What are some of the longest cases you do and how does it differ academia vs. PP

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
I was in on a back fusion when I was a resident that lasted 18 hours.


now it takes 2 in pp
 
wow. 18 hrs for a back fusion. would you say it was due to complications, or just pure slowness? that's a pretty incredible difference.
 
Whipple's (and variations thereof, including resections and re-arrangements of various abdominal organs) and liver transplants. Can vary anywhere from 8 to 14 hours, on average. Not that long ago, we did a commando "gutectomy" on an advanced metastatic colorectal CA patient (with one of our surgeons who we sometimes have to nail the coffin shut to convince him to stop operating) that took 26 hours. 😱

-copro
 
The biggest "blooper" cases I've seen:

Skin tag excision under MAC - 4 hours

Lap appy - 7 hours (required intraop gyn and urology consults and cystourethrogram for perfs)

Lap chole - 7 hours (whacked branches of hepatic artery & portal vein)

Parathyroidectomy - 8 hours to find the bugger + 1 hour in PACU then + return to OR for another 6 hours for hematoma = 15 hours
 
Yesterdays 4 hour LAVH, the 8 hout colon resection, both this week.:scared:
 
I recovered this pt in the ICU moonlighting while in school .... 33 hour craniofacial reconstruction on an unbelted ER physician who went through the windshield at 60 mph.

The surgeon's dictated op note was one paragraph, 12 pages long, single-spaced.
 
trinityalumnus said:
Might be kinda hard getting the pt to sign the surgical consent under those conditions 😱

And trolling plaintiff attorneys would be lining up at the door, near the end of the statute of limitations, to file for PTSD.
Click to expand...

For skin tags??

I've seen both family medicine and derm remove these in the office with liquid N2.

Dip a needle driver into liquid N2, clamp at base of skin tag, mission complete.

Scissor excisions do require some local but I've really never seen a case done under MAC.
 
for these super duper long surgeries, does the on call person relieve you or do you just keep going and get breaks? does the surgeon take breaks or does she/he keep going as well?
 
we regularly see ENT cases comprised of trach/total laryngectomy/pec flap/reconstruction that run over 12 hours.
and the technically difficult cranis for tumors that can run long. last week it was a total cranioplasty/reconstruction in a 4 year old that went 11 hours.
 
What do you do about bathroom breaks? I recall a thread that bitterly disputed peeing as a 'legitimate' reason to leave the patient's side. What if you're the only guy around, you soil yourself? Does the surgeon? Maybe a stupid question, but I'm curious.
 
geogil said:
What do you do about bathroom breaks? I recall a thread that bitterly disputed peeing as a 'legitimate' reason to leave the patient's side. What if you're the only guy around, you soil yourself? Does the surgeon? Maybe a stupid question, but I'm curious.
Click to expand...

Foley-Catheter.jpg


Boy Scouts: Always be prepared.
 
So which is it...my little flip/flopping friend.....do you just go and pee....or do you wear depends?????

I surmise ...based on your posts...that you just like to wear Depends....but go take a pee break when you have to go?????



flip/flop Planktonmd said:
How long does it take you to urinate?
What is the difference between the stable patient in the OR and any intubated ICU patient on IV Propofol?
Why can an RN watch the second one but not the first one?
Sure you are not going to leave while they are unclamping the Aorta in a AAA operation, but if the patient is stable and there is no conceivable surgical event that is about to take place, and if the alternative is wetting your pants, I say go for it and if something goes wrong the jury will understand.
Click to expand...

plankton's quote

flip/flop plank said:
Let's see here:
You want case reports about anesthesiologists who:
1- Went to the bathroom and
2- During their time in the bathroom something went wrong and
3-They got sued and
4-The jury was sympathetic to them when they went to trial?
I will have a hard time finding that.
Do you have case reports about
1- Anesthesiologists who went to the bathroom and
2- During their time in the bathroom something went wrong then
3- They got sued and
4- They were "laughed out of court and into jail"?
I don't expect you to understand the logic behind what I am trying to tell you but can you at least give it a sincere effort?
Click to expand...

planton's other quote

Planktonmd said:
Yes
packages_195x300.jpg
Click to expand...
 
militarymd said:
So which is it...my little flip/flopping friend.....do you just go and pee....or do you wear depends?????

