Saturday, March 30, 2019

Anesthesiologists Have One Job

It was late in the afternoon and I was about to relieve another anesthesiologist for the day. I walked into the operating room and met the anesthesiologist, who was talking with another anesthesiologist in the corner. I guess they wanted to chat away from the operating table so that they wouldn't disturb the surgeon while he was busy doing the case. Unfortunately, they were also far away from the anesthesia monitors, which were not visible from where they were standing.

Exchanging pleasantries, we walked back to the patient so that I could be given a report before I took over the case. When we glanced at the monitors, the first thing we both noticed was that the patient's systolic blood pressure was in the 60's. The blood pressure alarm had been muted so nobody noticed the dangerously low hypotension. Reacting quickly, my colleague gave a small bolus of phenylephrine which quickly brought the pressure back up to the 90's.

This incident perfectly illustrates the one job that anesthesiologists have to perform at all times--vigilance. From this single chore flows all our other responsibilities. It doesn't matter if you're the master of neuroanesthesia or an ace in the cardiac room. If you're not constantly watching the patient every second they are under your care, then you're not doing your job to ensure patient safety.

That's why distractions are so dangerous in the OR. Whether it is cellphone internet surfing or gabbing with colleagues, patient monitoring has to take place above all other activities. Nothing else will define an anesthesiologist's career like missing an event leading to patient harm because one is busy reading their Facebook feed.

Luckily the patient suffered no harm. But what if I hadn't walked into the room at that moment? What if the two of them remained in the corner away from the patient for a longer period of time and nobody intervened? How long do you think the patient's heart and brain can tolerate mean arterial pressures in the 40's? It's not the surgeon's job to monitor the patient while performing his meticulous work. You probably wouldn't want them to anyway. So anesthesiologists, don't f*** this up.  You have only one job in the OR. If you can't handle that then you probably need to go into a different line of work.

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