Sandy, this is your beloved scepticisim again...You know I have always been your great supporter, but I have to say scepicism is easy - you don't have to do anything. It is much harder to try and change things - it is much riskier, it costs time, effort etc. etc. But then in the end you get the satisfaction from doing good things. I have achieved a few small victories like this in the past and they are what i am and will be proud of when i retire. Those are the things I will be proud of.
Things don't have to be made more expensive - if there's a will there's a way. Start talking to the surgeons and then the administration. Once they understand the advantages of such an arrangement, they will be the ones who will institute the change. They will be the ones who will order the recovery room nurses to get extra training and they will be the ones to instutute that, not you.
Ivan Hronek MD Los Angeles, CA http://health.groups.yahoo.com/group/Anesthideas/ Do not fear to be eccentric in opinion, for every opinion now accepted was once eccentric. Bertrand Russell
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From: "Miller, Sanford" <sanford.miller@...> To: "Anesthideas@yahoogroups.com" <Anesthideas@yahoogroups.com> Sent: Saturday, July 4, 2009 1:44:14 PM Subject: RE: [ai] Bucking, LITA tube and APCU extubation
Get an RT specifically assigned to the PACU? Buy enough ventilators to supply the PACU if most pts come in intubated? In the midst of a hiring/purchasing freeze? Try to persuade the PACU nurses that it's OK for us to do this? Get the administration to understand thta this may be ultimately a money-saving proposition? Make our municipal hospital (where the residents do the actual work) more like a surgicenter?
Even in one's wildest dreams, it won't happen. Hard enough to get pts into the ORs on time in the morning. Efficiency isn't happening.
You can do that - these don't have to be sophisticated ventilators but usually you can get most patients breathing spontaneously towards the end of the case which then becomes the 'challenge' for us to achieve. Like Jim says, it's all just what you get people used to doing - then they consider that normal. If you get a respiratory tech assigned to PACU with a sufficient amount of circuits and explain the advantages of such an arrangement everyone understands - the administration, the surgeons and the anesthesiologists will all be happier as they get more done in a shorter period of time and the OR becomes more like an efficient surgicenter - look at the smoothness and low level of frustration in those in comparison with regular
ORs.
The LITA tube is an expensive way to perform the "Kempen technique" of lidocaine installation via any existing ETT. That LITA ETT has an injection port just...
Your post very deep as usual but a little complex as you tend to talk about more than issues at the same time. As to OR extubation: jaw thrust or similar...
Paul, we all respect your extensive experience and yes, you say my personal preference is to extubate in the OR... Extubation practices can influence how the...
Our practice of extubation in the OR vs recovery room is largely dictated by the culture of the institution. The recovery room nurses at my institution are...
So you have enough ventilators in the PACU to cover virtually all of your beds? We extubate in the OR unless the pt is going to stay ventilated, and seldom...
You can do that - these don't have to be sophisticated ventilators but usually you can get most patients breathing spontaneously towards the end of the case...
Somehow this thread has become very complicated over a very routine subject. Except for the sick patient who has been in surgery all day, or similar patient,...
Joe, if you were an OR manager, and if you critically look at the time it takes from the end of surgery to leaving the OR, in a large OR suite you will get to...
Ivan, I've just never worked anywhere that the anesthesia staff could not have the patient extubated and breathing spontaneously by the end of the case,...
Get an RT specifically assigned to the PACU? Buy enough ventilators to supply the PACU if most pts come in intubated? In the midst of a hiring/purchasing...
Sandy, this is your beloved scepticisim again...You know I have always been your great supporter, but I have to say scepicism is easy - you don't have to do...
Ivan, I love the way you love my skepticism, but you seem to have forgotten how Bellevue works-or, since you were a resident, you may never have known. Trying...
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