I surmise ...based on your posts...that you just like to wear Depends....but go take a pee break when you have to go?????





plankton's quote



planton's other quote
Click to expand...

Well how about you?
I guess with the small size issue you have to be seated or you will make a mess, maybe you can use a bed pan? :laugh:
 
We regulary used to do 14-20 hour spinal cord untethering cases in PP. I have to admire the surgeon. Everyone else go breaks. He would go the whole case without scrubbing out.

I was also in a 6 hour pacemaker case that burned up two C-arms and resulted in a 500 cc blood loss. The good news was that my radiation exposure was so high I couldn't do C-arm cases for six months.

David Carpenter, PA-C
 
Planktonmd said:
Well how about you?
I guess with the small size issue you have to be seated or you will make a mess, maybe you can use a bed pan? :laugh:
Click to expand...


once again...let's get a score card:

1) I post a couple of Plank's own posts.
2) I point out the contradictions
3) I ask about why the contradictions
4) I make an educated guess on the apparent contradictions

What does plank do?

1) just make juvenile insults...


I think plank just went down for the count a second time.
 
militarymd said:
once again...let's get a score card:

1) I post a couple of Plank's own posts.
2) I point out the contradictions
3) I ask about why the contradictions
4) I make an educated guess on the apparent contradictions

What does plank do?

1) just make juvenile insults...


I think plank just went down for the count a second time.
Click to expand...

Yes. Contradicting one's self about urinating or not in a pair of Depends in the OR cannot and should not be tolerated.

Are you serious?
 
core0 said:
...The good news was that my radiation exposure was so high I couldn't do C-arm cases for six months.
...
Click to expand...

You say that like it's a good thing. ... although I guess glowing in the dark would be pretty cool 😀
 
C-section 6 hours and 18 min. All under patchy epidural supplememented with Ketamine! (baby was out pretty quick)
 
Pooh & Annie said:
Yes. Contradicting one's self about urinating or not in a pair of Depends in the OR cannot and should not be tolerated.

Are you serious?
Click to expand...

If you read this forum regularly, you'll see that he flips and flops regularly...contradicting himself....


I will repost more of his stuff if you would like....but he's a mod now, so I suspect that his contradictory posts will probably disappear over the next few days.

It's just funny for such an opinionated person to contradict himself...hence the above funny (at least I thought so) post.

I've only reposted what he posted...

while he, on the otherhand, has now just resorted to baseless insults.
 
militarymd said:
If you read this forum regularly, you'll see that he flips and flops regularly...contradicting himself....


I will repost more of his stuff if you would like....but he's a mod now, so I suspect that his contradictory posts will probably disappear over the next few days.

It's just funny for such an opinionated person to contradict himself...hence the above funny (at least I thought so) post.

I've only reposted what he posted...

while he, on the otherhand, has now just resorted to baseless insults.
Click to expand...
:hardy:
 
ZonaRidicularis said:
Seriously... what does someone do in a situation like this? Especially if female? Go the astronaut route and wear a diaper? I mean damn... if that's what I have to look forward to I should have just been an astronaut and went to astronaut school!
Click to expand...

I made it past the initial astronaut-selection screen in 1998, then didn't get invited to an interview --- I think there were 4,000 applicants for 25 spots then.

If you're truly serious about this great job, you'll be pleased that NASA loves to have physicians apply for a non-pilot spot. Off the cuff, I'd say 10-15% of the current astronaut corps are physicians (either military flight surgeons, or civilians employed by NASA after being selected for astronaut training).

