Saturday, April 9, 2016

More Bloopers From The ASA Monitor

Still can't find pictures of real doctors, ASA?

Oh ASA. What are we going to do with you? You publish an award winning publication like the ASA Monitor, which just won the Bronze Award for Monthly Newsletter or Communication in the 2015 Association TRENDS All Media Contest, yet you continue to insult the intelligence of your anesthesiologist readers with god awful pictures of fake doctors and phony patients.

I know somebody over at ASA HQ is listening to my criticisms because they have usually been corrected shortly afterwards. When I pointed out how terribly unbelievably fictitious the cover photo of the then ASA Newsletter in May, 2015 was, the ASA soon after declared that they would start using more pictures of real doctors and not rely so much on stock photos. In January of 2015, when the ASA unveiled a new website that featured only female anesthesiologists on its homepage, I quickly pointed out how sexist that was and how excluding men doesn't make the organization more inclusive. The homepage was changed within 48 hours.

Don't get me wrong. I think the ASA Monitor is an important publication for the ASA to produce. I read it from cover to cover every month when it arrives in my mailbox. But because I consider it to be so relevant, I feel that we the readers should do our best to call upon its shortcomings to make it better.

Which is why I am calling out this picture that is printed on page 29 of the April 2016 issue. Included in the article titled "Interdisciplinary Teamwork and Bureaucracy Flattening: The Keys to Optimal Perioperative Care", the picture doesn't really have anything to do with the article. But that's not why I find this photo confounding. As a newsletter for anesthesiologists, I would think that the ASA editors would try harder to find pictures that didn't have so many flaws in it that could be noticed by even CA-1 anesthesia residents. You can actually see a much clearer image of this picture on the ASA's website if you're an ASA member.

1. There is not a single drop of blood anywhere during this "operation." It's not on the surgeon's gloves, the drapes, his instruments, or on his gown.

2. If there is no blood on the field, why is his assistant holding the suction in the surgical site? And that is the tiniest suction tubing attached to the suction catheter. I can just imagine the surgeon hollering at the circulating nurse seconds after the picture was taken, "Nurse, we need more suction!"

3. The IV reservoir is either completely full or completely empty. There is no fluid level seen within. No anesthesiologist would ever flush an IV line that way.

4. Worse, the IV line actually dangles on the wrong side of the ether screen. The surgeon's left elbow is brushing up against the IV. He will have to step back and replace his now contaminated surgical gown. How fast can a surgeon scream, "Get me another anesthesiologist!"?

5. On the patient's monitor behind the anesthesiologist, we see that the patient's heart rate is 68 and blood pressure is 116/71. The blue waveform that normally represent the pulse ox doesn't seem to synchronize with the ECG. The pulse ox appears to show a rate at least twice as fast as the ECG.

5. This is probably the biggest sin. The elbow on the anesthesia circuit is capped. There is no catheter in place to monitor the patient's end tidal CO2. This goes against the ASA's own guidelines about basic patient monitoring under sedation.

6. The anesthesiologist is standing. We all know that if a patient is as stable is this patient's monitor implies, we'd all be sitting down doing our Sudoku.

I don't mean to embarrass the ASA or the editors of the Monitor. Don't hate me because I point out the flaws in your publications. I only do it because I care. As your mother probably told you when you were growing up, "You can do better next time."


  1. Where is the eye protection on the scrub nurse? What in the world is the scrub nurse doing with her hands under the Mayo stand? The scrub nurse has too many extraneous instruments on her Mayo stand and they are arranged backward to boot. Scrub nurse's neck hair is exposed. If I were her supervisor, I would crack her knuckles with a sponge ring forceps.

  2. I think the suction that the surgical assistant has is the IV tubing.