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I feel like I've seen this thread before..... Didn't end well.😎
 
Well said. For awhile it's been the usual "Do you think I have a chance at residency x if I have y on my résumé," or folks claiming to know all the EXACT qualifications needed for each and every program in the western hemisphere. :bang:

Anybody have good case discussions, or questions about clincal anesthesia for a change?!
 
I have a case from last thursday night. More of a I can not believe this actually happened and I am very lucky that things happened the way they did.

Get a call from a surgeon at 11 pm. "I want to do an appy in a 41 year old smoker in the ed. No real history except she had a TEF repair as a child.". I was just finishing up an "emergency" discectomy in a 375 lb lady that I did as a favor for my neuro buddy so he could go skiing the next day. So I went to the ed to see the lady as i wanted to hear from her about the tef repair and see if intubating her could be a prolem. I walk into the room and she looks terrible. Her story is she woke up that morning with some chest pain and vomited a few times and ow she felt weak. Ct read was weak for inflamed appendix and she had no abdominal pain on plapation but she did have a white count in the 20's. I wanted to hear more about the chest pain as she had it and it was gone and i asked for an ekg. They had not done one so i ordered one and it had st elevations in V1 and v2. Wasnt huge but it was there. I was going to call back the surgeon and tell him he had to wait and this lady needed to see cards when the er doc comes in with a WTF look on his face and tries to give me a hard time with "this is a strait forward appy why are you wasting time and $ on and ekg. She has no reason to have heart trouble." i didnt know this er doc because we get some per deim guys from time to time. I took him out of the room and "gently" explained to him that i order what ever tests i want and he probably should have ordered one when the lady came in 5 hrs ago with a complaint of CP then stuck teh 12 lead in his face and finished with" i hope they taught you in medical school how to treat an acute MI cause you missed diagnosing it. I am going to bed tell jim he can go home he wont be doing an appy tonight.". So i thought my night was over and headed back to the call room for some well deserved rest. That was until i was called by the operator a few ours later saying they needed me in the cath lab right away. As i walk into the door the same young lady i was shooting the **** with is in cardiogenic shock with an LAD disection. I tube her and walk out the door. She gets an Abp and is life flighted out. I swing back through the ed on the way back to the call you to tell the ed doc and inform him to start hiding his assets and call his malpractice carrier. Blaz
 
bostonblaz said:
I have a case from last thursday night. More of a I can not believe this actually happened and I am very lucky that things happened the way they did.

Get a call from a surgeon at 11 pm. "I want to do an appy in a 41 year old smoker in the ed. No real history except she had a TEF repair as a child.". I was just finishing up an "emergency" discectomy in a 375 lb lady that I did as a favor for my neuro buddy so he could go skiing the next day. So I went to the ed to see the lady as i wanted to hear from her about the tef repair and see if intubating her could be a prolem. I walk into the room and she looks terrible. Her story is she woke up that morning with some chest pain and vomited a few times and ow she felt weak. Ct read was weak for inflamed appendix and she had no abdominal pain on plapation but she did have a white count in the 20's. I wanted to hear more about the chest pain as she had it and it was gone and i asked for an ekg. They had not done one so i ordered one and it had st elevations in V1 and v2. Wasnt huge but it was there. I was going to call back the surgeon and tell him he had to wait and this lady needed to see cards when the er doc comes in with a WTF look on his face and tries to give me a hard time with "this is a strait forward appy why are you wasting time and $ on and ekg. She has no reason to have heart trouble." i didnt know this er doc because we get some per deim guys from time to time. I took him out of the room and "gently" explained to him that i order what ever tests i want and he probably should have ordered one when the lady came in 5 hrs ago with a complaint of CP then stuck teh 12 lead in his face and finished with" i hope they taught you in medical school how to treat an acute MI cause you missed diagnosing it. I am going to bed tell jim he can go home he wont be doing an appy tonight.". So i thought my night was over and headed back to the call room for some well deserved rest. That was until i was called by the operator a few ours later saying they needed me in the cath lab right away. As i walk into the door the same young lady i was shooting the **** with is in cardiogenic shock with an LAD disection. I tube her and walk out the door. She gets an Abp and is life flighted out. I swing back through the ed on the way back to the call you to tell the ed doc and inform him to start hiding his assets and call his malpractice carrier. Blaz
Click to expand...