The civilians are paid as government civil servants. Certainly not what you'd make in private practice as a physician.

http://www.nasajobs.nasa.gov/astronauts/default.htm

Astronaut Candidate (Non-Piloting background)

Bachelor's degree from an accredited institution in engineering, biological science, physical science, or mathematics. Quality of academic preparation is important. Degree must be followed by at least 3 years of related, progressively responsible, professional experience. An advanced degree is desirable and may be substituted for experience as follows: master's degree = 1 year of experience, doctoral degree = 3 years of experience. Teaching experience, including experience at the K - 12 levels, is considered to be qualifying experience for the Astronaut Candidate position; therefore, educators are encouraged to apply.

Ability to pass the NASA long-duration space flight physical.

One of the members on the ill-fated Columbia mission in 2003 was a female physician: http://www.jsc.nasa.gov/Bios/htmlbios/clark.html

X-mmd, Dr. Clark did her residency at Bethesda. When I was there in 2006 I noticed they've named the large amphitheater on the first floor of building nine in her honor, and have some of her memorabilia in display cases. Very moving.
 
Last edited:
trinityalumnus said:
I made it past the initial astronaut-selection screen in 1998, then didn't get invited to an interview --- I think there were 4,000 applicants for 25 spots then.

......................

X-mmd, Dr. Clark did her residency at Bethesda. When I was there in 2006 I noticed they've named the large amphitheater on the first floor of building nine in her honor, and have some of her memorabilia in display cases. Very moving.
Click to expand...


trin..
I was one of the astronaut selection board nominees from the Navy for the 2003 class.

Dr. Clark never finished a residency...she only did an internship.

Although NASA likes MD's as Mission Specialists, the vast majority of them are Internship trained only...but their bio's read as if they are fully trained.. although this last time around, they did have an orthopod.
 
radslooking said:
wow. 18 hrs for a back fusion. would you say it was due to complications, or just pure slowness? that's a pretty incredible difference.
Click to expand...

I've seen a cherry-sized neck lipoma removal on a 450-lb JABBA take 4 hrs of anesthesia time due to surgeon's lack of planning/prep to position the lady. Looking back on it I can't believe I risked my lumbar spine helping lift while PAYING to be there are a med student.

This doc was a dude w/ all-Ivy pedigree and was triple-boarded in IM, Surgery, and CCM. Go figure.
 
Wednesday's CABG. Three vessels, 13 hours on table. (Including the hour watching the drains fill before his first re-look)
Once had a 6 hour IM nail femur. Had to show the ortho reg howto assemble the jig. Attending refused to leave his bed to come out and help the poor schmo'

Love academic practice sometimes.
 
A/P scolisis case done over 2 days...26 hrs..thats in PP..pt went home POD 7 in happy spirits
 
bilateral arm re-implantation... over the week-end, we basically rotated the CA-1s through that case every 4 hours... there was one crazy/annoying/know-it-all CA-1 that weekend, so i told her that for these long cases it is important to massage all pressure points every 30 minutes -

the beauty of it, she actually documented where she massaged every 30 mins (this is when we used to have paper charts - you guys should have seen the anesthesia record on this guy)...

it gets even better, with the 4 hour shift change she convinced the covering CA1 to massage the pressure points as well... the Plastic/Ortho hand guys must have thought the CA1s on call that weekend were nuts...
 
You must log in or register to reply here.

Similar threads

M
How different are big cases from little cases?
Replies
21
Views
3K
We'llBeDoneIn15Minutes
W
C
How are you all so competent in the SICU?
Replies
14
Views
3K
Radetzky
R
kidthor
Which of you are in the dos commas club?
Replies
26
Views
3K
aneftp
A
DrOwnage
Would you: Take a pay cut so you don’t work for AMC/pay cut to do your own cases solo?
2
Replies
60
Views
4K
sloh
S
C
good story PP vs Private equity
Replies
28
Views
4K
DirtDocMD
D
Top