"St. Louis man awake during surgery"

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Lashler9054 said:
Hey, there are MD only practices in TX too. TX is far from being a place where socialized HC will fly
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Yeah, I know that. Hence my comment. I want both. I want it all damnit!!
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anbuitachi said:
very lucky they are only suing for 25000 DOLLARS.

View attachment 336687

does that even cover lawyer fees...
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They are not suing for only 25K. That is the minimum amount in their state to get into big boy court. The ask to settle will be much higher. The cost of getting a suit ready for trial- expert fees, court reporter fees, filings, lawyers time is about 100K.
 
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dannyboy1 said:
You might only be hearing about this because he is a new grad. Could be he was called to the room and started making a big deal about it and letting the surgeons and the nurses know all about it. A more seasoned doc might just “keep calm and carry on” give some versed, give a ton of propofol at the end of the case so he is out of it when he gets to PACU, then see if the patient mentions anything. Just a bad dream buddy.
just saying....
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As an FYI.

The case was non-medical direction so not 1:4. They wouldn't have even been present for induction.

Just another reason to avoid non-medical direction, you're a liability sponge.
 
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shadowblade said:
As an FYI.

The case was non-medical direction so not 1:4. They wouldn't have even been present for induction.

Just another reason to avoid non-medical direction, you're a liability sponge.
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What’s a non medical direction vs medical direction vs supervision?
 
shadowblade said:
As an FYI.

The case was non-medical direction so not 1:4. They wouldn't have even been present for induction.

Just another reason to avoid non-medical direction, you're a liability sponge.
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There's medical direction - medical supervision - or nothing.
 
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shadowblade said:
You're absolutely right.

But medical supervision is essentially worthless. Having more than 4 rooms, theres no way anyone can monitor for even the most routine things.
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medical supervision is a huge misnomer. It is basically signing charts and dealing with life threatening emergencies. it isn't double checking that the CRNA in the room knows basics of providing anesthesia.

You couldn't pay me enough to do medical supervision. I want to be actively involved in patient care decision making and medical direction is a much better way to go about it
 
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BLADEMDA said:
No way your version is believed by a jury. If this case goes to trial the plaintiff’s experts will testify under oath a very different standard than the one you are claiming here. who will the jury believe? The experts who state the anesthesiologist should have stayed in the room for an extra 30-45 seconds to verify the anesthesia was actually turned on or the other experts who say the nurse anesthetist was 100 percent at fault here. If you were the attending Anesthesiologist would you risk a trial based on the known facts of this case?

This is one of those situations where “you own it” and accept partial blame for the outcome. To be honest, the CRNA and AANA should both step up on this case and admit the CRNA was 100 percent responsible for the total recall in the room. The idea that a provider of anesthesia whose organization claims equivalency wouldn’t accept 100 percent of the blame for this case just exposes the blatant hypocrisy of the AANA.

if I screwed up a case you can rest assured I would be willing to make certain the CRNA did not incur any liability for my error. Is it asking too much of the CRNA to do the same thing for me?
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YOU CANNOT SUPERVISE INDIVIDUALS WHO BELIEVE THEY ARE TOO SMART TO BE SUPERVISED. THE POLITICAL RHETORIC HAS CREATED A VERY UNSAFE DYNAMIC AND TEAM, AT THE END, AFFECTING PATIENTS. PERIOD. I AM 100% OKAY WITH CRNA'S PRACTICING INDEPENDENTLY.. JUST DON'T CALL ME FOR THE BAIL OUT. BY THAT SAME LOGIC, THE AANA SHOULD BE OKAY WITH AA'S. WHY ARE THEY SO WORRIED?
 
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Tragic case. 18-yr old suffered brain damage and died after few months

Physician (plastic surgeon) in this case was on probation and license was suspended later, then restored based Colorado Board of Medicine:



CRNA surrendered his license.
 
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Splenda88 said:






Tragic case. 18-yr old suffered brain damage and died after few months

Physician (plastic surgeon) in this case was on probation and license was suspended later, then restored based Colorado Board of Medicine:



CRNA surrendered his license.
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Tragic as this was, you cannot say this was due to a deficiency in CRNA training. It was just a bunch of fools who decided they didn't need to follow the standard of care. Patient was abandoned. Patient suffered anoxic brain injury and ultimately died.. What this does show however is how pathetic the nursing boards are at regulation. Even though this was largely the responsibility of thr CRNa, it was the surgeon who got his license suspended for unprofessional conduct while the CRNA voluntarily gave up his anesthetist license but still could work as a nurse.
 
