Sunday, September 6, 2009

The Pancake

Two patients from the last few weeks stand out.

The first because of an unsual tattoo. The patient, a middle aged white collar type presented for minor surgery. He turned out to be a typical Tel Aviv Bohemian. After anesthesia was induced I exposed the chest to auscultate (i.e. listen to the breath sounds) after intubation. I was surprised to see an anatomically correct tattoo of the heart, the great vessels and the coronaries. The tattoo was similar to this one:

Without hesitating, I shouted, "Get the boys from cardiothoracic surgery in here stat, they might learn somethin!"

The next patient was also scheduled for minor surgery in a nether region. This is surgery that is performed in the prone position.
After performing a saddle block, we positioned the patient. At some point, the patient said he was dizzy, I glanced at the monitor which showed a heart rate of 34 and then he flat lined. "Asystole, we need to start CPR."
The surgeon asked if we should turn the patient back supine and I answered in the affirmative. The patient was no lightweight and neither was the surgeon who could have played linebacker on any NFL team.
Within seconds he flipped the patient over like a pancake. Luckily the patient started breathing again immediately on the position change. He probably developed a vasovagal response due to anxiety. The pressure of his abdomen on the vena cava probably didn't help either. Since the patient was feeling nauseous, we decided to postpone the surgery.

Afterwards I told the surgeon that it was a good thing he was there instead of an itsy bitsy 50 kg surgeon.


Ari said...

Surprised you hadn't given the patient something for the anxiety earlier on?

Unknown said...

The truth is he didn't act anxious. He had several surgical procedures done. He fainted during the scrub. I didn't mention that the surgeon is a personal friend of the patient. I guess having a friend muddle about his "nether" regions was too much excitement for one day.

cap said...

it's surprising what you can find on the skin of a patient. i remember some strange and amazing tattoos too.

Chrysalis said...

Well heck yeah. Poor guy was probably doing cartwheels inside his stomach. Not something most guys care to share with their bud.

I laughed at at the first one though. Who would think he'd have that kind of tattoo? See, you just never know about people.

SeaSpray said...

Interesting idea.. thinking about the patients that stand out the most.

So..was the patient to be awake for the surgery. is that what a saddle block an epidural?

And would a patient ever be asleep for that position?

And one more question.

when I go in for uro procedures..I have to skootch to the end of the table. It's not long after that I am out.

I could do it in my sleep because Ive done it so often. it is weird when the OR staff doesn't have to tell you what to do or explain anything.

But..i wonder about something.

Does the anesthesiologist wake me up so I can slide back over to a stretcher? i don't remember that. Could be the versed. although.. i am lying very still when I wake up in post op and I am conscious, but can't seem to open my eyes or move.

Why is that?

Ha! consequently..I've been privy to conversations staff might not want me to hear. :)

another gasman said...

saddle block is nice but to be the only technique especially in prone , this is guestionable as sedation is not good for someone going to be in prone position, this will compromise his breathing more. We have a say there is no short procedure for anesthetists and beleive me all the problems you will ever see come from what the surgeons say , its a quicky

Lioness said...

That is a vile tattoo, honestly, I can't fathom people at times.

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