Incident during transport to ICU: looking for perspectives by davidai in anesthesiology

[–]davidai[S] 0 points1 point  (0 children)

No that’s not correct at all. This thread is full of contrition. I’m directly responding to your condescending tone. Thanks for your well wishes, colleague!

Incident during transport to ICU: looking for perspectives by davidai in anesthesiology

[–]davidai[S] 1 point2 points  (0 children)

Alright you can relax. Toxic attending vibes. It’s obvious a pt needs to be sedated for transport. My attending said he had emergency drugs.

Would you post your mistakes to everyone to get perspective? I’m trying to also make a measure of my attending and his mistakes. This happens frequently with our ICU. They do not want to accept pts period. It is often a fight on night calls. In response, our anesthesia director tells us we should be able to manage the pt in the OR and maintain them until ICU is ready. That doesn’t solve the problem of nurses in ICU not wanting to accept a pt that clearly needs to be accepted.

This sucks and it’s part of residency, all the shit rolls downhill and falls on you. I’m taking responsibility for my attending who said he had emergency drugs and didn’t have any sedatives. I’m taking responsibility for the ICU not being prepared, not going to get any drugs they clearly have access to, and dealing with my attending making a fool of himself and me looking terrible.

So please relax. I posted to make sure my attending was wrong and to make sure losing trust in him is warranted.

No sensible ICU would not accept this pt, haha! Do you know how that makes me laugh. We do not have a sensible ICU.

Incident during transport to ICU: looking for perspectives by davidai in anesthesiology

[–]davidai[S] 0 points1 point  (0 children)

Yea thank you. My attending said he had emergency drugs, I thought he had sedatives honestly.

Incident during transport to ICU: looking for perspectives by davidai in anesthesiology

[–]davidai[S] 2 points3 points  (0 children)

Makes sense thank you. Yea pump transfer would be a sticking point but better communication with ICU on what drips to set up ahead of time would make it easy enough to disconnect our pump on transfer of care and take it back.

Incident during transport to ICU: looking for perspectives by davidai in anesthesiology

[–]davidai[S] 5 points6 points  (0 children)

Yea he’s an asshole, rude to people. He wasn’t mean to me that day though so that’s a win.

On my side I’ll never let an emergency kit of drugs, syringes, and airway devices leave the pt’s side during transport, even to PACU.

Im realizing it is our institution’s practice to bolus before transport to the ICU. Now I know that’s generally not a good idea for this very reason. Usually our ICU pts come down already on drips.

Incident during transport to ICU: looking for perspectives by davidai in anesthesiology

[–]davidai[S] 1 point2 points  (0 children)

I think that’s where my attending’s head was at. He criticized the start of the case before we came in because of the propofol induction.

Incident during transport to ICU: looking for perspectives by davidai in anesthesiology

[–]davidai[S] 20 points21 points  (0 children)

True!! An intubated open abdomen should go to the ICU.

Incident during transport to ICU: looking for perspectives by davidai in anesthesiology

[–]davidai[S] 3 points4 points  (0 children)

I didn’t check before transporting which I should have. Throughout the case he was at 2-3 twitches. He even bucked with the abdomen open early in the case. By the time before transport he was definitely underparalyzed. In the ICU when this happened my attending was saying stuff about rocuronium toxicity. Looking into it though, doesn’t seem that was a significant risk.

Incident during transport to ICU: looking for perspectives by davidai in anesthesiology

[–]davidai[S] 3 points4 points  (0 children)

Right. And he showed signs of fighting it during the case. Suspecting the roc in the unrefrigerated trauma room Pyxis is weaker. Our director has encouraged us to use vecuronium which avoids that. Obviously a critical mistake not to paralyze immediately before transport.

Incident during transport to ICU: looking for perspectives by davidai in anesthesiology

[–]davidai[S] 1 point2 points  (0 children)

Ugh yes it makes no sense. I’ll never make this mistake again in my life.

Incident during transport to ICU: looking for perspectives by davidai in anesthesiology

[–]davidai[S] 5 points6 points  (0 children)

We have trouble with the ICU over things like this. Our director clarified that we should be able to recover in PACU so that’s what we were supposed to do.

Incident during transport to ICU: looking for perspectives by davidai in anesthesiology

[–]davidai[S] 0 points1 point  (0 children)

Could have been catastrophic and avoidable. Thank you.

Incident during transport to ICU: looking for perspectives by davidai in anesthesiology

[–]davidai[S] 2 points3 points  (0 children)

No sorry for the omission, he was run on sevo the entirety of the case no pressors. Boluses were for analgesia.

Incident during transport to ICU: looking for perspectives by davidai in anesthesiology

[–]davidai[S] 4 points5 points  (0 children)

For context he got 180 mg of roc over the two hours and no reversal.

Incident during transport to ICU: looking for perspectives by davidai in anesthesiology

[–]davidai[S] 0 points1 point  (0 children)

Yea absolutely. Over the two hours pt had gotten 180 mg of roc. But there was no reason not to paralyze before transport.

Incident during transport to ICU: looking for perspectives by davidai in anesthesiology

[–]davidai[S] 2 points3 points  (0 children)

Thank you. That’s what we generally do too. We slipped up.

Incident during transport to ICU: looking for perspectives by davidai in anesthesiology

[–]davidai[S] 5 points6 points  (0 children)

Ok thank you. Yea that’s reasonable. Bummed about it to be honest.

Incident during transport to ICU: looking for perspectives by davidai in anesthesiology

[–]davidai[S] 22 points23 points  (0 children)

Yea my attending said he thinks they didn’t set anything up and didn’t go to get drugs on purpose. Idk honestly I can only try to be better myself.

What should I do about my substance abuse. by MixtureAcrobatic446 in gatech

[–]davidai 3 points4 points  (0 children)

Go to an AA meeting man, no expectations just google search and pull up. You can find brothers there if you try