Sunday, September 8, 2013

Signs The Surgical Patient Isn't Doing Well

Surgeons regularly inquire over the ether screen about how the patient is doing during a case. This is very annoying to the anesthesiologist. It makes us feel like the surgeon is intruding on our turf. As a result, nine out of ten times they'll hear the standard reply, "Fine."

A far more accurate way to ascertain how the patient is faring during an operation is to take a quick glance at the head of the operating table. The anesthesiologist's actions and demeanor will tell the surgeon all he needs to know about the state of the patient.

Here is a list of ten signs the surgeon can use to decipher if the patient is really fine or things are not going as well as planned, starting from the least worrisome to the most. Each line is followed by an explanation for the action.

1. The anesthesiologist is sitting down and reading his Kindle.
The case is going so smoothly that the EMR can do all the work of charting the case.

2. The anesthesiologist is sitting but watching the patient monitor intently.
Vital signs are starting to fluctuate at the outer limits of comfort level for the anesthesiologist.

3. The anesthesiologist is standing and watching the monitor intently.
Because standing to watch fluctuating vital signs makes the anesthesiologist feel better even if it doesn't improve the outcome.

4. The anesthesiologist is looking over the ether screen.
He's wondering how soon the case will wrap up so he can get this patient off the table before something really bad happens.

5. The anesthesiologist is asking the surgeon how the case is going.
He's not trying to hide his desperation to get the patient off the OR table anymore.

6. The anesthesiologist is drawing up and pushing multiple syringes of drugs.
Pressors. Need more pressors.

7. The anesthesiologist is making phone calls and talking with an urgent tone of voice.
Time to call in the cavalry.

8. There are more people working above the ether screen than below.
Can never have enough hands to assemble drips and start lines.

9. The anesthesiologist is calling for the crash cart.
The fat lady is about to sing.

10. The anesthesiologist turns off the anesthesia machine.
Opportunity to document zero anesthesia complications during case.

So if any surgeons are reading this post, please follow its advice. Don't aggravate tensions in the room by constantly asking the anesthesiologist for a status update of the patient. With a keen eye, the anesthesiologist's actions will tell you everything you need to know.

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