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Surgery: Ebl?
Started by FractureFixer
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you just start with a liter, and then go up or down from there based on the following formula:
got blood on your gown/mask/face: add 200mL
blood soaked into your new danskos: add 500mL
PGY3 or less was operating: add 1L
Trauma case: add 2L
want a LOR from the attending: subtract 800mL
still mad at the chief resident for pimping you on rounds: add 500 mL
didn't get to sew: add 500mL
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wait so you add 200 ml if how much blood gets on your mask? One drop or if you get sprayed?? 😕
I asked anesthesia, if I couldn't figure it out from the suction canister.
Perhaps, but you have to subtract any irrigation used. A liter in the suction cannister isn't very helpful if you irrigated with a liter of saline.
If you have a ton of soaked lap pads, you'll have to add those as well.
Ask the attending.
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We use lots of irrigation, so that number would be way off. If there was a lot of blood loss, and I see someone reaching for the irrigation, I quick look at the suction to see how much blood is in there. Anesthesia usually figures EBL for us, but if it was <200 mL, I usually just write down how much I thought was lost. I used to write "EBL minimal" but now I try to give an idea like EBL < 25cc or something like that. The bowel resections were usually pretty bloodless. As soon as we touched the liver, it was like Niagara Falls in there.
Yea, why would the student be trying to determine the EBL anyway, outside of just for practicing purposes? Shouldn't an attending or a chief resident be determining the official number to put on there....what if the patient goes into hypovolemic shock the next day and some student overestimated the blood loss and then you get questioned for why the patient didn't receive any blood during or right after the procedure.
I think the OP is just trying to figure out how to write an immediate post-op note and for whatever reason chose to come on SDN instead of asking his intern/resident/fellow students how to figure out EBL.
👍 Everything we do is for practicing purposes OP, that's the whole point of the clinical years. Just do your best and remember it's called 'Estimated' for a reason. It's the staff/residents' job to do their own documentation. If the only post-op note in the chart is written by the student, that attending is taking a hell of a risk in more ways than simply regarding EBL.
That's fine, but I don't think the resident/attending would want differing EBL numbers going into the chart. It just seems kinda odd to me, usually the attending or senior resident will announce the EBL at the end of the procedure, so that the anesthesiologist and nurses have it for the chart too. It's cool to try to estimate the EBL yourself I suppose, although I question how accurate even the EBL the attending gives is...Beyond being able to tell when a patient lost minimal blood like 50 mL and when a patient lost a lot of blood, like 1L in a non-trauma situation, I don't know how much you gain from trying to guess-timate at a student.
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