Speaking of which…
I made it through an aflutter/afib ablation Thursday, the EP docs second of the day, took around 4 hours. I was in atypical flutter which made it a little longer, although I was still groggy when they explained it. General anesthesia this time, Halothane iirc, propofol for induction plus a benzo and fentanyl before that. No Bing!, eased back into consciousness in the outpatient prep room. They cut me loose the same day, unlike the 3 day stay with the vtach procedure.
They wouldn’t let me watch, although the Doc said they record it and I could have a copy of the video which I forgot about until the next day. Unlike Mayo this hospital doesn’t put every report, test, etc. online.
Glad you are through. Halothane? I haven’t heard tell of it in about 15 years. (I’m not familiar with iirc meaning?). Maybe halothane has some special use in EP procedures. One of the reasons it fell from favor (aside from the fact that each new generations of halogenated hydrocarbon volatile anesthetics was 10X less metabolized than the previous) was because it sensitizes the myocardium to epinephrine-induced irritability. Maybe for some EP procedures that is desirable to help reveal irritable loci.
There was a lot going on, I probably got the name wrong trying to look it up online and it seemed right, they did say it was a common gas in addition to the correct name, we talked more about how automated their equipment was. No flow through bagging like they had me do when I was a student. Besides an anesthesiologist there was a student nurse anesthetist (former OR nurse) who was going to (well, did) do the intubation, anesthesia, etc. She did a good job, just some residual soreness. My first few patient intubations were in the OR as a medic student, only fair that somebody practiced on me. They did kinda cheat, said they’d be using a glidescope, so I didn’t ask mac or miller.
IIRC - if I recall correctly. It’s becoming more useful with age
There are so many useful additions for intubations these days. Was once you only had a choice between curved and straight blades. Now there are glide scopes, endo equipment to directly visualize the path, etc.
SOME of this reminds me of all the Ultrasound usage these days. MY suspicion is that it is a way of charging more for what you do. But there are any number of other similar wastes of money modern medicine can do, picking on one is kind of unfair.
Lots of cool stuff. Around the time I retired 5 years ago our hospital was saying they used LMAs on everybody they could instead of ET tubes. I asked Mayo about them and got kind of a non-committal answer. Maybe that meant they aren’t very popular any more. I preferred straight blades but practiced with both, you probably did more intubations in a day than I did most months. Once our service got a McGrath I tried to make sure it was on my truck and used it for every intubation I could, of course for EMS that meant mostly codes. We used it with the glideslope hard curved stylet until glideslope stopped selling them to non-customers. The hospital never got don’t throw out the stylet so they gradually disappeared, they were even labeled keep or something like that.
I ended up with a pleural effusion and DIB, having gained about 10 pounds in two days, and another ER visit. Lasix made it much better. It’s a lot more fun being a provider than the patient
Appropriate you mentioned ultrasound, they did one on my heart, and didn’t find anything unusual. It was sensitive enough to pick up the ICD wires
My family doctor has an ultrasound, which he regularly uses to look at all kinds of things from thyroid to bladder to joints. I used to think of them as something exotic, but it now seems a routine way to peek inside.
Now there are even these handheld ultrasound gadgets which are kind of like a Star Trek tricorder.
These have their uses, but do not protect against aspiration of gastric contents the way an ETT does. To my knowledge, there has been no study - just hoping for the best. Since aspiration is rare, but highly morbid, it would take a very large number of participants for validity.
In my experience in the ED, LMA’s were only used by paramedic units when they had a difficult intubation or didn’t have much experience placing a tube. Pretty much ALWAYS they were removed as soon as the patient was settled in a bed in the ED - replaced by a proper ET tube if needed. With the advent of GlideScopes, boogie tubes, and endo, it was a long time ago since i was unable to place an ET tube. BUT we were probably much more “cowboy” about it, since it was a life-saving procedure when we did it, while an elective one when you did.
They talked about allowing LMAs on the truck locally but it never happened, we used Combitubes (later Kings, etc, I lost track of which) as a backup. I was also a volunteer with our rural volunteer fire department’s medical first responder licensed unit where we could only operate as MFRs. The VFD was part of a test protocol where we could place combitubes, I probably did more combitubes with them than in my medic job, . Our ER xrayed for ET tube placement and left them in place unless there was a problem, I imagine all the combitubes were pulled and replaced.
Different areas have different protocols.
Indeed! In IL there were groups allowed by IL State where in effect the Med Director had carte blanche to decide on protocols, equipment, etc. Each system was different. It was difficult if you worked in an ED which had multiple groups bringing patients because you never quite knew what you were getting. Some groups had known weak directors, so you could expect you would get a disaster. Other groups had strong programs, so you knew you got a well-packaged patient.