Anesthesia is safer than ever (even in France)
Anesthesiology--Survey of Anesthesia-related Mortality in France.
Anesthesiology--Survey of Anesthesia-related Mortality in France.
Contract Negotiations Between Insurers, Hospitals Increasingly Acrimonious
The exact same can be said for negotiations between hospitals and physician groups and insurance companies and physician groups. It all reminds me of that scene in Star Wars where the good guys are stuck in a trash compactor after their escape from the brig--all attempts to stop the walls from moving from the inside fail. (what, you were expecting a reference to Greek mythology?)
National Influenza Vaccination Week -- November 27--December 3, 2006
[A]nnual influenza vaccination is recommended for the following groups:
Persons at high risk for influenza-related complications and severe disease, including:
- children aged 6--59 months,
- pregnant women,
- persons aged >50 years,
- persons of any age with certain chronic medical conditions
andPersons who live with or care for persons at high risk, including:
- household contacts who have frequent contact with persons at high risk and who can transmit influenza to those persons at high risk, and
- health-care workers.
PortableApps Suite | PortableApps.com - Portable software for USB drives
Hospital computers tend to have Internet Explorer as the only web browser. It works (mostly), but it's not as secure, extensible, fast, standards-compliant as, say, Firefox. Besides that, I use Firefox at home and like to have the same bookmarks available. Portableapps.com allows me to carry my own apps in on a USB thumb drive.
1. Anatomy. (anatomy, & anatomy)
2. Position. (position, & position)
3. Time is beverage.
4. Sedation is your best friend.(but also a willing accomplice: if it hurts too much you are probably not doing it right).
5. When in doubt: whip it out.
6. A 1:200,000 solution of epinephrine contains 5-mcg/ ml of epinephrine.
7. The patient is always right.
8. Life is hard enough already: empty your bladder & adjust the lights.
9. Know when 'it's time to numb the big ganglion'.
10. No one cares if you enjoy your job as much as you care.
11. "J, don't fill up on bread." (not really a rule of regional anesthesia, but something important I learned from my parents.)
Funny and true!
A while ago Seth Dillingham wrote two Google modules for me: Allowable Blood Loss and BMI Calculator. Well, I still have a hard time finding them on Googles own module site, but I can find them both on googlemodules.com--the 'Unofficial Google Modules Site'.
I wanted to pass along another use for the allowable blood loss calculator--estimating surgical blood loss. Anesthetists are asked to estimate the volume of surgical blood loss that occurs during a procedure on their anesthetic record. Surgeons will often attempt to influence that figure downward by volunteering their own estimate of blood loss (often not grounded in reality) in the hope of getting me to go along with it.
In large blood loss cases where I've been following the hematocrit I use the formula to calculate the actual blood loss. For example, if a 100 kg male started with a hematocrit of 0.40 and wound up with a hematocrit of 0.32 I calculate their blood loss as 1600 cc. No arguments.
You've no doubt seen the headlines: "Hospital mistake paralyzes new mom," and "Hospital that overdosed preemies gave too much pre-delivery anesthesia to new mom." As is usually the case, 'coverage' of this sort of event raises more questions than it answers.
This new report appears completely unrelated to the previous reports out of this hospital describing heparin overdoses. Different department, different drugs, different delivery mode, different patient group. In fact, it has less to do with the hospital than with the anesthesiologist involved. So much for the headline.
The drugs used in labor epidurals are usually a dilute local anesthetic and a small amount of narcotic. Using both types of drugs in combination allows lower concentrations of each individual drug to be used, hence improving the margin of safety for each. In labor epidurals, our goal is relieve pain without causing significant weakness. That is why we use some local anesthetics over others, at low concentrations, and with narcotics (epidural narcotics relieve pain without paralyzing the patient).
This combination is typically infused via the epidural catheter at a rate of 10 to 15 cc/hr. If necessary (i.e. if the patient continues to have pain) we give additional volumes of epidural drug to try to get them comfortable. How much? I've given up to 26 cc in an hour.
What's going on with this patient? I can think of two possibilities: Either the 'paralysis' described is from the large amount of local anesthetic she received (in which case it will resolve) or the large volume of anesthetic compromised blood flow to the spinal cord (in which case it may or may not resolve).
But I have other questions as well. Medical errors rarely happen in isolation. There are usually several events that together contribute to the error.
A legal defense fund has been set up to help Anna Pou defend herself against criminal charges. Contributions may be sent to:
201 St. Charles Avenue
New Orleans, LA 70170
I'm sure any amount will be appreciated.
Anesthesiology has a nice article which attempt to quantify some of the less common risks of having an epidural during labor: epidural hematoma, infection, and neurologic injury.
Epidural hematoma 1 in 168,000 6 per million Deep epidural infection 1 in 145,000 7 per million Persistent neurologic injury 1 in 240,000 4 per million Transient neurologic injury
[< 1 year]
1 in 6,700 180 per million
It contains an interesting tidbit others might find interesting, too. There are 4 million births in the United States each year and 2.4 million involve epidural analgesia. Wow. That's three fifth of all live birth get an epidural! (And some call nights, it seems every single one does...)
From a critical care physicians stranded in a nearby hospital during Katrina:
My thoughts exactly...
The number of physicians in Pennsylvania has declined by approximately ten percent between 1999 and 2005. On its own that number may not sound like such a huge drop. Compare that number to the other 20 most populous states and it becomes obvious that the difference is very significant.
Almost all of have seen net increases of between 7% and 35% over the same period. I would find it very interesting to know how long the wait is for a new patient appointment in an internal medicine practice in Pennsylvania vs. these states that have seen an increase. A knee replacement? First visit to a Neurologist. Follow up visits? You get my drift. Pennsylvania has a population that is among the most aged. Medicare just announced plans for more cuts. New physicians are choosing not to practice in Pennsylvania and we've seen a net loss of 10% in our physicians with unique provider numbers over the last six years. Get the picture, Governor Rendel?
Data from State of Medicine in Pennsylvania--2005
There's a very good article in the July 20 New York Times titled "Medical and Ethical Questions Raised on Deaths of Critically Ill Patients" that describes the ethical questions raised in the New Orleans case with some very good quotes: