- Joined
- Jun 20, 2005
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Did a pretty funny case today. 60ish you lady with ESRD, CAD, HTN, Severe PVD s/p bilateral BKA's. She had an MI in December and received 4 DES (stents) supplying the vast majority of her coronary flow. On Plavix and ASA s/p stents. I did the anesthetic for her last BKA about 2 months ago withthe same surgeon. She bled like a stuck pig, big surprise since we didn't stop the plavix. He like many surgeons didn't have an accurate appreciation of plavix during the first BKA. He asked me why I was type and crossing the pt for a BKA. 😱 Now don't get me wrong, he's a good surgeon but thats it. He doesn't know much about medicine like many surgeons. He thinks, bring them to the OR, I can fix it. Fast forward to today. Pt is septic from infected BKA stump. We sort of need to debride it and I am not in favor of stopping the plavix. So we go to the OR and I say "Hey you want to put a tourniquet on that stump b/4 we start?" He says, "No, why?"
So I type and cross her again since he didn't do it, AGAIN.
He gets started and looks up at me and says, "she exsanguinating". No ****, I say. How about a tourniquet? Finally he puts a tourniquet on and gets control of the bleeding. Then I remind him of the last time we did her. 😴 Oh well, another day down.

