let me buzz...
Medical care includes a whole range of gadgets, some simple and many complex. Hollow tubes of different sizes and materials are recruited by us, be it in the form of a slender and puny iv cannula or a stout and rigid pain in the backside, flatus tube! A nasogastric tube is one such wonder for physicians who swear by its “hollowness”! I could never imagine that this wriggly worm like length of modified plastic could test my patience and the patient.
The first time I came across this entity was in undergrad when we went for bedside clinics. Frail patients would have one of these sticking out of their noses. Some would just wear it on their faces after contriving that all efforts to yank them out would be promptly rewarded with a stiffer newer tube assisted by the heavenly ambiance that the nurse threw in with her sharp retort while fidgeting with it.
As an intern, my sacred duty was to see that tubes of all sizes once in,stay in! patency is an emotional and sensitive issue in anesthesia,if you didn’t know.. Each defective cord would have to be replaced before the deadline that the nurse established before her ceremonial drug and tube feeds. Stepping into anesthesia by choice, encounters of the ryle tube kind became more frequent in the name of securing airway and beyond.
My tryst with the whim that a nasogastric tube is capable of became evident on a dull routine day in the ICU. Most of my patients stable (I hoped!), there was me sitting at the counter sifting through patient details before I handed over management details to my reliever hours away. The inevitable scene of a patient zonked on opiods suddenly waking up to find a tube down his mouth and a tube down his nose happened just then. With one swift yank,our dude yanks it out and hands it out to the nurse! The cacophony that followed had to be resolved with a brand new ryle tube being inserted after convincing the patient that it was for his own gastronomical good.
Fast forward into PGship where we received intensive training in the intensive care unit, a fresher had to do the odd jobs as we didn’t have subordinates. The universe would now and then intriguingly conspire to block the ryle tube in patients. And I mean patients who are zonked on sedation and ventilators “taking their breath away” kinds at that. Threading down a new one down his nose and throat would either be like a piece of cake job or end up like threading a needle in the dark! We require umpteen maneuvers and aids such as the light in your throat( laryngoscope) and my metal fingers (Mcgills forceps). Working at the depths of a patient’s tosilled throat can become tricky given the prompt efficiency that the scope boasts of, refusing to light up when I ever so desperately need it to work. A bad works man blames his tools,goes a famous saying.. well the guy wouldn’t have been an anesthetist now,would he ?! fidgeting with jelly and gloves, each contraption is guided into its glorious orifice to rest therein for aiding two way transit to fluids of weird compositions.
All the tubes in,I sign off for the day… until new challenges of the hollow kind beckon.
Sunday, January 10, 2010
Tuesday, January 5, 2010
Fentanyl: Cant smile without u!
let me buzz...
A colorless odorless liquid hidden at the depths of a puny ampule, this miracle looked back at me gleaming with possibilities. Pummeled into dilution duties early morning all through my fresher year,all I could remember about fentanyl was that it was to be made 10 per CC. The mundane yet imperative act of drug preparation was jived up by frequent possibilities of a drug becoming NA! “Not Available” in a govt setup meant one thing and one thing only..that the drug still gets on the tray no matter the hell you pass through hunting for it! Precious stones and pearls light up a dame’s face, as a first year resident,an ampule of fentanyl sure did the trick for me!
I do not remember the time this word fentanyl doesn’t come up in the OT. Premedication to analgesia to induction to reversal to spinal to epidural to weird skin tattoos for pain relief, we seem to get so obsessed with the drug. Ask an anesthetist dying of pain and his last words would be “fentanyl”.
Scene: surgery OT. Thesis case.. cholecystectomy under GA with specified drug dosage protocol. I break the last ampule of liquid gold (fentanyl),a mammoth 10 ml of it to load it for use. The consultant beside me, looking out for the multitude of errors that I can be capable of, says “ ok, induction!”.The senior resident takes the liquid of joy and pumps it in IV. The Buddha like peace on the patient’s face seems so discerningly uncanny.. I look up and see our stud with a dud of a gall bladder has stopped breathing with dipping vitals. Eyes going into a bizarre twirl, I try to figure out which bizarre crisis protocol the happenings fit into and why!. The resident sheepishly drops the empty syringe into the tray when something grabs my attention. I like my liquid gold fentanyl undiluted while the protocol says 10/cc! our dude had gotten zonked on 500 Mics of the luscious crystal meth of anaesthesia.. fentanyl!
