paper is the 2.8 to 5.9 based on?

 

[abolt18]

Here’s the answer: Per Miller’s Anesthesia, p. 1107, “As a rule, all patients undergoing elective surgery should have normal serum potassium levels. However, we do not recommend delaying surgery if the serum potassium level is above 2.8 mEq/L or below 5.9 mEq/L, if the cause of the potassium imbalance is known, and if the patient is in otherwise optimal condition.”

SHOULD YOU CANCEL SURGERY FOR A LOW POTASSIUM LEVEL OF 3.4 mEq/L?

anesthesiaexperts.com

Emphasis on "if the cause is known and the patient is in otherwise optimal condition"

 

[anbuitachi]

Emphasis on "if the cause is known and the patient is in otherwise optimal condition"

so like this?

Here’s the answer: Per Miller’s Anesthesia, p. 1107, “As a rule, all patients undergoing elective surgery should have normal serum potassium levels. However, we do not recommend delaying surgery if the serum potassium level is above 2.8 mEq/L or below 5.9 mEq/L, if the cause of the potassium imbalance is known, and if the patient is in otherwise optimal condition.”

 

[IMGASMD]

so like this?

Here’s the answer: Per Miller’s Anesthesia, p. 1107, “As a rule, all patients undergoing elective surgery should have normal serum potassium levels. However, we do not recommend delaying surgery if the serum potassium level is above 2.8 mEq/L or below 5.9 mEq/L, if the cause of the potassium imbalance is known, and if the patient is in otherwise optimal condition.”

Other than Blake’s example of supplements, any other causes for a persistent hyperkalemia?
Other than maybe exercise from this list…. I’d like still to know the reason.

Exactly all of this

I’d also like to add…. For most if not all of proceduralists, the patients are “theirs” only when it’s convenient. Their labs or any other abnormalities are only obstacles for their procedures, nothing more nothing less.

 

[anbuitachi]

Other than Blake’s example of supplements, any other causes for a persistent hyperkalemia?
Other than maybe exercise from this list…. I’d like still to know the reason.



I’d also like to add…. For most if not all of proceduralists, the patients are “theirs” only when it’s convenient. Their labs or any other abnormalities are only obstacles for their procedures, nothing more nothing less.

got to love the state of our healthcare in the US...

 

[coffeebythelake]

got to love the state of our healthcare in the US...

none moreso than ortho

 

[Beeftenderloin]

To further muddy the waters: Just last week did a TEE under MAC. K was 5.6 a week prior, patient otherwise optimized and at their baseline. Cardiology NP orders a redraw same day. I tell cardiologist I’m happy to proceed without it, so we do and patient does fine. K redraw comes back after we finish at 6.5 😅. Patient ended up getting admitted to poop out their K.

 

[coffeebythelake]

To further muddy the waters. Just last week did a TEE under MAC. K was 5.6 a week prior, patient otherwise optimized and at their baseline. Cardiology NP orders a redraw same day. I tell cardiologist I’m happy to proceed without it, so we do and patient does fine. K redraw comes back after we finish at 6.5 😅. Patient ended up getting admitted to poop out their K.

That would be a tough pickle u find yourself in if the patient had an intraop event

 

[Beeftenderloin]

That would be a tough pickle u find yourself in if the patient had an intraop event

Agreed. FWIW, K was 5.5 a month prior, 5.6 a week prior and patient had an EKG morning of with no evidence of hyperkalemia (wide QRS, peak T, etc.) so I felt comfortable proceeding. I still don’t think I would cancel this identical situation in the future. I would however wait for the lab to result if someone felt compelled to order it. Then obviously cancel if it came back 6.5 😂.

 

[Twiggidy]

none moreso than ortho

Orthopedic surgeons are some of coolest and nicest people in the OR but man sometimes they can live up to the stereotype

 

[Twiggidy]

To further muddy the waters: Just last week did a TEE under MAC. K was 5.6 a week prior, patient otherwise optimized and at their baseline. Cardiology NP orders a redraw same day. I tell cardiologist I’m happy to proceed without it, so we do and patient does fine. K redraw comes back after we finish at 6.5 😅. Patient ended up getting admitted to poop out their K.

was it for atrial fib or flutter because then maybe the BMP is more justified but it does support the saying “if you go looking for trouble you’re more likely to find it”