Oximetry
I don't know what I dreamed last night, only that the dream finished like a good story, ended like falling into deep sleep after a long, productive day. If there were a way for me to give that night to D, I would gladly have spent a sleepless night in his place. But sleep can't be given. We can be robbed of sleep, but we cannot have it as a gift. Anesthesia is not sleep, no matter how often we call it that, no matter how much it looks like sleep.
Odd overheard question this week, a surgeon telling an anesthesiologist that there is nothing more to be researched in this field. Anesthesiologist aghast. He'd like to be able to monitor exactly how much of the drugs are functionally in the patient, for one thing. Oh, they can watch vital signs (pulse oximetry only generally available within the last 30* years) and carefully titrate all their drugs, but there is no way to know how much is metabolized, how much actually in the bloodstream. Better drugs, a lot of new information coming out of doing so many nerve blocks with ultrasound, reports of myalgia with succinylcholine, are all research areas. He even mentioned acupuncture. Surgeon agreed, and subsided. This is part of what I love about my work, seeing the edges of ignorance shoved back a little.
Had my own ignorance shoved back as well. Removing metal from patients is not about electro-cautery (bovie) grounding issues. As the bovie is today, there is no issue of burning, only the much older models, with poor systems for grounding, were a problem. With current (ha) gel pads, even large amounts of implanted metal, the electricity does not cause burns. The machines simply won't function if the pads pull away. So, we remove rings to avoid swelling, and tape down piercings that won't come out to avoid pressure sores or loss of the jewelry. NOT, as I had always been taught, because of burns. And bipolar devices have never been an issue, as are used in arthroscopy, laparoscopy, and most hand cases, since the current is only at the tip of the forceps or coagulator.
Just as our newer c-arms, especially the mini c-arms, are just not much of a hazard as we use them in orthopedic surgery.
I also learned just this year that ortho means "right" or "straight" not bone, as I'd always assumed. In medical terminology, it's used as though it means bone, but that's Osseo, not ortho. I'm not going into how I missed the Pedi part. All greek to me.
*Pulse oximetry only became standard of care in the US in 1987. Imperfect as it is still. Glad I graduated nursing school after this.
Odd overheard question this week, a surgeon telling an anesthesiologist that there is nothing more to be researched in this field. Anesthesiologist aghast. He'd like to be able to monitor exactly how much of the drugs are functionally in the patient, for one thing. Oh, they can watch vital signs (pulse oximetry only generally available within the last 30* years) and carefully titrate all their drugs, but there is no way to know how much is metabolized, how much actually in the bloodstream. Better drugs, a lot of new information coming out of doing so many nerve blocks with ultrasound, reports of myalgia with succinylcholine, are all research areas. He even mentioned acupuncture. Surgeon agreed, and subsided. This is part of what I love about my work, seeing the edges of ignorance shoved back a little.
Had my own ignorance shoved back as well. Removing metal from patients is not about electro-cautery (bovie) grounding issues. As the bovie is today, there is no issue of burning, only the much older models, with poor systems for grounding, were a problem. With current (ha) gel pads, even large amounts of implanted metal, the electricity does not cause burns. The machines simply won't function if the pads pull away. So, we remove rings to avoid swelling, and tape down piercings that won't come out to avoid pressure sores or loss of the jewelry. NOT, as I had always been taught, because of burns. And bipolar devices have never been an issue, as are used in arthroscopy, laparoscopy, and most hand cases, since the current is only at the tip of the forceps or coagulator.
Just as our newer c-arms, especially the mini c-arms, are just not much of a hazard as we use them in orthopedic surgery.
I also learned just this year that ortho means "right" or "straight" not bone, as I'd always assumed. In medical terminology, it's used as though it means bone, but that's Osseo, not ortho. I'm not going into how I missed the Pedi part. All greek to me.
*Pulse oximetry only became standard of care in the US in 1987. Imperfect as it is still. Glad I graduated nursing school after this.
Labels: surgery
Posted by Zhoen on Wednesday, January 12, 2011
2 comments:
Your own posts so often shove back the edges of my ignorance. Many thanks.
Thank you! I learned something about electrocautery. Late in the day, but good to know.
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