Monitored Anesthesia Care

Question: Is it customary to use MAC (Monitored Anesthesia Care) for minor procedures? Lets consider Minor Procedures as those Level I procedures that involve skin lesions, moles, warts, cysts, lipomas and repair of lacerations or surgery limited to the skin and subcutaneous tissue. Could you use MAC on one of those procedures? I really need an Anesthesiologist friend to make a whole bunch of questions so anyone who is willing :)

Answer: You cold use MAC in combination with local, or just straight local.

Question: Did the hospital violate my informed consent? I recently had hand surgery and signed the anesthesia informed consent form in which I agreed to an axillary block and sedation. On the morning of my surgery, the person assigned to me was not qualified to do one so had to go and find an anesthesiologist. To make a long story short, it took a long time to find someone and then he never tested me for numbness andI ended up feeling the surgeon cut into me. The hospital said that the anesthetist assumed I would be having General Anesthesia since "most people who have hand surgery do" and hadn't looked at my chart. I got a copy of my medical records and I see on the consent form that I consented to the "axillary block and sedation" But on my chart it said "Monitored Anesthesia care with Local" which is different. Explains why the anesthetist was assigned to me - he would be qualified to do that. But why would the hospital admit to someone not looking at a chart instead of a chart error? Seems like the chart error is less negligent I am not looking to sue. I don't want to hurt anyone. I feel bad for the anesthetist and the anesthesiologist. They were put in a bad situation because of some dept. management issue. I am looking to find out what went wrong so that I can protect myself in the future.The surgeon did not plan to use local - he planned to use an axillary block. Why the anesthesia dept. made so many errors floors and concerns me. I have tried the Patient Advocacy office and Risk Management to get answers. Reasons I have received from the surgical services dept. are just out there (Most people have general anesthesia, it's common to test for numbness of the hand by lifting the arm). I have also found out that the contracted anesthesia corporation is being sued by anesthesiologists who work at the hospital because they haven't been paid. Anesthesiologists are leaving. I think the hospital didn't have enough staff and tried to give me GA instead of the block so they could use an anesthetist instead. The surgical services actually said that axillary blocks are rare for hand surgery. Most people have GA so the anesthetist assumed I would be having GA and hadn't looked at my chart. (yes they really said that) This is after he had handled me with latex gloves, started an IV of Versed... Of course he looked at my chart to checkfor allergies and see which side to start the IV on. My question is why would the hospital "admit" to a mistake that didn't happen. Makes me think that there is a bigger mistake behind it. I knew there was the possibility of having to go with GA if the regional didn't work. But I ssumed they would check to see if the block worked before cutting me open since various anesthesia references say that sensory and motor block are assessed before declaring a person surgically ready. If Anesthesiologists don't routinely check patients for numbness with regional anesthesia, that seems like a big problem to me. Not all patients want to sue. We want to trust doctors. Well the hospital website (and other resources) break anesthesia down into General, Regional, and Local. The informed consent I signed had a seperate section for MAC local which was not checked. The Regional Anesthesia box was checked with "axiillary block" noted. The axillary Block is (from my understanding) regional anesthesia which injects local anesthetic into the brachial prexus sheath to numb the nerves. My problem with the anesthesia I received was that the anesthesiologist did not check me for numbness before declaring me ready for surgery (and most likely did not allow adequate time for it to take effect). I felt the surgeon cut into my hand (down to the bone) as if I had no anesthesia at all. While I appreciate Pangolin's response. Her statement that I was only "treated poorly" seems to reflect the general apathy and insensitivity of the medical community. Like Sean said, that is what makes people angry (and likely to sue) and contributes to the doctor-patient distrust ***** So which came first the arrogant, apathetic doctor with no empathy or the frivolous medical malpractice lawsuit? Hmmm.... Reply to Dr. Arch. There was a problem with the anesthetist assigned - he was not qualified to do an axillary block which is why he had to waste15 precious minutes looking for an anesthesiologist. I got an anesthetist who was not qualified to do an axillary block. He never discussed the anesthesia with me either so I assumed he was going to do the block since that is what the surgeon, anesthesia dept and I had decided on the week before. It was only when I talked to the surgeon after he checked my site that the surgeon reminded the anesthetist that I was having a block. So then the anesthetist had to go find an anesthesiologist to do one. The hospital said that because "most people have general for hand surgery" that the anesthetist hadn't looked at my chart and assumed that that was what I was having. I got a copy of the anesthesia eval and the planned anesthesia said MAC local (instead of axillary block). The hospital's def of MAC local is sedation and then the surgeon injects local into the surgical site. So to me it seems like he did read the chart and was doing the right thing. But why would the hospital say he didn't read the chart unless there's a bigger error to hide?