I PMed you. I think we practice in the same region.
 
That's an amazing story. Thanks for sharing!! 👍👍

Although sometimes...I feel that some patients give various providers different versions of their stories. I remembered when I was a 3rd year med student, one of my patients (or rather, my only patient 😳 ) basically told my resident something that's very different from my HPI and then it was again something very different when she was interviewed by my attending to the point where I thought everyone must have thought I was a liar....

I certainly hope that there would be someone like you in the future to point out my mistake...and a good malpractice insurance.
 
bostonblaz said:
I have a case from last thursday night. More of a I can not believe this actually happened and I am very lucky that things happened the way they did.

Get a call from a surgeon at 11 pm. "I want to do an appy in a 41 year old smoker in the ed. No real history except she had a TEF repair as a child.". I was just finishing up an "emergency" discectomy in a 375 lb lady that I did as a favor for my neuro buddy so he could go skiing the next day. So I went to the ed to see the lady as i wanted to hear from her about the tef repair and see if intubating her could be a prolem. I walk into the room and she looks terrible. Her story is she woke up that morning with some chest pain and vomited a few times and ow she felt weak. Ct read was weak for inflamed appendix and she had no abdominal pain on plapation but she did have a white count in the 20's. I wanted to hear more about the chest pain as she had it and it was gone and i asked for an ekg. They had not done one so i ordered one and it had st elevations in V1 and v2. Wasnt huge but it was there. I was going to call back the surgeon and tell him he had to wait and this lady needed to see cards when the er doc comes in with a WTF look on his face and tries to give me a hard time with "this is a strait forward appy why are you wasting time and $ on and ekg. She has no reason to have heart trouble." i didnt know this er doc because we get some per deim guys from time to time. I took him out of the room and "gently" explained to him that i order what ever tests i want and he probably should have ordered one when the lady came in 5 hrs ago with a complaint of CP then stuck teh 12 lead in his face and finished with" i hope they taught you in medical school how to treat an acute MI cause you missed diagnosing it. I am going to bed tell jim he can go home he wont be doing an appy tonight.". So i thought my night was over and headed back to the call room for some well deserved rest. That was until i was called by the operator a few ours later saying they needed me in the cath lab right away. As i walk into the door the same young lady i was shooting the **** with is in cardiogenic shock with an LAD disection. I tube her and walk out the door. She gets an Abp and is life flighted out. I swing back through the ed on the way back to the call you to tell the ed doc and inform him to start hiding his assets and call his malpractice carrier. Blaz
Click to expand...

Were the cardiologists placing an LAD stent and caused the dissection?
 
bostonblaz said:
I have a case from last thursday night. More of a I can not believe this actually happened and I am very lucky that things happened the way they did.

