Feel like nothing went right today! Didn't start of well, I was late waking up to go to the private. Quickly checked my emails and found that I still didn't receive the quote for my list today so that made me grouchy. Drove to the private and the road that I normally go on was blocked so I had to go a different way. In the end I turned up at the same time as the surgeon. Then I couldn't find my patients and I was anxious about it because one of them was a particularly sickly elderly lady who uses home oxygen 16 hours of the day. So I didn't get to see any of my patients preoperatively
So she's the first case of the day. I went to look for her on the ward and she was already down in theatres. So I was tossing up whether to put a block or not and I thought yes I should and use the ultrasound. Now I'm not crash hot with the ultrasound and I had some difficulty with it and was about to give it away and just go back to using the nerve stimulator but as soon as my assistant left the room I thought I got it... but when I injected it, it wasn't that convincing. That was about half an hour of stuffing around.
So we came into the room and her drip half fell out. I managed to save it and ran to get a dressing for it to stick it down but she moved her hand and it fell out again... so I had to put another drip.
So put in another drip. Then they didn't put the drape on properly so my patient got all wet and cold and then her ECG fell off coz she was wet. I couldn't find it and so I had to wait for my anaesthetic assistant to come back to tell me where he'd put it.
Which was another point, today's assistant was just crappy. Eyes not taped, drips not connected, no blankets on patients so they were all cold... he did what he was told but I shouldn't have to tell about those things, really.
Showing posts with label Work. Show all posts
Showing posts with label Work. Show all posts
Friday, 18 March 2011
Wednesday, 20 October 2010
More medical behaviour I don't agree with!
Geez this blog has turned from being green and kiddy related stuff to work whinge!
I was doing the acute pain round yesterday and there was a man with a supraclavicular block/catheter for his hand - he had a reimplantation of a few fingertips which was a work related injury.
The patient actually wanted the fingers terminalised but the plastic surgeon decided to try to reimplant the fingers. And why do you think that is? Because the patient is workers comp - which means $$$.
So the patient was complaining about his numb arm and I had to tell him that we leave the infusion for about 3 days to help perfusion to those fingertips, and the patient was grouchy because he just wanted to go home. He was also having leech therapy to keep the blood thin in those fingers as well.
I was talking to one of my registrars yesterday who told me that he received a call from the anaesthetic consultant on call in the afternoon saying that he was coming in for a reimplantation of fingers. The registrar was surprised because it wasn't on the Emergency list, and so went to the Duty anaesthetist who also didn't know about the patient. A few minutes later there was a call from the plastics registrar who booked the case.
So the consultant anaesthetist was in, and told the registrar to put an art line in but he didn't care who put it in... and then I suppose he would have sent off some gases as well so you could claim serial ABGs. I asked if they put BIS on and of course they did, and it would be paid because it was a trauma (therefore high risk - though in reality totally NOT high risk because it's not really a trauma).
So is it ethical to put in extra things that you don't need because you will get extra (a lot!) money for it? Like SERIOUSLY. If this was just a non work related injury the patient would not have had all these extra interventions. It annoys me that people put extra things into workers compensation because of the extra money, and it seems like a total rort to me. Would I do those things? I don't think I would put in an arterial line or do gases.
This is such a small whinge, people will wonder why I whinge about it when there is extra money. But to me this is unethical behaviour. For monetary gain. There was a young 15 year old boy who died earlier in the year, who had his arm ripped off in some machinery accident - 2 specialists said terminalise the limb but the plastic surgeon decided to try to reimplant it. The boy died because of a transfusion related lung injury, an idiosyncratic thing which would not have happened because he wouldn't have needed so much blood products if they had just terminalised his limb.
I was doing the acute pain round yesterday and there was a man with a supraclavicular block/catheter for his hand - he had a reimplantation of a few fingertips which was a work related injury.
The patient actually wanted the fingers terminalised but the plastic surgeon decided to try to reimplant the fingers. And why do you think that is? Because the patient is workers comp - which means $$$.
So the patient was complaining about his numb arm and I had to tell him that we leave the infusion for about 3 days to help perfusion to those fingertips, and the patient was grouchy because he just wanted to go home. He was also having leech therapy to keep the blood thin in those fingers as well.
