Why do people always ask me

[2buckchuck]

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if we need to take out earrings or other piercings? I am responsible for 0% of the electricity being conducted to the patient. I don’t care about what implants are in their body. I don’t know where you put the bovie pad. Do I look like Thomas Edison, famed electrocutioner of elephants?

 

[dannyboy1]

if we need to take out earrings or other piercings? I am responsible for 0% of the electricity being conducted to the patient. I don’t care about what implants are in their body. I don’t know where you put the bovie pad. Do I look like Thomas Edison, famed electrocutioner of elephants?

Why not just tell em to take it out. If it can’t come out put tape over it. A word to the wise, it is generally advisable to try to avoid OR complications even if it might be, strictly speaking, not your fault. Guaranteed the plaintiff’s attorney will find a way to drag you in.

 

[Iso4ane]

Cause if we're not concerned for patient safety who is? The surgeons?

 

[aneftp]

The heavy beard especially on bmi 40 and up bother me more

So piercings do bother me. But we should be allowed to shave people’s beard also

 

[CopaceticOne]

The heavy beard especially on bmi 40 and up bother me more

So piercings do bother me. But we should be allowed to shave people’s beard also

In residency I had an attending who would do exactly that. And only did the area of the mask.

 

[abolt18]

If a piercing or jewelry is not near the site of the operation, and the electric current is unlikely to pass through the area with the piercing, I don't care if they leave them in. Burn risk in those settings is effectively zero.

Bigger risk is something getting caught and ripping it out traumatically, hence the argument for tape. I honestly don't even care much about putting tape on most of the time, but I do tell the patient that it's probably in their best interest to cover it with tape.

 

[jwk]

In residency I had an attending who would do exactly that. And only did the area of the mask.

Old doc at my first gig did this too. Beard = no anesthesia.

Tongue studs and lip piercings come out. Period.

 

[DG51]

In residency I had an attending who would do exactly that. And only did the area of the mask.

If my anesthesiologist told me I needed to shave or he was going to shave my beard, I would ask for a new anesthesiologist. This is a ridiculous thing to do.

 

[2buckchuck]

If my anesthesiologist told me I needed to shave or he was going to shave my beard, I would ask for a new anesthesiologist. This is a ridiculous thing to do.

And my beard, she isn’t even THAT hairy.

 

[AppTrail]

if we need to take out earrings or other piercings? I am responsible for 0% of the electricity being conducted to the patient. I don’t care about what implants are in their body. I don’t know where you put the bovie pad. Do I look like Thomas Edison, famed electrocutioner of elephants?

So effing annoying. My typical response is: "I don't use electrocautery for anesthesia, ask the surgeon"

 

[cchoukal]

If my anesthesiologist told me I needed to shave or he was going to shave my beard, I would ask for a new anesthesiologist. This is a ridiculous thing to do.

Honestly, if I think it's going to be difficult to mask someone because of their beard, I just put an LMA in and mask them until the roc sets up and I'm ready to intubate. I don't even try to mask-mask with the ZZ Top crowd.

 

[pgg]

Has there ever in the history of ever been a Bovie burn caused by an earring or piercing?

In a similar vein, has there ever in the history of ever been a Bovie burn caused by putting the return pad on the same leg as a hip prosthetic?

Is physics part of the BSN curriculum?

 

[Gator7]

Take it out or no surgery. I’m not going down over a nipple piercing. Same with dentures.

They magically all come out once you say they will be cancelled. They were told before they came in to remove all piercings so no reason for grace.

 

[cchoukal]

Has there ever in the history of ever been a Bovie burn caused by an earring or piercing?

In a similar vein, has there ever in the history of ever been a Bovie burn caused by putting the return pad on the same leg as a hip prosthetic?

Is physics part of the BSN curriculum?

I have a dot phrase in epic that says I counseled the patient on the risk of not removing their hardware, including burns and permanent disfigurement.

 

[Blackmateria]

In residency I had an attending who would do exactly that. And only did the area of the mask.

I had an attending who did this too but it was the whole beard. VA patients will put up with a lot.

 

[circleK]

I’ve had to take out many tongue piercings myself bc the pt claims “it doesn’t come out”. Yes, it does. But the new problem one is the dermal piercing bc it does not have a way to come out and is an issue when near the surgical site.

 

[pgg]

I have a dot phrase in epic that says I counseled the patient on the risk of not removing their hardware, including burns and permanent disfigurement.

Prudent.


But are these burns even possible, within the realm of physics as we understand it?

Maybe someone could draw a picture for me, with electrons and arrows and stuff.

Given the resistance of dry air is trillions to quadrillions of ohms per meter, I just wonder what kind of atmospheric conditions would have to be present in an OR that would permit an arc of lightning to jump from a patient's earring to, say, the metal frame of the bed they're on. I'm going to go out on a limb and guess that the kind of OR RN who gets spun up about earrings isn't going to let a case start if the air is 100% humid with the atmospheric pressure of Jupiter. (While the OR's line isolation monitor is alarming, too.) And even then I don't think the earring would be a problem.