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coffeebythelake said:
Tragic as this was, you cannot say this was due to a deficiency in CRNA training. It was just a bunch of fools who decided they didn't need to follow the standard of care. Patient was abandoned. Patient suffered anoxic brain injury and ultimately died.. What this does show however is how pathetic the nursing boards are at regulation. Even though this was largely the responsibility of thr CRNa, it was the surgeon who got his license suspended for unprofessional conduct while the CRNA voluntarily gave up his anesthetist license but still could work as a nurse.
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Ultimately, it sucks to be that patient.

Serves the surgeon right, if they take on the responsibility of supervising or allowing crna practice independently. Also is true to what we’ve said all along, they (whoever the proverbial they is) will come for the deep pockets, I am sure plastic surgeon has the better insurance and better reputation to protect.

Lastly, how unfair it is to us as physicians, when our licenses is evoked, we have no fallbacks, but your “nurse anesthesiologists” can go back being a nurse again. WTF!
 
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IMGASMD said:
Serves the surgeon right, if they take on the responsibility of supervising or allowing crna practice independently. Also is true to what we’ve said all along, they (whoever the proverbial they is) will come for the deep pockets, I am sure plastic surgeon has the better insurance and better reputation to protect.

Lastly, how unfair it is to us as physicians, when our licenses is evoked, we have no fallbacks, but your “nurse anesthesiologists” can go back being a nurse again. WTF!
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We saw how many CRNAs wanted to work in bedside nursing at the start of the COVID pandemic. The anesthetist lost their ability to practice anesthesia (good riddance) as a result of their reckless choices and will likely make less than a third of their previous income as a bedside nurse doing scutwork. That is likely his best option.

Setting the intraop episode aside, the surgeon allowed a patient who coded and never regained consciousness to sit in his surgery center the rest of the day before finally deciding to transfer out. His license was suspended, rightfully so, but it has been reinstated and his practice will continue. Had he actually had his license revoked, he still has an MD behind his name and can easily pivot his role to another lucrative career in administration or consulting.
 
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2.0% said:
We saw how many CRNAs wanted to work in bedside nursing at the start of the COVID pandemic. The anesthetist lost their ability to practice anesthesia (good riddance) as a result of their reckless choices and will likely make less than a third of their previous income as a bedside nurse doing scutwork. That is likely his best option.
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Worked with plenty of crnas who would not doing any “RN” works, even during the height of covid. They would only consider working as icu midlevels, because they felt bedaide rn work was beneath them. What a crock pot full of ****. The mental gymnastics they perform to justify their work (!ethtic!) is unbelievable.


2.0% said:
Setting the intraop episode aside, the surgeon allowed a patient who coded and never regained consciousness to sit in his surgery center the rest of the day before finally deciding to transfer out. His license was suspended, rightfully so, but it has been reinstated and his practice will continue. Had he actually had his license revoked, he still has an MD behind his name and can easily pivot his role to another lucrative career in administration or consulting.
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At the surgicenters where I’ve worked it’s always the anesthesia’s call for pre and post op care. I see your point; however, at the same time the crna/anesthesia (in this case) also has the responsibility to advance the care. This is exactly where my problem is, they only want the easy cases/decisions, when the going gets tough, “I am only the nurse anesthetist, MD aware.”

I can beat my chest too, but I can and will accept any decisions and the fallouts that I make.

Edit: will add this for discussion.
https://forums.studentdoctor.net/i...-them---patient-seen-by-NP-and-dies?.1442988/
 
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IMGASMD said:
Worked with plenty of crnas who would not doing any “RN” works, even during the height of covid. They would only consider working as icu midlevels, because they felt bedaide rn work was beneath them. What a crock pot full of ****. The mental gymnastics they perform to justify their work (!ethtic!) is unbelievable.




At the surgicenters where I’ve worked it’s always the anesthesia’s call for pre and post op care. I see your point; however, at the same time the crna/anesthesia (in this case) also has the responsibility to advance the care. This is exactly where my problem is, they only want the easy cases/decisions, when the going gets tough, “I am only the nurse anesthetist, MD aware.”

I can beat my chest too, but I can and will accept any decisions and the fallouts that I make.

Edit: will add this for discussion.
https://forums.studentdoctor.net/index.php?threads/How-often-do-you-sign-midlevel-charts-like-this-without-a-chance-to-hear-about-them---patient-seen-by-NP-and-dies?.1442988/
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I think we're in agreement here. The CRNA surrendered their license and their career. It looks like they took responsibility for their (poor) decisions.
 
i dont know why, this started trending on tiktok now even though its old. anyone know what happened to the lawsuit? i didnt see anything. the blame on the anesthesiologist is strong out there. entire comment section blaming the MD. dont think public even know what crna is. MD takes the blame for it all in public eyes. crnas have a good job...
 