Get a call from a surgeon at 11 pm. "I want to do an appy in a 41 year old smoker in the ed. No real history except she had a TEF repair as a child.". I was just finishing up an "emergency" discectomy in a 375 lb lady that I did as a favor for my neuro buddy so he could go skiing the next day. So I went to the ed to see the lady as i wanted to hear from her about the tef repair and see if intubating her could be a prolem. I walk into the room and she looks terrible. Her story is she woke up that morning with some chest pain and vomited a few times and ow she felt weak. Ct read was weak for inflamed appendix and she had no abdominal pain on plapation but she did have a white count in the 20's. I wanted to hear more about the chest pain as she had it and it was gone and i asked for an ekg. They had not done one so i ordered one and it had st elevations in V1 and v2. Wasnt huge but it was there. I was going to call back the surgeon and tell him he had to wait and this lady needed to see cards when the er doc comes in with a WTF look on his face and tries to give me a hard time with "this is a strait forward appy why are you wasting time and $ on and ekg. She has no reason to have heart trouble." i didnt know this er doc because we get some per deim guys from time to time. I took him out of the room and "gently" explained to him that i order what ever tests i want and he probably should have ordered one when the lady came in 5 hrs ago with a complaint of CP then stuck teh 12 lead in his face and finished with" i hope they taught you in medical school how to treat an acute MI cause you missed diagnosing it. I am going to bed tell jim he can go home he wont be doing an appy tonight.". So i thought my night was over and headed back to the call room for some well deserved rest. That was until i was called by the operator a few ours later saying they needed me in the cath lab right away. As i walk into the door the same young lady i was shooting the **** with is in cardiogenic shock with an LAD disection. I tube her and walk out the door. She gets an Abp and is life flighted out. I swing back through the ed on the way back to the call you to tell the ed doc and inform him to start hiding his assets and call his malpractice carrier. Blaz
Click to expand...

I would have just told the er doc that I don't bother him at this job when he is sucking somebody's d#$$. Yup, it is tough to make a living and put food on the table dealing with these clowns.
 
bostonblaz said:
I have a case from last thursday night. More of a I can not believe this actually happened and I am very lucky that things happened the way they did.

Get a call from a surgeon at 11 pm. "I want to do an appy in a 41 year old smoker in the ed. No real history except she had a TEF repair as a child.". I was just finishing up an "emergency" discectomy in a 375 lb lady that I did as a favor for my neuro buddy so he could go skiing the next day. So I went to the ed to see the lady as i wanted to hear from her about the tef repair and see if intubating her could be a prolem. I walk into the room and she looks terrible. Her story is she woke up that morning with some chest pain and vomited a few times and ow she felt weak. Ct read was weak for inflamed appendix and she had no abdominal pain on plapation but she did have a white count in the 20's. I wanted to hear more about the chest pain as she had it and it was gone and i asked for an ekg. They had not done one so i ordered one and it had st elevations in V1 and v2. Wasnt huge but it was there. I was going to call back the surgeon and tell him he had to wait and this lady needed to see cards when the er doc comes in with a WTF look on his face and tries to give me a hard time with "this is a strait forward appy why are you wasting time and $ on and ekg. She has no reason to have heart trouble." i didnt know this er doc because we get some per deim guys from time to time. I took him out of the room and "gently" explained to him that i order what ever tests i want and he probably should have ordered one when the lady came in 5 hrs ago with a complaint of CP then stuck teh 12 lead in his face and finished with" i hope they taught you in medical school how to treat an acute MI cause you missed diagnosing it. I am going to bed tell jim he can go home he wont be doing an appy tonight.". So i thought my night was over and headed back to the call room for some well deserved rest. That was until i was called by the operator a few ours later saying they needed me in the cath lab right away. As i walk into the door the same young lady i was shooting the **** with is in cardiogenic shock with an LAD disection. I tube her and walk out the door. She gets an Abp and is life flighted out. I swing back through the ed on the way back to the call you to tell the ed doc and inform him to start hiding his assets and call his malpractice carrier. Blaz
Click to expand...

This is marvelous. Way to advocate and be more than right in the process. Imagine what would have happened if some poor naive and pushover anesthesiologist had just done what was asked of them. Surgeons have no idea how many crappy outcomes we save them from. And apparently this ED doc had no clue.
 
Oh Michigan girl. Surgeons do know. They just don't care. And when they are screaming at me in the preop area, I just yell back because I care.
 
cincincyreds said:
Oh Michigan girl. Surgeons do know. They just don't care. And when they are screaming at me in the preop area, I just yell back because I care.
Click to expand...

You really need to find a new gig ... I don't know how you put up with that. :lame:
 
pgg said:
You really need to find a new gig ... I don't know how you put up with that. :lame:
Click to expand...

I really only care about the patients as I am thankful I am not in their situation. That is how I put up with things.
 
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