Sunday, February 27, 2005
Saturday, February 19, 2005
I've seen situations where a patient has had surgery, received some fluid during the procedure, discharged home, and readmitted upto a week later, with a diagnosis of too much fluid during anesthesia when there are clearly other issues in play. A week later! I've seen surgeons blame anesthesia for kidney failure in a patient who had a liver transplant, when that is clearly a known complication during such an extensive operation. Seems to me that in particular surgeons are micro managers... at least in general... at least at the University level. I've had surgeons ask me to give blood products to patients at the same time not to raise the central venous pressure (which is a measure of volume status and raised directly by giving fluids or blood)
I'm not saying anesthesiologists are perfect. I'm saying that we've been to medical school too, and we've gone through specialized training. Give us a break.
Saturday, February 12, 2005
Thursday, February 03, 2005
Later I'm giving the resident in the room a break while we're on bypass and I look at the intraoperative lab work. The hematocrit (aka "crit"), or percentage blood count, is 41 on the slip -- it's circled and the tech or perfusionist or someone had written "Outstanding!" next to it. This struck me as kind of funny. Someone was impressed enough with the lab value to comment about it.
A "normal" hematocrit is generally listed at 42-54 percent, but in my experience cardiac surgery patients tend to be a bit anemic and run in the 30-40 range. Now after you go onto bypass the hematocrit tends to drop a bit because the bypass pump is primed with fluid so the blood volume gets diluted and a hematocrit above 27 tends to be acceptable for most patients. Some patients start low and drop further on bypass and receive blood as a result. So 41 is really doing pretty good. I look back to the first set of labs before the patient is asleep and the crit is 48. Again still within the normal range, but quite a bit higher than we usually see for our cardiac patients. Explanations for this are many, and include disorders such as polycythemia vera where the blood is abnormally thick. In this clinically setting the most likely diagnosis is dehydration. In this instance, it was caused by us, in our instructions for the patient not to eat or drink.
So when this patient said he was thirsty... he really meant it.