Upcoming Grey's Anatomy patient accidentally awake

[AnesFuture]

I just saw some preview of this weeks upcoming Grey's Anatomy show will feature a mistake where the patient is left awake and moving during the surgery.

---

Members don't see this ad.

 

[Camel]

I just saw some preview of this weeks upcoming Grey's Anatomy show will feature a mistake where the patient is left awake and moving during the surgery.

That show's writers must hate anesthesiologists. My wife watches it and in my peripheral attention I have seen 2 separate instances where the anesthesiologist is... well, far less than ideal.

Once, the anesthesiologist was drunk and fell asleep during a peds surgery and got kicked out by McWhatever. Another time, there was an explosive device in a patient and the anesthesiologist bailed and left Grey to handle it alone. Sure, he had a family, but that second time started smelling like a trend. 🙄

 

[G-Man82]

That show is all about "Surgery." I think they give the impression sometimes that the surgeons manage the anesthesia and that its the surgeons who are checking out the monitor and reacting if the patient goes into VTach or the BP drops. I don't really know about other places, but usually at mine, they take a step back when the Anesthesiologist starts reacting to possible emergencies.

 

[Coastie]

won't that show die already!

Someone needs to put it out of its misery.

Next, it'll have CRNAs nursingly directing MD(A)'s. It'll probably go something like this:

CRNA: Now, MDA Coastie, make sure you wrap the pink blanket of love around the patients head during her mastectomy. You know how it will reduce the narcotic requirements to only 50 mcg/kg/hr during this surgery!

MDA Coastie: Yes, doctor nurse jackie. 🙁



pink blanket ref:
http://www.allshadesofpink.org/Comfort_Blanket_Program.html

 

[Intensivist]

l fkn hate that idiotic show... please, make it stop....

 

[Bertelman]

That show is all about "Surgery." I think they give the impression sometimes that the surgeons manage the anesthesia and that its the surgeons who are checking out the monitor and reacting if the patient goes into VTach or the BP drops. I don't really know about other places, but usually at mine, they take a step back when the Anesthesiologist starts reacting to possible emergencies.

It sounds like you don't know too much about the dynamic between surgery and anesthesia. Most of the surgeons I work with wouldn't even know if the patient went into VTach. Beyond the tonal changes of the pulse ox, what we do is a mystery to them. In their eyes, if the patient moves "they are waking up". If bleeding becomes an issue, they will reflexively ask if the b.p. is elevated. And of course, the 2 pack/day smoker should never buck during emergence.

If the patient is on the sicker side, some of the more caring surgeons will periodically ask "if everything is OK". Beyond that, they don't understand what we do, and vice versa. It seems to work best that way. With the exception of CT surg, if your surgeon is recognizing an unstable patient before you, you've probably got your head up your ass, because the surgeon most definitely has their head up the patient's ass.

 

[SleepIsGood]

I just saw some preview of this weeks upcoming Grey's Anatomy show will feature a mistake where the patient is left awake and moving during the surgery.

Ithought on the that show the surgeon is also doing the anesthesia🙄

 

[Apollyon]

It sounds like you don't know too much about the dynamic between surgery and anesthesia. Most of the surgeons I work with wouldn't even know if the patient went into VTach.

I thought you were saying the same thing. If the pt is starting to deteriorate, and the anes says so, the surgeons stepping back seems to support what you are saying.

 

[Bertelman]

I thought you were saying the same thing. If the pt is starting to deteriorate, and the anes says so, the surgeons stepping back seems to support what you are saying.

Maybe I misread, maybe it's just semantics. My point is that in most situations, it's the anesthesiologist that's informing the surgeon that something bad is even happening. "Surgeon steps back" sounds like he had to step forward to begin with. Aside from events in the field like diaphragm movement or bleeding, I damn well better be the one telling the surgeon what's the score.

Otherwise, I'm not really doing my job.

 

[Apollyon]

"Surgeon steps back" sounds like he had to step forward to begin with.

I took it to mean "stop operating" and put direct pressure on any active bleeders, and to stand by with their reason for gutting the patient until you stabilize/save the pt.

