When attending to a weekend surgery at the hospital, make sure you don't find yourself all alone with too much to do.
A 61-year-old patient was the only scheduled surgery on a Saturday morning, where he was to undergo endoscopic retrograde cholangiopancreatography (ERCP) for suspected inflamed gallbladder/bile duct gallstones. The patient had type 2 diabetes, major depressive disorder, essential hypertension, and a remote history of a cerebrovascular accident. Dr A, the anesthesiologist for the surgery, classified the patient as ASA III [having severe systemic disease] and anticipated a difficult intubation.
On the morning of the scheduled surgery, Dr A, the only anesthesiologist on call at the hospital that weekend, learned that he was also to attend to a cesarean section for a patient with failed labor.
The ERCP started at 8:15 that morning and, after a difficult intubation, proceeded without incident. Surgery concluded at 9:25 but hospital staff notes at 9:35 showed the extubated, bag-masked patient in the post-anesthesia care unit (PACU) as unresponsive.
Dr A ordered new dosages of relaxant reversals, without improvement. Dr A then readministered a muscle relaxant and attempted to reintubate the patient. When the reintubation failed, Dr A was successful in placing a laryngeal mask airway (LMA). At 10 AM, with the LMA in place and connected to a ventilator, Dr A left the patient in the care of the nursing staff and respiratory therapists as he began general anesthesia for the cesarean section in the OR next door.
Medscape Editor's Key Notes:
• Be wary of staffing shortages, and when possible, reach out to leadership to see if additional on-duty or on-call staff are available.
• When the workload seems overwhelming, work with colleagues to see if schedules can be shifted to attempt the safest environment for patients.
• Juries will look to physicians to be patient advocates, so being assertive is sometimes necessary to achieve the best work environment and a good medical outcome.
© 2020 Cooperative of American Physicians, Inc.
This case comes from Medicine on Trial, originally published by Cooperative of American Physicians, Inc., to provide risk management lessons from litigated case histories.