Thursday, September 21, 2006

And winner for the longest anaesthetic...

A very old woman is to undergo a laparotomy for investigation of small bowel obstruction.

She has no significant cardiovascular or respiratory problems excellent.

She has been admitted to ITU/HDU after a surgery last year due to difficulties ventilating – bollocks!

Time = 0hrs 0mins

The lady comes to anaesthetic room, very cheerful and smiling as all the “sick” old women are. The anaesthetist tries for 20 minutes to find a peripheral vein to cannulate. After around seven attempts he abandons this and moves onto an arterial line.

Time = 0hr 50mins

The arterial line is still not sited despite attempts in both radial arteries and brachial arteries (one under ultrasound guidance). It is decided to move on to a femoral arterial line. At this point a vein on the rear of the lady’s forearm stands to attention and lets us cannulate it.

Time = 1hr 10mins

A rapid sequence induction with cricoid pressure is carried out. This happens with relative ease. Despite popular belief across the pond cricoid pressure is required as (in this case) the patient risked aspirating 700mls of fluid from the stomach.

Time = 1hr 25mins

After a number of trips for ODAs and students to ICU a femoral line is finally sited under ultrasound guidance.

Time = 1hr 40mins

The epidural is finally sited despite this patient seeming to be made entirely of calcium.

Lessons learnt:

Little old ladies are made of clotted cream, atheroma and calcium...

Always use cricoid pressure in rapid sequence induction...

If at first you don’t succeed… use ultrasound guidance...

Even the best can sometimes struggle !


Anonymous Anonymous said...

Hmmm had a similar problem with a middle aged woman, about 15 attempts (med student 2, resident 5, anaesthesist 8) what we usually do then is head down and put it in the ext. jugular, works every time.

4:42 PM  
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10:04 PM  
Anonymous Anonymous said...

this is hillarious, at least the way u wrote it made it all funny.

it is brilliant. i wish i was there to help out!!

xx Amanda

10:46 AM  
Anonymous treatment rooms london said...

This is an interesting take on it. Funny post as well. Never had an issue with be put out for an op I must be lucky

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