Prone positioning

[Putmetosleep]

Hello all. I stumbled upon the AWESOME website. Does anyone have tips in prone positioning. I can't seem to get it right with all of the wires and IV lines trying to decapitate the patient during turning. What do you guys/gals do? Do you disconnect everything from the patient (monitors, iv's, ETT) prior to turning? Thank you.

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[UTSouthwestern]

Hello all. I stumbled upon the AWESOME website. Does anyone have tips in prone positioning. I can't seem to get it right with all of the wires and IV lines trying to decapitate the patient during turning. What do you guys/gals do? Do you disconnect everything from the patient (monitors, iv's, ETT) prior to turning? Thank you.

Usually disconnect everything except the IV. After turning them prone, I reconnect the tube, make sure the gas is on, reconnect all the monitors, put the patient in about 30 degrees reverse T berg and we're ready to go.

 

[jetproppilot]

Usually disconnect everything except the IV. After turning them prone, I reconnect the tube, make sure the gas is on, reconnect all the monitors, put the patient in about 30 degrees reverse T berg and we're ready to go.

Man, the parallels between anesthesia and aviation are unnerving. This post shows that UT is not "monitor dependent", like alot of pilots today are "GPS dependent".
In aviation today, with all the GPS advanced technology, knowing where you are at any time is so much easier than it used to be. All you have to do in the airplane is look at your moving map which depicts your airplane in the middle, and say to the air traffic controller, "five miles east southeast of AEX VOR." Before GPS the pilot had to use 2 VORs (a VOR is a land based navigational instrument that receivers in your airplane pick up; using two VORs you can use trigonometric principles to triangulate your position) to determine position (well,..theres another instrument, the DME, distance monitoring equipment, but we'll omit that for this conversation). With GPS monitoring exact location is made much easier.
Same in anesthesia with SPO2, BP, etc. A clinician knows exactly where the patient is at. But what if a monitor fails? Or what if a scenerio presents itself, like prone positioning, where monitoring during that certain time becomes beyond laborious?
This is where you can tell a clinician from a non clinician. Remember 30 years ago pulse ox was non-existent, BPs were palpated, ECGs were on a flinstone oscilliscope, and the clinician had to be well in touch with how the patient looked, felt, and sounded.
Gain the "old school" principles of patient well being (or old school navigation), and you have mastered your craft.
When you can feel comfortable by looking at the patients color, nailbeds, and strength of radial pulse, you have mastered anesthesia.
And when you know where you are in an airplane at a moments notice without the luxury of GPS, you are on your way to being a stellar pilot.

 

[Noyac]

Disconnect it all. IV, monitors, circuit, even the a-line. Flip the pt and reconnect in order of importance (circuit, IV, etc). Nothin to it.

 

[jwk]

Disconnect it all. IV, monitors, circuit, even the a-line. Flip the pt and reconnect in order of importance (circuit, IV, etc). Nothin to it.

I d/c all the monitors, and then the circuit right before the flip. I leave the IV and A-line intact if possible (just as much work capping four connections and reconnecting them). But to each his own - find a system that works for you.

 

[jwk]

Man, the parallels between anesthesia and aviation are unnerving. This post shows that UT is not "monitor dependent", like alot of pilots today are "GPS dependent".
In aviation today, with all the GPS advanced technology, knowing where you are at any time is so much easier than it used to be. All you have to do in the airplane is look at your moving map which depicts your airplane in the middle, and say to the air traffic controller, "five miles east southeast of AEX VOR." Before GPS the pilot had to use 2 VORs (a VOR is a land based navigational instrument that receivers in your airplane pick up; using two VORs you can use trigonometric principles to triangulate your position) to determine position (well,..theres another instrument, the DME, distance monitoring equipment, but we'll omit that for this conversation). With GPS monitoring exact location is made much easier.
Same in anesthesia with SPO2, BP, etc. A clinician knows exactly where the patient is at. But what if a monitor fails? Or what if a scenerio presents itself, like prone positioning, where monitoring during that certain time becomes beyond laborious?
This is where you can tell a clinician from a non clinician. Remember 30 years ago pulse ox was non-existent, BPs were palpated, ECGs were on a flinstone oscilliscope, and the clinician had to be well in touch with how the patient looked, felt, and sounded.
Gain the "old school" principles of patient well being (or old school navigation), and you have mastered your craft.
When you can feel comfortable by looking at the patients color, nailbeds, and strength of radial pulse, you have mastered anesthesia.
And when you know where you are in an airplane at a moments notice without the luxury of GPS, you are on your way to being a stellar pilot.

Unfortunately, I remember first-hand the days of manual BP's, no pulse ox or end tidal, and the "bouncing ball" EKG trace that disappeared all too quickly. Copper kettles? Been there. Ploss valve? Great concept back then. And, OMG, the planes of anesthesia.

JPP is absolutely correct. Take care of the PATIENT, not the monitors, although ya better pay close attention when the ETCO2 reads zero after intubation.

I actually like to mess with my students by turning off monitors - hey JPP, just like running partial panel It's amazing how many don't know how to tell if a patient is still adequately oxygenated or even if their heart is still beating. Patients (and their nurses) look at me like I'm crazy when I tell them they shouldn't wear makeup or nail polish. I hate when the arms are tucked - there's lots of info to be had from a radial pulse. Rate, pressure, rhythm. The really old-school CRNA's used to have a thing about "always have a finger or hand on the patient". They knew what they were talking about.

 

[militarymd]

I hate when the arms are tucked - there's lots of info to be had from a radial pulse. Rate, pressure, rhythm.

Although I must agree with having an extremity available (addidtional IV access, peripheral pulse assessment, color or lack thereof, etc.), you really can not assess rhythm without electrocardiography unless you have some extraordinary ability with the Force.

 

[jwk]

Although I must agree with having an extremity available (addidtional IV access, peripheral pulse assessment, color or lack thereof, etc.), you really can not assess rhythm without electrocardiography unless you have some extraordinary ability with the Force.

Luke Skywalker and I are best friends.

Actually - it would be more appropriate to say whether the rhythm was regular or irregular. I wouldn't diagnose anything that way, but 30 years ago when some didn't use an EKG at all, you could at least get an idea if the rhythm had changed, or perhaps some PVC's.

 

[IceDoc]

Man, the parallels between anesthesia and aviation are unnerving. This post shows that UT is not "monitor dependent", like alot of pilots today are "GPS dependent".
In aviation today, with all the GPS advanced technology, knowing where you are at any time is so much easier than it used to be. All you have to do in the airplane is look at your moving map which depicts your airplane in the middle, and say to the air traffic controller, "five miles east southeast of AEX VOR." Before GPS the pilot had to use 2 VORs (a VOR is a land based navigational instrument that receivers in your airplane pick up; using two VORs you can use trigonometric principles to triangulate your position) to determine position (well,..theres another instrument, the DME, distance monitoring equipment, but we'll omit that for this conversation). With GPS monitoring exact location is made much easier.
And when you know where you are in an airplane at a moments notice without the luxury of GPS, you are on your way to being a stellar pilot.

VOR'S? Pansy. You should be using your sextant on the sun or stars !
Actually my favorite is pilotage; there's something satisfying about turn left at the water tower, fly down the valley, then look hard to find that anomalous straight stretch of sweet pavement waiting to caress your tires in a greeser.