 

[G-Man82]

Maybe I misread, maybe it's just semantics. My point is that in most situations, it's the anesthesiologist that's informing the surgeon that something bad is even happening. "Surgeon steps back" sounds like he had to step forward to begin with. Aside from events in the field like diaphragm movement or bleeding, I damn well better be the one telling the surgeon what's the score. Otherwise, I'm not really doing my job.

Sorry for the semantics. I was being too colloquial I suppose. Yes, what I meant to say was that on the show, it looks like the surgeon responds to all emergencies, even the mysterious cardiac dysrhythmias. At our hospital, by saying "stepping back," I was just trying to be nice to them. It's more like they (certain surgeons especially more so than others) are looking at the anesthesiologist with clueless 😕 expressions when the anesthesiologist starts talking and reacting frantically. It happened once on a routine orthopedic case. Looking back, after the arrhythmia was stabilized, it was really hilarious.

 

[Bertelman]

*Bertelman stepping back*

I think we're all on the same page here.

 

[rsgillmd]

Sorry for the semantics. I was being too colloquial I suppose. Yes, what I meant to say was that on the show, it looks like the surgeon responds to all emergencies, even the mysterious cardiac dysrhythmias. At our hospital, by saying "stepping back," I was just trying to be nice to them. It's more like they (certain surgeons especially more so than others) are looking at the anesthesiologist with clueless 😕 expressions when the anesthesiologist starts talking and reacting frantically. It happened once on a routine orthopedic case. Looking back, after the arrhythmia was stabilized, it was really hilarious.

If you see an anesthesiologist talking frantically then something is very seriously wrong. Fast/expeditious movements may be misinterpreted as frantic behavior, but it rare to see an anesthesiologist talking fast or yelling. If you've anticipated possible problems and have a plan in your head, then it is easy to execute your plan in a calm manner.

 

[rsgillmd]

BTW I didn't realize that show was still on. I agree with the others -- they should kill it. The couple of episodes I watched of the first season just turned me off to it. I don't think it just disgraces anesthesiologists, but rather disgraces the whole medical profession.

 

[Licoricestick]

Seeing as none of our non anaesthetic colleagues actually understand what we do, is it any wonder that the medical advisors on these shows also have no clue.

I tend to find the ENT surgeons the best to work with, in terms of understanding anything about what we do, but even today the surgeon decided to pay attention to the HR she could hear on the pulse oximeter. HR 130 90 min after surgical start for an adult tonsillectomy (inexperienced surgeon + difficult tonsillectomy). Didn't believe me when I said the tachycardia would go away within a minute or two of the gag coming out and wanted to know whether the tachycardia was due to blood loss (100mL)!

 

[nap$ter]

Seeing as none of our non anaesthetic colleagues actually understand what we do, is it any wonder that the medical advisors on these shows also have no clue.

I tend to find the ENT surgeons the best to work with, in terms of understanding anything about what we do, but even today the surgeon decided to pay attention to the HR she could hear on the pulse oximeter. HR 130 90 min after surgical start for an adult tonsillectomy (inexperienced surgeon + difficult tonsillectomy). Didn't believe me when I said the tachycardia would go away within a minute or two of the gag coming out and wanted to know whether the tachycardia was due to blood loss (100mL)!

why didn't she believe you?

why were you letting her see your vitals screen anywho? why did you have the beep turned up? turn it down, the ENT suggestions will magically disappear.. even an inexperienced ENT has done far more adult tonsils than you, so if she commented something must have been different... or she must have had an awakening...

that being said, i hope you commended her for at least thinking about physiology, and tactfully gave some education... and if it were me, and i had promised a drop in HR at the end of the case (which i agree happens 95% of the time) - i would have a stick of beta-blocker at the ready just in case - you'd sure hate this to be the one patient who runs fast for a little bit longer.. every once in a while you have to help physiology conform to the norms for surgeon education..

 

[veetz]

i would have a stick of beta-blocker at the ready just in case - you'd sure hate this to be the one patient who runs fast for a little bit longer.. every once in a while you have to help physiology conform to the norms for surgeon education..

Seems a bit irresponsible to push a Bblocker for tachycardia just to 'help physiology conform to the norms'. What if the pt is tachy b/c of hypovolemia and now you just took away the conpensatory mechanism that was maintaining their CO? What if the pt is tachy b/c of pain or stimulation?

I think I understand the point you are trying to make, but I disagree with how said it.

