DR FAIL

[Kiwiology]

Epinephrine 1:10,000 given IM seems kind of excessive. Most doses for IM Epinephrine start out around 0.3-0.5 mg, which is 3-5 mL of the 1;10,000 solution.

Most of our IM adrenaline is .3mg (I have seen .5mg given in severe asthma) but it's still a 1:10,000 solution

The only time we give a 1:1,000 solution is cardiac arrest in which case we do not dilute it with saline.

Anyway .... back to what we were talking about

Threat hijacker, away!

[VentMedic]

Most of our IM adrenaline is .3mg (I have seen .5mg given in severe asthma) but it's still a 1:10,000 solution

The only time we give a 1:1,000 solution is cardiac arrest in which case we do not dilute it with saline.

Anyway .... back to what we were talking about

Threat hijacker, away!

No really hijacking.

It just shows how easily mistakes can be made if people don't stop and think a few seconds before they act. If the OR team has followed the safety guidelines that were in place, a missing surgeon would have been noticed.

If the paramedic in the epi situation had taken time to check the "Rights" before giving the Epi, the med error would not have been an issue.

[Kiwiology]

No really hijacking.

It just shows how easily mistakes can be made if people don't stop and think a few seconds before they act. If the OR team has followed the safety guidelines that were in place, a missing surgeon would have been noticed.

If the paramedic in the epi situation had taken time to check the "Rights" before giving the Epi, the med error would not have been an issue.

True; I got offended when I was told "I don't like you drawing up my drugs" or "show me where you got that clear liquid from" by more senior officers; I thought it was personal; like I was stupid or something but it's y'know, thier arse so fair enough

Most are pretty good tho; you draw it up and show them what you did n' its cool.

I am exploring this whole issue more; I call it PRM (practitioner resource management) when I was working for the airlines I learnt a lot about CRM (crew resource management) ... I should cross the two over and god knows I'd make buckets of money

[ERDoc]

I hate to be the one to break it to you Kiwi, but you are a little late. That has been a huge theme here in the US for many years. They've even written books about it.

[VentMedic]

True; I got offended when I was told "I don't like you drawing up my drugs" or "show me where you got that clear liquid from" by more senior officers; I thought it was personal; like I was stupid or something but it's y'know, thier arse so fair enough

Most are pretty good tho; you draw it up and show them what you did n' its cool.

I am exploring this whole issue more; I call it PRM (practitioner resource management) when I was working for the airlines I learnt a lot about CRM (crew resource management) ... I should cross the two over and god knows I'd make buckets of money

There are other ways to cut for time management but checking meds is not one of them. Licensed professionals are generally educated enough to know mistakes happen. If you did not take the time to confirm the medication whether you draw it up yourself or especially if someone else does, then you have no defense. A med error may still occur but if one makes it a habit of checking regardless of how offended their EMT-B or P partner gets, that person will be less likely to make a deadly mistake.

EMS also did studies on the time/steps it took to do an IV and eliminated as much as they could, including proper cleaning, which may also explain part of the reason why field IVs are removed in the hospital. ETI was another area. I cringe when I hear new students wanting to race each other for starting IVs or sinking a tube during their clinicals. Those are the ones that will not be left out of the sight of a licensed professional.

[Kiwiology]

I hate to be the one to break it to you Kiwi, but you are a little late. That has been a huge theme here in the US for many years. They've even written books about it.

Oh well there goes my early retirement!

[tniuqs]

There are other ways to cut for time management but checking meds is not one of them. Licensed professionals are generally educated enough to know mistakes happen. If you did not take the time to confirm the medication whether you draw it up yourself or especially if someone else does, then you have no defense. A med error may still occur but if one makes it a habit of checking regardless of how offended their EMT-B or P partner gets, that person will be less likely to make a deadly mistake.

1-Interesting .... so whom do I hold accountable for those bubbles in my preloads or premixed bags of dopamine ? j/k.

2-It is interesting to observe that different nations use different concentrations of Rx, will be looking even more diligently when I am reading "resus" stats from different places.

Although Ronca was placed under general anesthesia for 90 minutes for the brain shunt, it was never inserted. Unbeknown to Ronca, her surgeon - Dr. Paolo Bolognese - was on a plane to Florida for a family vacation.When the OR staff and assistant medical director realized Bolognese wasn't coming, they reached out to the chief of neurosurgery, Thomas Milhorat. He refused to cover for his colleague. Both surgeons violated professional standards and hospital policy, the report said

3- Doest this look like scheduling error to anyone else, although given this information is the "on -call" skull cracker responsible to cover and not be informed about that patient ...looks like he was the whistle blower in this but paid the price.

Bolognese, who is not board- certified and who earned $2.5 million in 2007, is still operating.

Umm Yikes .. great system of checks and balances there maybe this TIME OUT and one should ask for credentials too?

Edited September 26, 2009 by tniuqs

[Dustdevil]

Luckily, in Iraq it was always pretty obvious which limb was the one to be amputated.

[scubanurse]

I used to be afraid of them operating on the wrong joint but now I figure that even if they did the wrong side or joint...the one they do open up will probably need work too so I don't worry about it so much!

[Doczilla]

Not to excuse anything here, as there are certainly several lapses in judgement and care (and I'm more than happy to beat down the neurosurgeons when opportunity presents), BUT....

This was an elective procedure. It could be that a clerical error resulted in the procedure being scheduled on the wrong day, and the operating surgeon did not realize it. He could have thought it was NEXT Monday.

The Chief of Neurosurgery may have been right to refuse to operate on the patient. Think about it... operate on a patient he has never met for an elective procedure for a long-standing painful problem which his colleague has diagnosed and treated, for which his colleague has a treatment plan? I think the prudent thing here would be to NOT operate, to allow her to recover from anesthesia, and do the procedure another day. All while offering many apologies to the patient as well as wiping clean the hospital bill.

'zilla