Quick Resident Preop Case

[pjl]

I assume he's talking about temporary TV pacers (pacing swans, etc). We definitely did this during residency and I've had to do it a handful of times in practice (not CV fellowship trained).

Same. It is REALLY not difficult. I have done it a handful of times in practice. I have only used transcutaneous pacing as a bridge to placing a pacing swan, I guess I thought that was normal.


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[GravelRider]

To all of you who would do the case and send him home:

6 mo later you get served a lawsuit because the guy went home and died in his sleep the same night of the surgery. They claim that you negligently did the case, plus you also negligently discharged him home. They also claim that anesthesia has many chronotropic effects that you did not disclose to him and if you had done so he would have never consented to the anesthetic.

What is your defense?

I actually agree that the case shouldn't be done for a few reasons and most definitely not discharged home the same day. However, I think the family would have a hard time finding a lawyer to take this case. The death of an 89 year old who has been walking around in complete heart block for years and refusing pacemakers doesn't exactly seem like a big money case for a lawyer. If you are convinced into doing the case then I definitely think you need a cardiologist's input...even just for documentation purposes. You need to obtain all of his cardiologist's records of his conversations with the patient in the chart. If you frame the surgery as palliative due to his discomfort, I don't think a lawyer takes this case even if he dies in his bed the next day. Lawyers don't like the 89 year olds with a terminal illness...especially if you document appropriately.

 

[urge]

, I think the family would have a hard time finding a lawyer to take this case. The death of an 89 year old who has been walking around in complete heart block for years and refusing pacemakers doesn't exactly seem like a big money case for a lawyer.

That's a good point but if the death happened on the night of surgery it will make it more appealing. Any layman will say it was a periop complication.

 

[sigrhoillusion]

That's a good point but if the death happened on the night of surgery it will make it more appealing. Any layman will say it was a periop complication.

The odd thing is that this patient was clearly knowledgeable about his heart issue and had a cardiologist. You'd think that at either his ortho appointment he'd bring up his heart block, or at his cardiac appt he'd bring up his upcoming surgery.

Either way the surgeon you'd think would make sure he had appropriate clearance. Heck, seems like our orthos send people for clearance if they look at them funny. And if not, the cardiologist should have had the notion to forward this info on.

Seems like someone dropped the ball, and this isn't something that should be decided day of surgery in preop area.

I've had some 70yo DOS show up for hernia repair in complete heart block. I want to say seen on a prior EKG or maybe it was an ordered EKG, but patient was asymptomatic and didn't know about it. sorry bud, off to cardiology.

Thing is even if we didn't have the ekg in holding area and he had no complaints, as soon as we got into OR and hooked him up, would see the rhythm and probably postpone at that point. I had a guy a month or so ago who was getting a lower extremity procedure done. 30yo otherwise healthy. We brought him back to OR early to do a nerve block. Gave him 2mg versed on way back. Got into OR hooked him up and whammm rapid wide complex tachycardia. Patient otherwise stable, asymptomatic with pulse.

Told ortho. postponed case. cardiology consulted. Started a procainamide or sotalol infusion and then ended up going to cath lab for cardioversion later when that failed. Also turned out patient remembered he had arrhythmia afterwards. WPW.