Now, a tongue piercing absolutely needs to go, because I'm not interested in chasing that thing down someone's trachea.

 

[NPJR]

If the patient or the surgeon don't care after explaining the rationale, why should I care? Leave your tongue ring in , eat breakfast, wear make up, keep your nipple and face and lip rings in, These things dont bother me. a medical malpractice lawsuit is hard to win especially if I told you the risks and its documented

 

[Ashers]

In residency I had an attending who would do exactly that. And only did the area of the mask.

So did I. I ended up personally shaving one guy's beard because my attending made me. I'm like, I've never shaved a face before!

 

[Ashers]

Has there ever in the history of ever been a Bovie burn caused by an earring or piercing?

In a similar vein, has there ever in the history of ever been a Bovie burn caused by putting the return pad on the same leg as a hip prosthetic?

Is physics part of the BSN curriculum?

But one time there was a little bit of redness on the bovie site (on that patient with super sensitive skin).

And I usually put tape on stuff if they cannot remove it. Tongue rings, I definitely make them take those out. I had a patient super mad because "it's hard to take out."

 

[Simba1711]

I hate beards too. If truly concerned about airway I wouldn’t feel bad about making them shave. Haven't gotten to that point. It’s the mask ventilation and being able to secure airway with tape if they’re in prone position. (Usually use umbilical tape ).

For mask ventilation I smear their beard in lube while I’m preoxygenating.

 

[dabears505]

If the patient or the surgeon don't care after explaining the rationale, why should I care? Leave your tongue ring in , eat breakfast, wear make up, keep your nipple and face and lip rings in, These things dont bother me. a medical malpractice lawsuit is hard to win especially if I told you the risks and its documented

Bro I hope you don't ever find out the hard way warning them of the risks does not protect you at all. You may win the suit, but it doesnt stop them from filing and making your life miserable.

 

[dannyboy1]

Honestly, if I think it's going to be difficult to mask someone because of their beard, I just put an LMA in and mask them until the roc sets up and I'm ready to intubate. I don't even try to mask-mask with the ZZ Top crowd.

Never had an LMA that dosent sit quite right? Not discounting LMA, it’s a phenomenal rescue device (have personally witnessed it save a life) but mask ventilation should be effective 100% of the time. If you don’t think the patient is able to be mask ventilated then it should be an awake intubation…

 

[cchoukal]

Never had an LMA that dosent sit quite right? Not discounting LMA, it’s a phenomenal rescue device (have personally witnessed it save a life) but mask ventilation should be effective 100% of the time. If you don’t think the patient is able to be mask ventilated then it should be an awake intubation…

Sure. If they look difficult to mask AND difficult to tube, sure, a sedated topicalized intubation all the way. But I don't agree that being predicted to be difficult to mask obligates this approach. But then, I give paralytics WITH induction, and I have a VL in every room, so if I couldn't mask with the LMA, I'd just intubate.

 

[DesiredMemberName?]

Sure. If they look difficult to mask AND difficult to tube, sure, a sedated topicalized intubation all the way. But I don't agree that being predicted to be difficult to mask obligates this approach. But then, I give paralytics WITH induction, and I have a VL in every room, so if I couldn't mask with the LMA, I'd just intubate.

I almost never mask ventilate any more. I stopped doing it during the pandemic and just never went back. I also mostly VL now, which seems to require less waiting for deep neuromuscular blockade.

Also, I don’t bat an eye at a bearded patient. Just tape the tube to their upper cheek and slap some tegaderms on there. It’s not going anywhere.

 

[dannyboy1]

I almost never mask ventilate any more. I stopped doing it during the pandemic and just never went back. I also mostly VL now, which seems to require less waiting for deep neuromuscular blockade.

Also, I don’t bat an eye at a bearded patient. Just tape the tube to their upper cheek and slap some tegaderms on there. It’s not going anywhere.

Sure. If they are supine and you have access to the head. Prone neurosurgery cases are a different animal altogether entirely

 

[CopaceticOne]

Never had an LMA that dosent sit quite right? Not discounting LMA, it’s a phenomenal rescue device (have personally witnessed it save a life) but mask ventilation should be effective 100% of the time. If you don’t think the patient is able to be mask ventilated then it should be an awake intubation…

Pudgy-baby

 

[drmwvr]

Where do folks draw the line at rings?

 

[Iso4ane]

I almost never mask ventilate any more. I stopped doing it during the pandemic and just never went back. I also mostly VL now, which seems to require less waiting for deep neuromuscular blockade.

Also, I don’t bat an eye at a bearded patient. Just tape the tube to their upper cheek and slap some tegaderms on there. It’s not going anywhere.

Once had a patient who had a beard that was up to his eyeballs, told him real nicely that I would have to trim it a little bit and he didn’t care. Otherwise was nice and make sure the line it up and make sure it was even.

 

[NPJR]

If you don’t think the patient is able to be mask ventilated then it should be an awake intubation…

That is old school thinking (JOnathan benumof style) that I happened to agree with.