ERRES2288 said:
I’m curious about this as well. I would think an induction dose of prop would provide amnesia for at least 10 min or so.
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Not me. I've had dozens of surgeries. I can remember everything, even when I feel the meds kicking in, until I'm out. With or without versed on board before hand.
 
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anbuitachi said:
i dont know why, this started trending on tiktok now even though its old. anyone know what happened to the lawsuit? i didnt see anything. the blame on the anesthesiologist is strong out there. entire comment section blaming the MD. dont think public even know what crna is. MD takes the blame for it all in public eyes. crnas have a good job...
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Again the hypocrisy with thr AANA is on full display here. These nurses should be defending the anesthesiologist here since the cRNa was fully capable of being an independent provider. Turning on the vaporizer doesnt require higher order thinking. I guess a physician is needed to make sure the nurse does it appropriately. 🙄
 
coffeebythelake said:
Again the hypocrisy with thr AANA is on full display here. These nurses should be defending the anesthesiologist here since the cRNa was fully capable of being an independent provider. Turning on the vaporizer doesnt require higher order thinking. I guess a physician is needed to make sure the nurse does it appropriately. 🙄
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Since news of this lawsuit broke, I’ve turned on the vaporizer for CRNAs at least three different times. It’s become part of my checklist before leaving the room (arguably should have been the whole time).
 
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anaesthetic said:
Since news of this lawsuit broke, I’ve turned on the vaporizer for CRNAs at least three different times. It’s become part of my checklist before leaving the room (arguably should have been the whole time).
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always been a habit of mine.
double check that ventilator is switched on (!!) and vaporizer dialed up before i leave the room.
been doing that even before hearing about this lawsuit.
 
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patriot6 said:
no one is suggesting propofol provides retrograde amnesia. you're not special, sry.
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My point was neither propofol or versed reliably provide retrograde amnesia, not that I might be an exception to the rule.
 
srleslie said:
Not me. I've had dozens of surgeries. I can remember everything, even when I feel the meds kicking in, until I'm out. With or without versed on board before hand.
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srleslie said:
My point was neither propofol or versed reliably provide retrograde amnesia, not that I might be an exception to the rule.
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Lack of retrograde amnesia with both propofol and midaz is well established. Anyone who is relying on that is going to have a very upset patient on their hand.

If you don’t remember the tube going in then it sounds like the propofol works exactly the same for you as it does for everyone else. I have plenty of patients tell me they remember the burning of the medicine going in with their last anesthetic. As others have said, there is nothing particularly unique about your experience.
 
@srleslie I never suggested there is retrograde amnesia from propofol only that I believe there to be 10 min or so of amnesia AFTER an induction dose of propofol is given
 
I’m guessing the alarms were disabled, set incorrectly (unsafely), or had the audio alert turned off. The first thing I do when I come in to a room for the day is reset the monitor and make sure the machine was reset and tested that AM. People are stupid and do stupid things all the time. You can’t trust anyone.
 
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Beeftenderloin said:
Lack of retrograde amnesia with both propofol and midaz is well established. Anyone who is relying on that is going to have a very upset patient on their hand.

If you don’t remember the tube going in then it sounds like the propofol works exactly the same for you as it does for everyone else. I have plenty of patients tell me they remember the burning of the medicine going in with their last anesthetic. As others have said, there is nothing particularly unique about your experience.
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I never claimed there was anything unique about my experience. The propofol makes me unconscious. Of course I don't remember intubation.

I never remember extubation so I'm assuming it's from the drugs.
 
coffeebythelake said:
always been a habit of mine.
double check that ventilator is switched on (!!) and vaporizer dialed up before i leave the room.
been doing that even before hearing about this lawsuit.
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I missed this thread last time, but I had a case similar to the lawsuit here. Except when I left the room the vaporizer was on. Easy case, healthy patient, and once the tube went in and I saw sevo on I went to start the big case with lines. And for some reason I decided I needed to circle back. I even announced it for some reason. I said something like "I need to go back to my other room to make sure that crna hasn't killed the patient yet". I don't know why I said or thought that. So I walk in and immediately say "why is the patients HR in the 130s?" Crna: "huh, I don't know". Me: "are you running a tiva?, There's no gas on". I immediately knew what happened. They moved the patient lower on the bed, and the crna killed the sevo and disconnected the circuit when moving and never turned it back on. It had been off for almost 10 minutes. Luckily we had no recall. Im just glad my Spidey sense kicked in and made me go back to the room. So you can make sure the gas is on when you leave, but at some point you have to trust the crna in the room to not do something stupid.
 