 

[W222]

I think this lame @ss show is being watched by our surgical friends and its making them into *****s. Had a patient that bucked the vent a few times during the case, the surgeon said "she is awake", I said "no, her muscle relaxant has worn off." The genius then goes, "How can someone move if they aren't awake? Can you explain that to me." Ugghhh, F-ing idiots I swear.

 

[IlDestriero]

I think this lame @ss show is being watched by our surgical friends and its making them into *****s. Had a patient that bucked the vent a few times during the case, the surgeon said "she is awake", I said "no, her muscle relaxant has worn off." The genius then goes, "How can someone move if they aren't awake? Can you explain that to me." Ugghhh, F-ing idiots I swear.

I would have said that "It would take too long to explain, obviously."
Ask to not work with that surgeon anymore. If he/she's that slow, there's no telling what else they doesn't know.

 

[Breezee]

I think this lame @ss show is being watched by our surgical friends and its making them into *****s. Had a patient that bucked the vent a few times during the case, the surgeon said "she is awake", I said "no, her muscle relaxant has worn off." The genius then goes, "How can someone move if they aren't awake? Can you explain that to me." Ugghhh, F-ing idiots I swear.

"The same way you woke up this morning in a different position than when you went to bed last night, genius. Did you wake up to move?" Surgeons kill me sometimes.

 

[W222]

The same surgeon also kept telling me how short the case would be, "Oh, we will be really quick so don't give her alot ok?." I was like, so you want her not to move an inch but you also want her to wake up at the snap of your fingers.

 

[MountainEM]

That show's writers must hate anesthesiologists. My wife watches it and in my peripheral attention I have seen 2 separate instances where the anesthesiologist is... well, far less than ideal.

Once, the anesthesiologist was drunk and fell asleep during a peds surgery and got kicked out by McWhatever. Another time, there was an explosive device in a patient and the anesthesiologist bailed and left Grey to handle it alone. Sure, he had a family, but that second time started smelling like a trend. 🙄

ha!!! The classic "I don't watch it but my wife does" line. I call total BS. You are referencing a little too well my friend.

 

[Camel]

ha!!! The classic "I don't watch it but my wife does" line. I call total BS. You are referencing a little too well my friend.

🙂 We have a projector and she watches the shows on there, and I sit on the couch and use my laptop. When I see something "medical" (I use that term loosely) I pay attention. My wife's a nurse actually and laughs a lot at some of the BS they have on there.

Now, turnabout is fair play... your quick jump to that indicates that you've used the line yourself ;-)

Peace.

 

[Bertelman]

So, I just scanned the show online. Here's what I saw.

1) Surgeon FREAKS! at the first sign of tachcyardia, looking to the anesthesiologist to pass blame.

2) Patient is then wide awake, looking around, while surgeon berates the anesthesiologist

3) Pt. later denies any care from the surgeon, recalling how the surgeon was stressed and yelling in the OR

4) Pt. later needs repair for the open wound, describes incident as "like being in a coffin, I couldn't talk, couldn't move", but somehow cranial nerves 3, 4, 6, 7, 11 were communicating with the motor fibers, because she was looking all over the place.

5) Doesn't let attending touch her because she was acting irrational. Lets resident do the case because she stayed calm.

6) During the redo, gasman quotes "BIS level is 45, she's sound asleep."

7) Gasman justifies reading JCA in the OR, followed by my favorite quote "I actually don't like the sitting down part of my job. It's not good for my back. I like to keep in shape. So I can lift my big buckets of money."

 

[DreamLover]

4) Pt. later needs repair for the open wound, describes incident as "like being in a coffin, I couldn't talk, couldn't move", but somehow cranial nerves 3, 4, 6, 7, 11 were communicating with the motor fibers, because she was looking all over the place."

besides the fact that the entire episode made me want to vomit my cookies...that was my favorite (in a sarcastic way) part....she was frozen in her coffin as she was bucking during the surgery, shivering and her eyes were moving all over the place...MmmmHmmmm

we all know the show is BS but it's just a pet peeve of mine because the lay public already can't tell the difference between us and our midlevel practioning friends...we don't need the lame, bad press...ugh, give me a break

 

[Nordeen]

won't that show die already!

Someone needs to put it out of its misery.