 

[PpfSuxTube]

If the patient or the surgeon don't care after explaining the rationale, why should I care? Leave your tongue ring in , eat breakfast, wear make up, keep your nipple and face and lip rings in, These things dont bother me. a medical malpractice lawsuit is hard to win especially if I told you the risks and its documented

That's very naive and probably not true.

Im in one right now where the patient claims the risk conversation was rushed and therefore invalid

 

[BobLoblaw78]

That's very naive and probably not true.

Im in one right now where the patient claims the risk conversation was rushed and therefore invalid

Agree with your first statement, but your username gives some credence to the second statement. (IRL if they had questions, they should've asked. If they felt rushed they should've paused. The most important part in my risks discussion is to genuinely ask and answer questions that they may have.)

 

[PpfSuxTube]

Agree with your first statement, but your username gives some credence to the second statement. (IRL if they had questions, they should've asked. If they felt rushed they should've paused. The most important part in my risks discussion is to genuinely ask and answer questions that they may have.)

What does my username have to do with anything? Its not my risk conversation that has anything to do with the case ive mentioned, its the surgeons...

 

[2buckchuck]

What does my username have to do with anything? Its not my risk conversation that has anything to do with the case ive mentioned, its the surgeons...

I’m concerned that Bob Loblaw is giving bad legal advice on his law blog.

 

[DesiredMemberName?]

I’m concerned that Bob Loblaw is giving bad legal advice on his law blog.

Bob Loblaw Lobs Law Bomb

 

[NPJR]

That's very naive and probably not true.

Im in one right now where the patient claims the risk conversation was rushed and therefore invalid

The law doesn't say it cannot be rushed. It was discussed rushed or unrushed

 

[Maz777]

if we need to take out earrings or other piercings? I am responsible for 0% of the electricity being conducted to the patient. I don’t care about what implants are in their body. I don’t know where you put the bovie pad. Do I look like Thomas Edison, famed electrocutioner of elephants?

Agreed. Nothing to do with my anesthetic. As long as it's not in the airway, I don't care. Nurses can document that the surgeon alone approved that any piercing or ring can stay on. I am not the gatekeeper of intraoperative cautery (CIEDs excluded since they can interfere with my anesthetic). Do not ask me.

 

[dmk5n]

Re: piercings - what does the tape do?

 

[pgg]

Re: piercings - what does the tape do?

Same thing putting a wet washcloth over the taped-closed eyes of a patient who's getting a laser lithotripsy does:

Satisfies some policy-enforcing sweater-wearing clipboard commando RN who got a C- in high school physics.

IOW nothing. It's stupid.

 

[IlDestriero]

If my anesthesiologist told me I needed to shave or he was going to shave my beard, I would ask for a new anesthesiologist. This is a ridiculous thing to do.

Dying because you won’t shave your beard is pretty ridiculous. Giant fat guy with a beard, sounds like an awake fiber brother. Or THRIVE, but I don’t like beards, so 🪒

 

[DG51]

Dying because you won’t shave your beard is pretty ridiculous. Giant fat guy with a beard, sounds like an awake fiber brother. Or THRIVE, but I don’t like beards, so 🪒

Sure, if you don't have access to succ, suggamedex, or video-scopes, then I could maybe understand your thought process.

Someone on here should create a poll and ask who is regularly masking patients prior to intubation. My guess is near majority are not mask ventilating.

 

[pgg]

Sure, if you don't have access to succ, suggamedex, or video-scopes, then I could maybe understand your thought process.

Someone on here should create a poll and ask who is regularly masking patients prior to intubation. My guess is near majority are not mask ventilating.

Yeah we see giant fat toothless guys with ZZ Top / West Virginia Hill People scraggly beards all the time and very, very few get awake fiber intubations.

I do mask almost everyone though. No reason to let them lay there apneic while the roc works. I rarely use succ, except when there's a solid RSI indication or I really do want optimal intubating conditions ASAP.

 

[IlDestriero]

Sure, if you don't have access to succ, suggamedex, or video-scopes, then I could maybe understand your thought process.

Someone on here should create a poll and ask who is regularly masking patients prior to intubation. My guess is near majority are not mask ventilating.

I want to be able to mask ventilate. I don’t necessarily need to, but it’s nice to know I can. I don’t do RSIs unless there is a reason to do them, so they get mask ventilation.
Though one thing the .mil taught me was all you need is a 10 blade, your pinky, and a 6.0 tube. 🤙
I’ll just push the ZZ Top beard to the side.

 

[<(^_^)>]

That's very naive and probably not true.

Im in one right now where the patient claims the risk conversation was rushed and therefore invalid

Seems like a pretty big loophole if a patient can just claim it was “rushed” without evidence and therefore any discussion on possible issues is invalid.

 

[CopaceticOne]

Seems like a pretty big loophole if a patient can just claim it was “rushed” without evidence and therefore any discussion on possible issues is invalid.

They can claim anything they want. All they need is an attorney who is hungry enough for $$$ - Is the potential juice worth the upfront squeeze?