I was talking to one of my registrars yesterday who told me that he received a call from the anaesthetic consultant on call in the afternoon saying that he was coming in for a reimplantation of fingers. The registrar was surprised because it wasn't on the Emergency list, and so went to the Duty anaesthetist who also didn't know about the patient. A few minutes later there was a call from the plastics registrar who booked the case.
So the consultant anaesthetist was in, and told the registrar to put an art line in but he didn't care who put it in... and then I suppose he would have sent off some gases as well so you could claim serial ABGs. I asked if they put BIS on and of course they did, and it would be paid because it was a trauma (therefore high risk - though in reality totally NOT high risk because it's not really a trauma).
So is it ethical to put in extra things that you don't need because you will get extra (a lot!) money for it? Like SERIOUSLY. If this was just a non work related injury the patient would not have had all these extra interventions. It annoys me that people put extra things into workers compensation because of the extra money, and it seems like a total rort to me. Would I do those things? I don't think I would put in an arterial line or do gases.
This is such a small whinge, people will wonder why I whinge about it when there is extra money. But to me this is unethical behaviour. For monetary gain. There was a young 15 year old boy who died earlier in the year, who had his arm ripped off in some machinery accident - 2 specialists said terminalise the limb but the plastic surgeon decided to try to reimplant it. The boy died because of a transfusion related lung injury, an idiosyncratic thing which would not have happened because he wouldn't have needed so much blood products if they had just terminalised his limb.
Saturday, 16 October 2010
Total spinal and a missing Laerdel bag...
I was on call last night and I got a call at about 10pm from MC who was the registrar overnight telling me he had an issue that I need to know about.
He did an epidural on Labour ward, and he had given her a test dose of 3mL of 2% Lignocaine with Adrenaline, and he waited what he thought was a reasonable period of time and then gave her 5mL of Ropivacaine 0.2%. After he finished injecting the 5mL she stated that her legs were heavy and numb, which rapidly progressed to not feeling well, then unable to move her arms and then difficulty breathing. He had laid her down when he injected the 5mL of Ropivacaine, and when she felt unwell he did a BP which was 80 systolic. He then gave some aramine from the drawer and when the patient complained of difficulty breathing he asked the nurses for a Laerdel bag, and the nurses pushed the Emergency button as well. They came back with the arrest trolley but were unable to procure a Laerdel bag, by which stage the patient was really unable to breathe and oxygen saturations were dropping. MC stated that he explained to the patient that he would have to breathe for her and had to perform mouth to mouth whilst waiting for a Laerdel bag. The MET team arrived and he asked them for a Laerdel bag and they didn't have one on them, the trolley was coming in the lift.
O+G registrars turned up and he informed them that they would need theatres urgently and the anaesthetic nurse arrived from theatres with a Laerdel bag and intubation equipment and then the patient was anaesthetised and paralysed and intubated. They proceeded to LSCS and the baby was born fit and well, and they transferred the mother up to intensive care, by which stage she was spontaneously breathing and awake and obeying commands and extubated.
MC said he had to perform mouth to mouth for about 5 minutes!!! And the husband was present when he first started to do mouth to mouth and was freaked out. MC went to ICU to see the patient afterwards, and the baby was brought up to her, and the patient and the husband thanked Matthew for everything, and seemed to be very happy with the outcome despite the complication that occurred.
I could not sleep after MC told me the events that happened and I asked him if he needed me to come in, he said he didn't, but I decided to go in anyway, as it was a pretty major traumatic event in terms of anaesthetic complications, and give him a bit of consultant support, reassure him that he did the right thing and managed the situation well. I think he was surprised to see me at the early hours of morning and we talked for more than an hour about the situation, and just general conversation as well afterwards. I think I left him feeling supported and reassured, though of course he would still feel like an idiot (though I told him that he did all the correct things and managed things well). Poor MC.... I am glad everything turned out but geez, we are going to get on top of the fact that there was no resuscitation equipment in Labour ward quick smart!!!
17/10 update:
I was wondering if I was being a bit over the top by going in. I know when I had my bad incident at work in ICU, when the consultant came in to chat I felt so supported that I wanted to make sure I did that for my own registrars. When I turned up I was wondering to myself if MC thought I was being an idiot or just wished I went away. But I got an email later that morning from him:
Hi J,
Thanks again for coming in, it has made me feel much better.
