They did a c-section without anesthesia - page 5

The pt had an epidural, but it didn't do the trick. We don't have in-house anesthesia, and it took 20 minutes to get to the hospital. meanwhile there were heart tones in the toilet and the baby... Read More

  1. by   Jolie
    Quote from jwk
    If you place it, you manage it. Finish what you start. It has nothing to do with revenue. What happens when there is a complication? You think the anesthesia provider wants to manage problems with an epidural placed by an OB doc? Not a chance.
    To an extent, I understand and agree with what you are saying, but these MDAs were notorious for practicing obstetrical anesthesia at their convenience. This was a small hospital with a relatively low-risk population, and the MDAs were not required to be in house with active labor patients. They would drag their heels coming in when a mom requested an epidural and were similarly slow about returning to re-dose existing epidurals. The OBs were not enhancing their revenues by placing epidurals, they were simply trying to offer their patients timely pain relief.

    Also, although the MDAs claimed liability issues in dosing epidurals they had not personally placed, they re-dosed each-other's epidurals all the time, so that argument lost a bit of its believability. And think about it, we utilize existing IV and art lines all the time. We don't start a new IV simply because we think there is too great of a liability in infusing meds thru a line started by someone else. We assess the patency and appropriate placement of the line first, which is exactly what I would have expected the MDAs to do with the epidurals.
  2. by   imenid37
    Quote from jwk

    We also had an idiot anesthesia doc from another hospital place his wife's epidural AT HOME when she first went into labor, and then came to our hospital demanding that we use it and manage it. We told him we wouldn't. The OB nurses caught him dosing it when he thought they weren't looking, using drugs he had taken from his hospital. Not a smart move on his part, as he found out when he returned to work (for a very short time).
    What a jerk! I worked w/ a nurse who took demerol out of the narc box for an MDA to push postpartum for his soon to be ex-wife. (he had been kind enough to transmit HSV to her during the pregnancy). They were separated and he was not on duty at the time. There is no way I would have done this. Why did he have stuff for the epidural at home??? Maybe he can get together w/ the guy down in FL who was doing plastic surgeries at his patients homes. Unbelievable.
  3. by   Mrs.S
    Quote from SmilingBluEyes
    We have but one OB doc who will even touch an epidural and that is to turn it off, if needed. Other than that, nobody touches them except to discontinue at MDA order. We call the MDA in if the patients need re-bolusing or if a c/section is called. That is how it works at my smallish community hospital anyhow.

    This is how it is where I work too. I had no idea OB docs did stuff with epidurals at other places. THAT would be handy!
  4. by   merrick
    Quote from Mrs.S
    This is how it is where I work too. I had no idea OB docs did stuff with epidurals at other places. THAT would be handy!
    Yeah, I thought it was weird too after watching all those baby shows that always show an anesthesiologist, but apparantly it's the norm there for the docs (at least the ones in that practice) to do their own.
  5. by   jwk
    Quote from imenid37
    What a jerk! I worked w/ a nurse who took demerol out of the narc box for an MDA to push postpartum for his soon to be ex-wife. (he had been kind enough to transmit HSV to her during the pregnancy). They were separated and he was not on duty at the time. There is no way I would have done this. Why did he have stuff for the epidural at home??? Maybe he can get together w/ the guy down in FL who was doing plastic surgeries at his patients homes. Unbelievable.
    He stole the epidural tray, just like he stole the drugs.
  6. by   jwk
    Quote from Jolie
    To an extent, I understand and agree with what you are saying, but these MDAs were notorious for practicing obstetrical anesthesia at their convenience. This was a small hospital with a relatively low-risk population, and the MDAs were not required to be in house with active labor patients. They would drag their heels coming in when a mom requested an epidural and were similarly slow about returning to re-dose existing epidurals. The OBs were not enhancing their revenues by placing epidurals, they were simply trying to offer their patients timely pain relief.