Answer: OR schedules are crazy. We don't usually get much information in anesthesia until the afternoon before. ALL anesthetics are potential general anesthetics, and you should have been told that (if the local anesthetic had caused as seizure, for example, you go to sleep and get intubated for airway protection). Medicine does not come with any guarantees. Surgeons usually post the case and one of the things they put on the posting is the anticipated anesthetic. I'd guess your surgeon planned to do the case with local. From this and your other posts, it seems the charting was less than spectacular. If you're looking for a reason to sue, though, you have to have some serious damage, like permanent injury or death. Being treated poorly doesn't make much of a case.

Question: Puppy died from anesthesia? I am grieving the loss of my little baby. 1 and a half year old puppy died from anesthesia. I noticed he was walking funny, kinda stiff, so I took him to the vet immediately. They did a Lyme's disease test and it was negative. They told me it's possible it was his back, put him on Prednisone and a pain reliever with complete rest. I followed all instructions to a T. In a one week period of time, took him back 4 times because it was progressively getting worse. They finally told me to see a neurologist, got me the appointment to go there immediately. Once I got there, they proceeded to tell me they didn't perform MRIs until Monday morning. It is Friday at this point. They told me it's definitely his back, they would monitor him until Monday and we would go forward with MRI and possible surgery. Sunday morning comes, 7:30 a.m., and they called me and said his condition was worsening and they needed to perform a myelogram. An hour later, said he had a herniated disk, they removed it and it was a success. Another hour goes by and they call me to tell me My little puppy stopped breathing. They had critical care there and he had a 50/50 chance to start breathing again on his own. Needless to say, I waited 5 minutes, called them back and said I was on my way. They told me a doctor would get back to me. 15 minutes later, they said chances were still 50/50. My husband and I rushed, a 1 hour drive to the hospital, where they proceeded to tell me that he would not make it. That is the summary of treatment. With all that said and done, we decided to take him off life support and die on his own. Strangely, when I felt his chest for a heartbeat 3 seconds later, there was none. It left me a little puzzeled. Now a receive a whooping bill of $4000 for my baby's death. My heart is just breaking that I lost him due to anesthesia, especially due to his age, and blood stats and urine was perfect 2 days prior. I do not know if they performed more tests before surgery. This was a healthy 1 and a half year old puppy, he had been under anesthesia before for neutering and was fine. While reviewing the bill, I noticed a charge for an euthinization injection. I never approved of this, nor did I know it was administered. Come to question, was he even alive when I arrived there. I am so desperately reaching out for answers and no one will help. I tried to procede to do a necropsy, but wanted to go outside the hospital that did the surgery. NO ONE will perform it unless he is a patient there. I had requested to keep him "REFRIGERATED" for a day until I got back to them. Sure enough, the froze him. It goes on and on. Does anyone have any answers for me of why this would happen, dying from anesthesia in a healthy puppy...do you thing there is foul play here? This is not about money or a lawsuit, it is trying to find closure and put my baby's soul to rest. Please, please can someone tell me what you think! Thank you everyone for all your emotional support. My puppy was a 25 pound Beagle/King Charles mix. He was my pride and joy. I am having a very hard time coping with his lose and your kind words are comforting. I just hurts so bad, and I keep thinking did I make the right decisions. Did I do this to my baby. I was told he would be fine, that it is common in Beagles. I would have given him the world if I could have. I will contact the hospital once I get my baby's ashes. I am fearful if I do or say anything wrong they will not release him. As far as ICEBREAKER - your words cut right through me. May God forgive you. Take off the breaker on your name - ICE! An example, if a family member went into the hospital for a gallbladder operation and died from anesthesia, would that be acceptable to you? And, no, the law does not compare our beloved pets to a chair. Poor selection of words for anyone greiving such a loss. I need to know if I did everything possible for my baby!