Next, it'll have CRNAs nursingly directing MD(A)'s. It'll probably go something like this:

CRNA: Now, MDA Coastie, make sure you wrap the pink blanket of love around the patients head during her mastectomy. You know how it will reduce the narcotic requirements to only 50 mcg/kg/hr during this surgery!

MDA Coastie: Yes, doctor nurse jackie. 🙁



pink blanket ref:
http://www.allshadesofpink.org/Comfort_Blanket_Program.html

Way to go Coastie. Just what we need more MDA's and CRNA's slamming each other. Make sure when you complete your residency accept a "MDA only" position or familiarize yourself with the competencies of CRNA's.

 

[DreamLover]

Way to go Coastie. Just what we need more MDA's and CRNA's slamming each other. Make sure when you complete your residency accept a "MDA only" position or familiarize yourself with the competencies of CRNA's.

Look Coastie...you managed to get someone's first post on our board to tout the competencies of CRNA's...did you try to do that on purpose?

 

[Bifid Uvula]

Seeing as none of our non anaesthetic colleagues actually understand what we do, is it any wonder that the medical advisors on these shows also have no clue.

I tend to find the ENT surgeons the best to work with, in terms of understanding anything about what we do, but even today the surgeon decided to pay attention to the HR she could hear on the pulse oximeter. HR 130 90 min after surgical start for an adult tonsillectomy (inexperienced surgeon + difficult tonsillectomy). Didn't believe me when I said the tachycardia would go away within a minute or two of the gag coming out and wanted to know whether the tachycardia was due to blood loss (100mL)!

Could just be my bias, but I think at least in the USA the surgeons who have the greatest understanding/appreciation/respect for Anesthesia and what goes on behind the curtain are the Oral-Maxillofacial Surgeons. I guess ENT might have some experience too since they like to mess with the airway too...

I saw the show the other night... what a load of fresh,steamy crap!

 

[anonymousername]

I don't watch Greys Anatomy all too often but I saw the episode in question tonight and to be quite honest after seeing it, my respect has increased for anesthesiologists. Obviously there are some discrepancies between what the show portrays and what actually happens. But the episode showed the anesthesiologist holding his own against a belligerent surgeon, it showed that he wasn't at fault for anything that happened, it showed that the pt was traumatized more by the behavior of the surgeon during the procedure, and it showed the surgeon apologizing to the anesthesiologist.

whatever, it's a mediocre show at best with a terrible leading actress.

 

[G-Man82]

What BS. I was watching this episode, and there was a moment where the patient started bleeding uncontrollably and the Anesthesiologist, who is just standing there, states "BP is 80/60 and falling" (or something ... ) and she, the surgeon, tells him to "push another atropine." That's so disappointing.

 

[nap$ter]

Seems a bit irresponsible to push a Bblocker for tachycardia just to 'help physiology conform to the norms'. What if the pt is tachy b/c of hypovolemia and now you just took away the conpensatory mechanism that was maintaining their CO? What if the pt is tachy b/c of pain or stimulation?

I think I understand the point you are trying to make, but I disagree with how said it.

dude - it was a joke. don't overthink it. and btw our whole job is about helping physiology conform to the norms - we are but ectopic homeostatic mechanisms.

 

[pgg]

ectopic homeostatic mechanisms

I like that phrase.

.sig material, it is.

 

[G0S2]

What BS. I was watching this episode, and there was a moment where the patient started bleeding uncontrollably and the Anesthesiologist, who is just standing there, states "BP is 80/60 and falling" (or something ... ) and she, the surgeon, tells him to "push another atropine." That's so disappointing.

I rolled my eyes at that scene as well. Made the anesthesiologist look pathetic again.

 

[chocomorsel]

I catch reruns of that show sometimes on Lifetime. They had a patient the other day on the floor and apparently crashing. The surgery chief of the entire department states "Alright, get me 20mg of etomidate, 100 of sux and an intubation tray now!!" and of course the residents go scurring away to do the attending's bidding. What crap!! And who has such horribly loud alarms going off in the OR when the patient is slightly bradycardic and hypotensive?

Next time in the OR I after I put the patient to sleep and he/she is prepped and draped I will see what happens when I say " Alright, I will take a number 9 blade and a bovie" and see what happens.

Soo pathetic.