riv_nurse

Yes, pre-oxygenation buys you more time for apnea if you have airway difficulty, but it isn't a lapse in safety if it doesn't occur. So if there had been airway difficulty, it would have been a lapse in safety but since there wasn't, it was okay. I guess that doesn't make sense to me but as long as I don't have to chart it, I'm okay with it. I guess what really freaked me out about this whole experience from a safety point of view is that apparently no one did a sensory or motor check on the patient before the surgery started either. She clearly felt pain and was able to move her arm when she tried to get off the table. After the patient was out the surgeon basically tore the CRNA a new one about it. I guess I feel bad for the patient - somehow I let her down. She was really scared and now the chart doesn't even reflect what she went through. I guess I'm being too soft. I suppose after a few months I will get over it. Thanks for the responses.

Thanks jwk, Well I am new in the OR (just over 6 months) and this is the first time that anything remotely scary happened. This patient came in with the regional, very relaxed etc. She literally jumped when the surgeon made the incision and said she could feel it. He made the decision to quickly put her under and she literally tried to get off the table. I had originally charted the regional and I made a note in the chart about the conversion but another more experienced nurse later told me I did not need to and should remove the note and modify the anesthesia type to GA so I did but now I feel guilty about it and am worried that I did something wrong. As for the preox... it has always been done in all the surgeries I've been in on. This is the first case I've been on where there seems like there were so many lapses in patient safety. The patient is fine - she had some bp issues in the PACU - so I guess it shouldn't matter but I just feel like the chart doesn't reflect what actually occurred and that I may get in trouble.

If a patient comes into the OR with a block but it's discovered that the block isn't working (after the incision is made) and then GA has to be quickly administered (w/o preoxygenation), do I need to document this in the record if there are no other complications?