I know you don't believe in subdural block but the more I read up this seems that it could have been a "subdural" catheter. No CSF via tuohy needle and no CSF able to be aspirated via catheter. Onset wasn't very rapid, but sort of intermediate. Very extensive block. progressive respiratory incoordination rather than just sudden apnoea, relatively little cardiovascular instability. All of which fits with the literatures description of a subdural block. Or maybe I'm just trying to convince myself because for some reason it just seems a little less worse to me... more bad luck then just my incompetence.
I saw her this morning. She has no residual block and was happily breast feeding her son. She has minimal pain and no headache (yet).
Anyway, have a good day. Hope you have a good party tomoorow for Julian.
Thanks again.M
20/10 Update:
God I felt bad! I told 2 colleagues, AC and PC, and when I got to work on Tuesday apparently EVERYBODY knew about what happened to MC. I felt terrible! AC said he waited about half an hour before he started to SMS everyone... Poor MC! He said he told JL, who was a good friend of his at Liverpool who was on night shift and JL asked him if he slipped the tongue in! The funny thing is, that because I'm quite close to the incident (I was on call after all), that all these things didn't even enter my mind. But after the incident, I can see why everyone is laughing about it (in a good natured way, ie they look at MC as doing a fantastic job, heroic almost! And that they can tease him because there was a good outcome). Others have asked if he had taken a mint beforehand, was the patient good looking, etc. I did his ITA online form with him yesterday and we had a bit of a talk about the whole thing, and he seems ok now, though he wishes they weren't teasing him about it. He said that he was teaching a medical student in his theatre about bag mask ventilation and the medical student mentioned that there was a registrar who did mouth to mouth on a patient... and MC was said that he had to tell that student it was true, and it was him. Looking back at it now, I think people will think of MC as a legend which is quite amusing! I am still very proud of him, I have defended him tooth and nail when people ask about it in any kind of disparaging way. Sometimes I think of him as a prized student or something! I only hope that I can be the kind of consultant that he looks up to as well.
He did an epidural on Labour ward, and he had given her a test dose of 3mL of 2% Lignocaine with Adrenaline, and he waited what he thought was a reasonable period of time and then gave her 5mL of Ropivacaine 0.2%. After he finished injecting the 5mL she stated that her legs were heavy and numb, which rapidly progressed to not feeling well, then unable to move her arms and then difficulty breathing. He had laid her down when he injected the 5mL of Ropivacaine, and when she felt unwell he did a BP which was 80 systolic. He then gave some aramine from the drawer and when the patient complained of difficulty breathing he asked the nurses for a Laerdel bag, and the nurses pushed the Emergency button as well. They came back with the arrest trolley but were unable to procure a Laerdel bag, by which stage the patient was really unable to breathe and oxygen saturations were dropping. MC stated that he explained to the patient that he would have to breathe for her and had to perform mouth to mouth whilst waiting for a Laerdel bag. The MET team arrived and he asked them for a Laerdel bag and they didn't have one on them, the trolley was coming in the lift.
O+G registrars turned up and he informed them that they would need theatres urgently and the anaesthetic nurse arrived from theatres with a Laerdel bag and intubation equipment and then the patient was anaesthetised and paralysed and intubated. They proceeded to LSCS and the baby was born fit and well, and they transferred the mother up to intensive care, by which stage she was spontaneously breathing and awake and obeying commands and extubated.
MC said he had to perform mouth to mouth for about 5 minutes!!! And the husband was present when he first started to do mouth to mouth and was freaked out. MC went to ICU to see the patient afterwards, and the baby was brought up to her, and the patient and the husband thanked Matthew for everything, and seemed to be very happy with the outcome despite the complication that occurred.
I could not sleep after MC told me the events that happened and I asked him if he needed me to come in, he said he didn't, but I decided to go in anyway, as it was a pretty major traumatic event in terms of anaesthetic complications, and give him a bit of consultant support, reassure him that he did the right thing and managed the situation well. I think he was surprised to see me at the early hours of morning and we talked for more than an hour about the situation, and just general conversation as well afterwards. I think I left him feeling supported and reassured, though of course he would still feel like an idiot (though I told him that he did all the correct things and managed things well). Poor MC.... I am glad everything turned out but geez, we are going to get on top of the fact that there was no resuscitation equipment in Labour ward quick smart!!!