The eternal showdown in little OT notwithstanding, the consultant precisely points out my ever so subtle mistakes with heaps of advice and criticism garnishing it. We get the case done and the dude is wheeled out retaining his smile of absolute bliss.
Win some and lose some they say.. well I lost some gained ground for sure while the gallbladder dude won a trip of a lifetime, free! ‘Dilutionary’ misgivings getting less frequent, I still use the smile maker everyday in discreet amounts. Any guesses for my most FAV song…. Leisurely sung by Barry Mannilow.. I CANT SMILE WITHOUT YOU!!
Saturday, January 2, 2010
laws of buzzocaine.. apt yet inept!
with profound insight and scant relevance to public opinions,i now propose the new laws of buzzocaine.. apt yet inept.
1)the chances of an air column entering the IV line is inversely proportional to the the number of times u check the fluid remaining in the vac.
2)law of blood loss estmation: product of the surgeon's estimate and the anesthetist's estimate is always a constant.
3)relevance of an epidural seems to gain importance exponentially when u have a case under spinal anesthesia.
4)the time taken for an epidural is directly proportional to the duration of surgery.
5)top up dose of relaxant in the drug tray is always one dose short.
6)a stilette is always needed when not checked.
7)malfunction of the pilot balloon on enodtracheal tube only occurs in full stomach patients.
8)gauge of the IV canula in situ is directly proportional to the hypovolemic status of the patient.
9)the vac of fluid you want to push fast IV is always punctured!
10)the probability of late reversal is directly proportional to the amount of opiods that u admit was injected (never the truth!)
11)chances of regional techniques failing rises exponentially with the patient's mallampatti score.
12)uterine perforation during MTP happens at 4 pm on friday evening!
13)light of a laryngoscope fails only in difficult airway!
will keep u guys posted!
Monday, December 28, 2009
Plight of the proseal plier!
let me buzz...
Proseal LMA is an improved supraglottic device with a drain port and a dorsal cuff incorporated for better seal and prevention of aspiration… the multitude of adjectives and traits kept ogling out from the vociferous tone of my well read superior. As a fresher, u just can’t imagine that this floppy thing with 2 tubes and a hood of a spitting cobra is going to be ever so vital in the anesthesia scheme of things!
The first week went with poignant accounts of peruse checks, looking for cuff leaks and insertion techniques. You stand beside your superior watching them shovel the 2 tubed snake into a zonked out patient all in the name of maintenance of airway. Well ,wait the fun doesn’t end there, does it! You pump in some air into the cuff and volla!! Positive pressure ventilation seems a piece of cake! It couldn’t get more easier than this… just hold the reservoir bag and SQUEEZE!
But you couldn’t get away with scant solace when surrounded by airway addicts now, could you? Zipping back rewind mode to shoveling down the snake moment… bespectacled pair of observant eyes glaring through, the consultant says “..Hmm.. Judging by the way the bite block got nudged out with inflation, placement tho theek lag rahi hai. Connect the circuit and check for ventilation”, she says. Taking my role of a 1st year with a sense of pride, I obediently yank at the flinty circuit to connect it to the snake dude in the zonked out dude’s mouth. “Hmm…”,says my consultant, “jelly and ryle’s tube..”. my superior snatches the moment to drill some gyan into my ever fresh from MCQs mode cerebral cortex. “how do you check for correct placement?”, he asks. Now, as a first year, I need not be right with answers given the notion “ ye tho first year hai!’. I rant out calculated guesstimates of plausible methods from my vague memory. The fun thing about anesthesia is that all questions will be repeated. If you ask me,if you learn about 1 entity once, u can survive upto 3 weeks of drillbit questioning going by the number of repetitions of the questionnaire that all seniors tap from.
