Upcoming case - help a brother out!

[abolt18]

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2nd Cardiology fellow, I like to look at other forums to see what they do and get a different perspective.

Welcome. We also appreciate when people contribute different perspective.

 

[deleted697535]

Dunno, my job is to get her optimized for the OR 😜

Were very grateful.

Looks lads were getting way down the rabbit hole here...
We do 5 of these hips some weekends cept were not checking gases on 100 yr old cripples. Give her a slug of whatever, flip her lateral, shove in 2 mls of something thru a quinke and sit in the chair for 90 mins.
These people are on borrowed time. This is a palliative procedure.

2nd Cardiology fellow, I like to look at other forums to see what they do and get a different perspective.

Wowza. God bless america. A cards fellow telling career cardiac anesthesiologists and intensivists how to give an anesthetic. I love it

 

[aafisahar]

Wowza. God bless america. A cards fellow telling career cardiac anesthesiologists and intensivists how to give an anesthetic. I love it

Where did I say what anesthetic to give? I merely provided a plan to get her ready for the OR.

 

[anbuitachi]

Were very grateful.

Looks lads were getting way down the rabbit hole here...
We do 5 of these hips some weekends cept were not checking gases on 100 yr old cripples. Give her a slug of whatever, flip her lateral, shove in 2 mls of something thru a quinke and sit in the chair for 90 mins.
These people are on borrowed time. This is a palliative procedure.

Wowza. God bless america. A cards fellow telling career cardiac anesthesiologists and intensivists how to give an anesthetic. I love it

someone is clearly tripping these old cripples around your institution

we do a lot of old traumatic hips here too, not that many, but its a daily case. always get 'optimized' as much as possible first. we dont treat them as emergent cases, only urgent. too many demented patients who can barely move in the first place. dont need to rush to OR from ED.

 

[ISoNitrous]

What was her gas like during thr case ? Why a decision for NRB and not PAP?

No intraop gases were drawn. Not sure why NRB was chosen over PAP; my guess is the logistics of getting BiPAP into the OR and maybe traction from respiratory therapy.

 

[ISoNitrous]

patient isnt even optimized. why even proceed with the case... we dont always have to go ahead with these cases. this patient's chance of dying from something else is far higher than this fracture. was she even in a lot of pain from this fracture?

The fracture had her bedbound and was causing pain with any movement.

 

[abolt18]

No intraop gases were drawn. Not sure why NRB was chosen over PAP; my guess is the logistics of getting BiPAP into the OR and maybe traction from respiratory therapy.

You can literally set up your anesthesia machine as BiPAP. It's called, strap the mask onto the face and turn on pressure support. Titrate pressures as needed.

 

[coffeebythelake]

You can literally set up your anesthesia machine as BiPAP. It's called, strap the mask onto the face and turn on pressure support. Titrate pressures as needed.

yep and this works very well in certain clinical situations.

 

[Hoya11]

You canucks are weirdos...

On the LMA debate... I would be OK with it too.

There seems to be some LMA shaming that goes on here.

She is currently on Nasal Cannula O2.

An LMA is going to be a big upgrade for her.

With an LMA, she is going to have higher FiO2, and a more open airway.

Just because you see pulmonary edema and an o2 requirement doesnt immediately mean ETT.

Spontaneous ventilation, minimal narcotic, breathing sevo, remove LMA to face mask o2.

 

[vector2]

Sat up for epidural...
0 sedation (other than intrinsic CO2)

Nice case, but the quoted above is the part that made the case just mildly complex instead of extremely complex, and you guys were lucky to have a cooperative pt like this. The real question is what to do if she was non-cooperative for neuraxial position, or what if she had horrible anxiety or claustrophobia once positioned for surgery.... especially considering the exaggerated effect that sedatives have on someone who's already hypercarbic. It feels like the fat pulmonary/cardiac cripples I get are never "easy" 0 sedation pts like this.

 

[deleted697535]

On the LMA debate... I would be OK with it too.

There seems to be some LMA shaming that goes on here.

She is currently on Nasal Cannula O2.

An LMA is going to be a big upgrade for her.

With an LMA, she is going to have higher FiO2, and a more open airway.

Just because you see pulmonary edema and an o2 requirement doesnt immediately mean ETT.

Spontaneous ventilation, minimal narcotic, breathing sevo, remove LMA to face mask o2.

Grateful to see the LMA gets sdn approval. We must alert the FDA. This new invention could be big

 

[ISoNitrous]

You can literally set up your anesthesia machine as BiPAP. It's called, strap the mask onto the face and turn on pressure support. Titrate pressures as needed.

This was a consideration. However, Our 1970 ventilator prototypes (Penlon) leave a lot to be desired in terms of delivering the desired parameters. The ENIAC-era programming often delivers triple (or sometimes one third) of what’s programmed. Lots of alarms, 1200cc tidal volumes, etc.

But hey - it beats bagging.

 

[PainDrain]

This was a consideration. However, Our 1970 ventilator prototypes (Penlon) leave a lot to be desired in terms of delivering the desired parameters. The ENIAC-era programming often delivers triple (or sometimes one third) of what’s programmed. Lots of alarms, 1200cc tidal volumes, etc.

But hey - it beats bagging.

Do you practice in the US?

 

[GassYous]

Do you practice in the US?

I've used an mri compatible one