17/10 update:
I was wondering if I was being a bit over the top by going in. I know when I had my bad incident at work in ICU, when the consultant came in to chat I felt so supported that I wanted to make sure I did that for my own registrars. When I turned up I was wondering to myself if MC thought I was being an idiot or just wished I went away. But I got an email later that morning from him:
Thanks again for coming in, it has made me feel much better.
I know you don't believe in subdural block but the more I read up this seems that it could have been a "subdural" catheter. No CSF via tuohy needle and no CSF able to be aspirated via catheter. Onset wasn't very rapid, but sort of intermediate. Very extensive block. progressive respiratory incoordination rather than just sudden apnoea, relatively little cardiovascular instability. All of which fits with the literatures description of a subdural block. Or maybe I'm just trying to convince myself because for some reason it just seems a little less worse to me... more bad luck then just my incompetence.
I saw her this morning. She has no residual block and was happily breast feeding her son. She has minimal pain and no headache (yet).
Anyway, have a good day. Hope you have a good party tomoorow for Julian.
Thanks again.M
20/10 Update:
God I felt bad! I told 2 colleagues, AC and PC, and when I got to work on Tuesday apparently EVERYBODY knew about what happened to MC. I felt terrible! AC said he waited about half an hour before he started to SMS everyone... Poor MC! He said he told JL, who was a good friend of his at Liverpool who was on night shift and JL asked him if he slipped the tongue in! The funny thing is, that because I'm quite close to the incident (I was on call after all), that all these things didn't even enter my mind. But after the incident, I can see why everyone is laughing about it (in a good natured way, ie they look at MC as doing a fantastic job, heroic almost! And that they can tease him because there was a good outcome). Others have asked if he had taken a mint beforehand, was the patient good looking, etc. I did his ITA online form with him yesterday and we had a bit of a talk about the whole thing, and he seems ok now, though he wishes they weren't teasing him about it. He said that he was teaching a medical student in his theatre about bag mask ventilation and the medical student mentioned that there was a registrar who did mouth to mouth on a patient... and MC was said that he had to tell that student it was true, and it was him. Looking back at it now, I think people will think of MC as a legend which is quite amusing! I am still very proud of him, I have defended him tooth and nail when people ask about it in any kind of disparaging way. Sometimes I think of him as a prized student or something! I only hope that I can be the kind of consultant that he looks up to as well.
Wednesday, 22 September 2010
Exciting case at work which turned out not!
Having recently become the Director of Obstetric Anaesthesia at my hospital there was an interesting case on which had a lot of workup and preparation in the event of a disaster which fortunately turned out not to be a disaster!
We had a primiparous woman who had fertility issues having successfully conceived her first child with IVF, had an anterior Grade IV placenta praevia, who also happened to be a Jehovah's Witness. ARGH!
(Translation: Woman who had difficulty falling pregnant but finally got conceived with IVF, turned out to have the placenta covering the cervix so the baby can't be born without bleeding to death, as well as being at the front of the uterus making it difficult to get to the baby out via caesarean because there is the risk of cutting the placenta as you go in to get the baby... complicated by the fact that she was a Jehovah's Witness who by their religion refuse blood transfusions or they go to hell)
So there was a lot of discussion about this lady and teams involved. The patient agreed to cryoprecipitate, as well as the cell saver, and the Interventional Radiologists were involved and they put balloon catheters in place in her common iliac arteries so that in the event she did bleed, we could inflate them and stop the blood flow to the uterus so we wouldn't lose that much blood. Everything was set up, teams were ready, and we were all prepared for an emergency. Fortunately though she didn't end up bleeding much and we didn't need all our special fancy equipment but you can bet your bottom dollar that if we didn't have all that stuff set up she would have bled like buggery and probably died.
It's a bit strange I think, my colleague's attitudes to Jehovah's Witnesses. Anaesthetists say that in the event that the patient was going to die that they would give a blood transfusion even though the patient specifically requested not to. They say because they want to "Do no harm". However, I am not sure that I would do the same, I don't see why they find it so difficult to accept that despite their best efforts the patient died because of blood loss. I guess they feel that it was because it was a preventable death, that they could have done something to save the patient. But if you give blood to these patients, they become unclean, and they basically think they'll not go to heaven. Is it really up to us to disrupt someone's religious beliefs and life because we don't want to feel the guilt of someone dying under our care? I know if someone died because of bleeding when I'd done their anaesthetic I'd feel terrible about it, but I at least take comfort in the fact that I didn't do anything to their religious beliefs or faith. I wonder if that makes me a worse doctor? I don't think so, I think that if I had some special wish that I would like people to respect it. It bothers me when people say "oh these stupid people and their religions, wrecking our lives making us stressed because of their stupid beliefs". I just keep quiet but inside I'm thinking "How would you like it if someone told you that you had to do something against your beliefs because they thought it was stupid?"
