They did a c-section without anesthesia

  1. 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 needed out, so...they just did it without him. no local or anything. I wasn't there but it sounds like it was a horrific case.
    have you seen anything like this, and if so, what were the repercussions if any?
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  2. 93 Comments

  3. by   BSNtobe2009
    I grew up in a rural area and very often, the anesthesia was on-call.

    I often think about cases like that where emergency doesn't even begin to describe it, and by the time they get in their car to drive to the hospital the patient could be dead.

    It just blows my mind that there isn't laws requiring at least one to stay at a hospital 24/7.
  4. by   Jolie
    I don't begin to understand why a local wasn't used. It still wouldn't have been optimal in terms of anesthesia, but would have spared the mother horrific pain, and doesn't require much time, or the presence of an anesthesia provider.
  5. by   muffie
    how are mom and baby ?
  6. by   jwk
    Quote from Mrs.S
    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 needed out, so...they just did it without him. no local or anything. I wasn't there but it sounds like it was a horrific case.
    have you seen anything like this, and if so, what were the repercussions if any?
    Sounds like your OB panicked. There's no excuse or rationale for not putting in local.
  7. by   jwk
    Quote from BSNtobe2009
    I grew up in a rural area and very often, the anesthesia was on-call.

    I often think about cases like that where emergency doesn't even begin to describe it, and by the time they get in their car to drive to the hospital the patient could be dead.

    It just blows my mind that there isn't laws requiring at least one to stay at a hospital 24/7.
    You're kidding, right?

    There are areas of the country where a single CRNA might cover 5 rural hospitals in 5 different counties.

    There are still areas of the country where an FP delivers babies instead of an OB doc. Why does this still happen?

    The better question is "Why should a hospital that only delivers a few babies a week or even a month be allowed to offer OB services at all?"
  8. by   hoppermom3
    I work in a small rural hospital with a FP and a CNM who deliver. We do less than 30 deliveries a month. We have had excellent outcomes, low C-section rate, and high patient satisfaction rate.
    I myself have had babies at both large and small hospitals, one with an OB, one with FP, and even one with DO. My best experience was at a small county hospital hospital with the DO.
    I know that there are certain risks with small facilities, but for our patients a two hour drive to a larger facility also presents a risk.
  9. by   BSNtobe2009
    Quote from jwk
    You're kidding, right?

    There are areas of the country where a single CRNA might cover 5 rural hospitals in 5 different counties.

    There are still areas of the country where an FP delivers babies instead of an OB doc. Why does this still happen?

    The better question is "Why should a hospital that only delivers a few babies a week or even a month be allowed to offer OB services at all?"
    Good question....the nearest hospital aside from the local ones that don't have a CRNA is 1 1/2 hours away.
  10. by   SmilingBluEyes
    I have trouble with any place providing OB services that does not have IMMEDIATE anesthesia coverage on-call and at the ready. I would not work in such a place, either.
  11. by   Spidey's mom
    Quote from SmilingBluEyes
    I have trouble with any place providing OB services that does not have IMMEDIATE anesthesia coverage on-call and at the ready. I would not work in such a place, either.
    What is your definition of "immediate"?

    Our surgery crew, for unscheduled things, are on-call and have 20 minutes to respond. Our CRNA lives 5 miles away.

    We do ortho and general surgery and cesareans. Planned things obviously the crew is already in-house. Unplanned - like a bad fall at a local campground and a broken ankle . . .. or a hot appy . . . or a emergent cesarean . . all covered by the entire surgery crew that is on-call.

    We have very good outcomes regarding timeliness.

    As to the op's example, I too don't understand not using local and why didn't the doc re-dose the epidural to see if it would work?

    steph
  12. by   SmilingBluEyes
    That is immediate enough. I guess I should rephrase. Ours is defined as 20 minutes response and ready to cut. that is not really immediate....you are right to point out, Steph.

    But if we have a VBAC in house, in labor, then immediate means exactly that. IN HOUSE dedicated OB and MDA throughout active labor of TOLAC, no exceptions. I should add, we have our own OR suite and do our own csections, so in dire cases, if ordered to, we wheel em back and get em prepped while dr/MDA are coming in. That saves some time.

    So you see where I am coming from. I would not work in a place that was described to share CRNA with other hospitals at the same time. NOPE.
  13. by   Spidey's mom
    Quote from SmilingBluEyes
    That is immediate enough. I guess I should rephrase. Ours is defined as 20 minutes response and ready to cut. that is not really immediate....you are right to point out, Steph.

    But if we have a VBAC in house, in labor, then immediate means exactly that. IN HOUSE dedicated OB and MDA throughout active labor of TOLAC, no exceptions. I should add, we have our own OR suite and do our own csections, so in dire cases, if ordered to, we wheel em back and get em prepped while dr/MDA are coming in. That saves some time.

    So you see where I am coming from. I would not work in a place that was described to share CRNA with other hospitals at the same time. NOPE.
    We don't do VBAC's . . . .

    Our CRNA is on-call 24/7. He does take time off and a replacement CRNA comes and stays in our registry housing.

    I wouldn't share our CRNA either . .. .

    steph
  14. by   imenid37
    I work at a place probably similar to Deb and Steph. The anesthesia coverage is 24/7, but not in house. They have 30 min. from decision to incision. We almost never fail to meet it for a stat. I can't remember any cases in the last 10 yrs. where we didn't. I think in certain cases, like a blizzard, that anesthesia should have to stay onsite. I had a doc come in to place an epidural a couple of years ago during a snow storm and then leave. To me, that is not acceptable. He said if a stat was needed, Ob could call himand then he could tell her how to "dose it up." Yeah, right. BTW 4/5 of our ob's are DO's and they are really good doctors. We have a drill to practice how we would prep pt. for stat C/S and we have a local anesthesia box at the ready.

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