With the surgery resident onlooking with the praying mantis pose, all decked up in sterile disposable layers of paper, the patient is handed over to them. Brief interruptions of additional queries from the senior resident interrupt my tryst with the beeps, blips and bells that the monitor efficiently rants out. Reversal of anesthesia is the next moment of reckoning. Pump in some drugs IV and the dude starts breathing again. Adamant commands ensue to wake him up to get the snake out. “ Aankhen kholo,saans lo, gehri gehri saans lo”, goes my senior resident. Not to be left behind, I join the chanting for total vocal reversal of anesthesia! “ Suction!!”,commands my resident. The snake has to come out or the patient will chew on it to behead the slithering thing! Sounds like a harry potter tale of the weird kind!
The two tubed snake is out ,the patient wheeled out and the next patient walks in.Routine events with tubes cannot be more intriguing as this for a fresher now, wont u agree?
As a popular saying goes… for a fresher, anesthesia is TDBD..”Tube Daalo,Bag Dabaao!”
Proseal LMA is an improved supraglottic device with a drain port and a dorsal cuff incorporated for better seal and prevention of aspiration… the multitude of adjectives and traits kept ogling out from the vociferous tone of my well read superior. As a fresher, u just can’t imagine that this floppy thing with 2 tubes and a hood of a spitting cobra is going to be ever so vital in the anesthesia scheme of things!
The first week went with poignant accounts of peruse checks, looking for cuff leaks and insertion techniques. You stand beside your superior watching them shovel the 2 tubed snake into a zonked out patient all in the name of maintenance of airway. Well ,wait the fun doesn’t end there, does it! You pump in some air into the cuff and volla!! Positive pressure ventilation seems a piece of cake! It couldn’t get more easier than this… just hold the reservoir bag and SQUEEZE!
But you couldn’t get away with scant solace when surrounded by airway addicts now, could you? Zipping back rewind mode to shoveling down the snake moment… bespectacled pair of observant eyes glaring through, the consultant says “..Hmm.. Judging by the way the bite block got nudged out with inflation, placement tho theek lag rahi hai. Connect the circuit and check for ventilation”, she says. Taking my role of a 1st year with a sense of pride, I obediently yank at the flinty circuit to connect it to the snake dude in the zonked out dude’s mouth. “Hmm…”,says my consultant, “jelly and ryle’s tube..”. my superior snatches the moment to drill some gyan into my ever fresh from MCQs mode cerebral cortex. “how do you check for correct placement?”, he asks. Now, as a first year, I need not be right with answers given the notion “ ye tho first year hai!’. I rant out calculated guesstimates of plausible methods from my vague memory. The fun thing about anesthesia is that all questions will be repeated. If you ask me,if you learn about 1 entity once, u can survive upto 3 weeks of drillbit questioning going by the number of repetitions of the questionnaire that all seniors tap from.
With the surgery resident onlooking with the praying mantis pose, all decked up in sterile disposable layers of paper, the patient is handed over to them. Brief interruptions of additional queries from the senior resident interrupt my tryst with the beeps, blips and bells that the monitor efficiently rants out. Reversal of anesthesia is the next moment of reckoning. Pump in some drugs IV and the dude starts breathing again. Adamant commands ensue to wake him up to get the snake out. “ Aankhen kholo,saans lo, gehri gehri saans lo”, goes my senior resident. Not to be left behind, I join the chanting for total vocal reversal of anesthesia! “ Suction!!”,commands my resident. The snake has to come out or the patient will chew on it to behead the slithering thing! Sounds like a harry potter tale of the weird kind!
The two tubed snake is out ,the patient wheeled out and the next patient walks in.Routine events with tubes cannot be more intriguing as this for a fresher now, wont u agree?
As a popular saying goes… for a fresher, anesthesia is TDBD..”Tube Daalo,Bag Dabaao!”
Subscribe to:
Posts (Atom)