We had a primiparous woman who had fertility issues having successfully conceived her first child with IVF, had an anterior Grade IV placenta praevia, who also happened to be a Jehovah's Witness. ARGH!
(Translation: Woman who had difficulty falling pregnant but finally got conceived with IVF, turned out to have the placenta covering the cervix so the baby can't be born without bleeding to death, as well as being at the front of the uterus making it difficult to get to the baby out via caesarean because there is the risk of cutting the placenta as you go in to get the baby... complicated by the fact that she was a Jehovah's Witness who by their religion refuse blood transfusions or they go to hell)
So there was a lot of discussion about this lady and teams involved. The patient agreed to cryoprecipitate, as well as the cell saver, and the Interventional Radiologists were involved and they put balloon catheters in place in her common iliac arteries so that in the event she did bleed, we could inflate them and stop the blood flow to the uterus so we wouldn't lose that much blood. Everything was set up, teams were ready, and we were all prepared for an emergency. Fortunately though she didn't end up bleeding much and we didn't need all our special fancy equipment but you can bet your bottom dollar that if we didn't have all that stuff set up she would have bled like buggery and probably died.
It's a bit strange I think, my colleague's attitudes to Jehovah's Witnesses. Anaesthetists say that in the event that the patient was going to die that they would give a blood transfusion even though the patient specifically requested not to. They say because they want to "Do no harm". However, I am not sure that I would do the same, I don't see why they find it so difficult to accept that despite their best efforts the patient died because of blood loss. I guess they feel that it was because it was a preventable death, that they could have done something to save the patient. But if you give blood to these patients, they become unclean, and they basically think they'll not go to heaven. Is it really up to us to disrupt someone's religious beliefs and life because we don't want to feel the guilt of someone dying under our care? I know if someone died because of bleeding when I'd done their anaesthetic I'd feel terrible about it, but I at least take comfort in the fact that I didn't do anything to their religious beliefs or faith. I wonder if that makes me a worse doctor? I don't think so, I think that if I had some special wish that I would like people to respect it. It bothers me when people say "oh these stupid people and their religions, wrecking our lives making us stressed because of their stupid beliefs". I just keep quiet but inside I'm thinking "How would you like it if someone told you that you had to do something against your beliefs because they thought it was stupid?"
Thursday, 11 February 2010
First day back at work
First day doing work after having Julian. Starting it off with my usual orthopaedic private list. Only have a shoulder and a knee on it today so not too long. I was quite worried about sleep so yesterday I hit the sack straight after playing World of Warcraft and though well Julian will be up for his feed soon...
Next thing you know I've woken up, it's dark and I look at the clock and it's 530am! So either I slept through him crying or he slept through! I went to his room and he was sound asleep like I left him. After I fed him, got Erika's breakfast ready and got her up and fed her pear porridge at about 630am. Got her done before 7 which was great because I needed to leave the house then. Now I really have to remind myself next time not to forget:
1) Breast pump (steamed it up but forgot it in the rush out)
2) Breast pads
3) Eat breakfast and take vitamins! (did brekkie but forgot my tablets)
Thank goodness I haven't got much on today I can make it home in time to express before I leak all over the place. I don't know why I was so blessed and had such a good night and good sleep but I am grateful.
Next thing you know I've woken up, it's dark and I look at the clock and it's 530am! So either I slept through him crying or he slept through! I went to his room and he was sound asleep like I left him. After I fed him, got Erika's breakfast ready and got her up and fed her pear porridge at about 630am. Got her done before 7 which was great because I needed to leave the house then. Now I really have to remind myself next time not to forget:
1) Breast pump (steamed it up but forgot it in the rush out)
2) Breast pads
3) Eat breakfast and take vitamins! (did brekkie but forgot my tablets)
Thank goodness I haven't got much on today I can make it home in time to express before I leak all over the place. I don't know why I was so blessed and had such a good night and good sleep but I am grateful.
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