    Also, although the MDAs claimed liability issues in dosing epidurals they had not personally placed, they re-dosed each-other's epidurals all the time, so that argument lost a bit of its believability. And think about it, we utilize existing IV and art lines all the time. We don't start a new IV simply because we think there is too great of a liability in infusing meds thru a line started by someone else. We assess the patency and appropriate placement of the line first, which is exactly what I would have expected the MDAs to do with the epidurals.
    An epidural is NOT anywhere close to being as innocuous as an IV or an art line. There's a lot of difference between a little phlebitis from poor sterile technique with an IV and poor technique with an epidural that can result in an epidural abscess that can turn someone into a paraplegic. Who gets blamed if there's a complication? Both if they both managed it.
  7. by   imenid37
    Quote from jwk
    He stole the epidural tray, just like he stole the drugs.
    I realized how dumb my question was later. What a doof and thought he could get away w/ it too. GEEZ!
  8. by   nurseKim28590
    in an obstetrical emergeny where there the fetal heart rate is low you don't have 20 minutes to wait for anesthesia, you don't have five minutes if you expect a reasonable outcome. i agree...i wouldn't work in an obstetrical unit that doesn't have in house anesthesia coverage...but the OB should have used a local. i work in a hospital with in house anesthesia coverage and have had situations where they just couldn't get here fast enough because they can't leave their patients on the table...never seen a case where the OB didn't give local...and if I'm the mom, I want them to do whatever is needed to get that baby out so it has a reasonable chance for a good outcome....but some local would be nice. Hopefully, the outcome was good, so that the mother can be thankful that the OB had the guts to go ahead and cut ....she has a healthy baby and the pain is over.
  9. by   PMFB-RN
    Quote from mom23RN
    There are hospitals in the UP of Michigan that don't even have a DOCTOR on staff - not even in the ER.
    *** Not just in the UP of MI either. Many small hospitals all over rural America have no doctor of any kind available 24/7. I used to be a frequient visitor to the ER of our local 12 bed hospital. After 5:00PM or any time on the weekend there was no doctor in the building. There was (and still is) a fantastic NP that runs the show. She has stitched me up half dozen times, flicked tiny bit of shredded brass out of my cornia with an 18ga needle, given me IV antibiotics after I stepped on a nail that first passed through my manure covered boot (I used to be a dairy farmer), set broken fingers, diagnosed and treated various broken bones in my feed, hands and arms, delivered our first born child and lots of other stuff. Total staff there was the NP, an RN, and a CNA. If they had many full beds maybe another RN or LPN.
  10. by   cozmo_blozmo
    So please tell us how you exope



    So please enlighten us as to how a hospital with a solo anesthesia provider is suppose to live at a hospital 24/7 265 days a year?




    Quote from BSNtobe2009
    I don't think having an CRNA in-house 24/7 makes a facility a Level I trauma center.

    The fact is, we aren't talking about some things that can be done TEMPORARILY by another doctor or nurse...Anesthesia is Anesthesia. If you don't have at minimum a CRNA there, then someone shouldn't have to choose between getting a surgery without property pain control and dying when immediate transport is not possible, and more is required to stablize a patient.

    I'm not saying that rural hospitals should be able to do everything and every hour....anesthesia is just something that I cannot believe hospitals "skimp" on. It's just too important.
  11. by   kimdanielrn
    I'm seen this before. I'm a NICU nursem and the baby was in distress.....The mother had no IV access....They had to hold her down to the bed. The epidural never worked. This hospital had a very good PR team.
  12. by   Mrs.S
    wow, that kinda boggles my mind that some of you have seen this bfore...doesn't sound like it happens too often though. I'm still perplexed as to why a local wasn't used; I'm wondering if it would have gone deep enough? anyway, thanks for your responses. I haven't gotten any answers to my questions at work yet, but I've had some time off so...if I find anything interesting out I'll update.
    thanks again
  13. by   heartICU
    Quote from kimdanielrn
    I'm seen this before. I'm a NICU nursem and the baby was in distress.....The mother had no IV access....They had to hold her down to the bed. The epidural never worked. This hospital had a very good PR team.
    Patient had an epidural yet no IV access? Hmmm...something fishy here.

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