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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 to change things is
a constant effort here, and it’s necessary to choose one’s battles.
As to taking time, effort, etc, that’s a lot of what Levon and, to a
lesser extent, I do. Yeah, he’s achieved a lot, but given present
circumstances I can’t see that this is a useful change to try to accomplish.
We really want to have the residents learn how to wake pts up at the end of the
procedure, so the particular issue we’re discussing is essentially moot.
Sanford M.
Miller, MD
sanford.miller@...
From: Anesthideas@yahoogroups.com
[mailto:Anesthideas@yahoogroups.com] On Behalf Of Ivan Hronek
Sent: Saturday, July 04, 2009 6:28 PM
To: Anesthideas@yahoogroups.com
Subject: [ai] Recovery room extubation
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.
Sanford M. Miller, MD
sanford.miller@
nyumc.org
____________ _________ _________ __
From: Anesthideas@
yahoogroups. com [mailto:Anesthideas@ yahoogroups. com] On Behalf Of Ivan Hronek
Sent: Friday, July 03, 2009 1:13 PM
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.
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