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ASA6 said:
I missed this thread last time, but I had a case similar to the lawsuit here. Except when I left the room the vaporizer was on. Easy case, healthy patient, and once the tube went in and I saw sevo on I went to start the big case with lines. And for some reason I decided I needed to circle back. I even announced it for some reason. I said something like "I need to go back to my other room to make sure that crna hasn't killed the patient yet". I don't know why I said or thought that. So I walk in and immediately say "why is the patients HR in the 130s?" Crna: "huh, I don't know". Me: "are you running a tiva?, There's no gas on". I immediately knew what happened. They moved the patient lower on the bed, and the crna killed the sevo and disconnected the circuit when moving and never turned it back on. It had been off for almost 10 minutes. Luckily we had no recall. Im just glad my Spidey sense kicked in and made me go back to the room. So you can make sure the gas is on when you leave, but at some point you have to trust the crna in the room to not do something stupid.
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For this reason I actually do like using succinylcholine for some short cases, so long as paralysis is not needed, ensures patient is deep enough. Forces you to make sure patient is deep before paralyzing, assuming you don’t push the roc immediately after the tube goes in.
 
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ASA6 said:
I missed this thread last time, but I had a case similar to the lawsuit here. Except when I left the room the vaporizer was on. Easy case, healthy patient, and once the tube went in and I saw sevo on I went to start the big case with lines. And for some reason I decided I needed to circle back. I even announced it for some reason. I said something like "I need to go back to my other room to make sure that crna hasn't killed the patient yet". I don't know why I said or thought that. So I walk in and immediately say "why is the patients HR in the 130s?" Crna: "huh, I don't know". Me: "are you running a tiva?, There's no gas on". I immediately knew what happened. They moved the patient lower on the bed, and the crna killed the sevo and disconnected the circuit when moving and never turned it back on. It had been off for almost 10 minutes. Luckily we had no recall. Im just glad my Spidey sense kicked in and made me go back to the room. So you can make sure the gas is on when you leave, but at some point you have to trust the crna in the room to not do something stupid.
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I stop the flows when disconnecting the ETT for this reason. If I forget to turn the vent back on, it’ll alarm at me, the. I turn it on and the sevo is still on.

If turn down the sevo and forget to turn it back on, I better hope I recognize it in time.
 
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Dantrolene FC said:
I stop the flows when disconnecting the ETT for this reason. If I forget to turn the vent back on, it’ll alarm at me, the. I turn it on and the sevo is still on.

If turn down the sevo and forget to turn it back on, I better hope I recognize it in time.
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I simply leave the vent and sevo on and move, maybe disconnect if I need to and give the room a few 500 ml sevo breaths, or put the circuit on the stopper like doing a leak test.
 
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dipriMAN said:
I simply leave the vent and sevo on and move, maybe disconnect if I need to and give the room a few 500 ml sevo breaths, or put the circuit on the stopper like doing a leak test.
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Our machines have a Pause function that stops all flows, and turns off the vent. It defaults to 2 minutes but you can dial shorter or longer if you want. Super useful feature.
 
dipriMAN said:
I simply leave the vent and sevo on and move, maybe disconnect if I need to and give the room a few 500 ml sevo breaths, or put the circuit on the stopper like doing a leak test.
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Gassing the room at all is really unnecessary if one is using a GE machine nowadays.

Screenshot_20230314_205626_Acrobat for Samsung.jpg


Plus if you use this feature you don't need to refill your bellows
 
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dipriMAN said:
Nice. Never used a GE. All Drager at every hospital I have been in my area.
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New Drager Perseus has a pause button. Stops all gas flow, so you don't blast the room. Then just hit resume when done.
 
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dipriMAN said:
Perseus, never seen one, sounds fancy
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Very fancy. Very overrated IMO. It's massive and clunky. Poorly engineered placement of the water trap cause you can't see it and it's a pain to replace, especially if room is cramped. However, our peds people really love it because they can deliver much more precise tiny tidal volumes for neonates and premies.
 
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abolt18 said:
Very fancy. Very overrated IMO. It's massive and clunky. Poorly engineered placement of the water trap cause you can't see it and it's a pain to replace, especially if room is cramped. However, our peds people really love it because they can deliver much more precise tiny tidal volumes for neonates and premies.
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The Draeger Perseus is the machine I was referencing earlier. It's got some fantastic features but all in all I agree that it's overrated and not ideally engineered.
 
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