Answer: I'm so sorry you lost your dog. I understand how heartbroken you are. It doesn't sound like his death was due to the anesthesia. He evidently came out of the anesthetic but he was a very sick little boy. I don't want to upset you but he wasn't a healthy little boy or you would not have seen him deteriorating to the point where you needed to take him to the vet 4 times within a week. He was very ill and getting worse, which is why you needed the expertise of a neurologist. I honestly doubt there was foul play, they want their patients to survive to go on to live a long healthy life. They also are very upset when they lose a patient. Health regulations determine that they must freeze the body if it is to remain with the vet. They don't have the option to refrigerate without freezing unless an autopsy has already been arranged and they are given your permission to proceed with it. Did you contact your own vet to see if he was prepared to oversee or organize the autopsy? They probably could have arranged that. I would absolutely refuse to pay the charge for the euthanasia injection. They have charged you for something they didn't do. Don't pay for it. They are adding insult to injury and I would be having words with them about it. This is hard enough on you as it is without you needing to dispute the bill due to their error. As for the $4000 bill, it sounds reasonable considering the tests, surgery and hospital care. I paid over $5000 for TPLO on my dog's knee and she was only in hospital overnight. Specialist fees are very expensive. Take your time to grieve the loss of your boy....and take care of yourself. You did everything humanly possible to help him but sometimes it's not meant to be. It hurts so much and acceptance is so difficult. I feel your pain, I have recently lost my much loved girl to cancer. She had to be euthanised to spare suffering. As my vet said, this beautiful girl was only halfway through her life. Your story has touched my heart. I light a candle each night for my girl and I will think of you and your boy when I light it tonight.

Question: Need help in getting over surgery phobia because of anesthesia awareness and reactions to paralytics.? I have had four episodes of anesthesia awareness and severe prolonged reactions to paralytic agents. Was completely paralyzed for 6 hours two times yet not hooked up to any monitors so couldn't tell anyone anything. Nurses kept recording on my chart, "patient asleep." I need to have surgery and can't bring myself to risk it again. I've been suffering something like post-traumatic stress disorder for years as a result. I'm terribly distraught. I need hip surgery so badly I can't get around; I'm losing my ability to earn an income; yet I'm so phobic I can't consent to surgery. I've heard and researched something about pseudocholinesterase deficiency, yet health care professionals just poo-poo me, which is what they've done before resulting in horrific experiences. Help!

Answer: let the doctors know about it, that way they can whack you over the head with the bedpan before any injections or anything to make sure your asleep.

Question: What do pet owners think about "vet techs" who think they shouldn't have to have an education? There are lots of people who use the title "veterinary technician" who haven't gone to school and think its not worth it. Or who want to be a "vet tech" without having to earn a degree in veterinary technology. What do you think about having those people who may have as little as a few minutes of instruction on how to monitor anesthesia as the only people monitoring your pet while performing a dental cleaning under anesthesia with no one else in the room? Do you think that the people who are providing nursing care for your pet should be educated? Do you owners who think experience is more important than an education understand that often all of the training that they get on the job is less than 3 minutes of instruction and then turned loose. For example, I have asked the "tech" at a local clinic who I know was currently performing a dental how much training she had (the vet wasn't even on the premises and she had worked in the clinic for less than a month and she had an animal under anesthesia) and she said "I've watched someone perform one". And this person was monitoring anesthesia and performing the dental cleaning at the same time. (And this was her first job at a clinic.)

Answer: I agree, they should be educated. It just makes sense for them to receive an education and learn anesthesia, parasitology, proper animal restraint, etc. That being said, I have worked with some outstanding "vet techs" who were not formally educated, and I have worked with some terrible LVTs. So I do not think education is any guarantee for their abilities...but it would be nice if it was required for everyone.

Question: Care to share your wisdom teeth extraction nightmares? I had all four of my infected, impacted, abscessed, fully grown wisdom teeth extracted yesterday. The only oral surgeon in the state my insurance would allow me to use was, of course, a two hour drive away. Upon further research, I found that he has had to pay a few settlements to patients, bad reviews from patients, and actual warnings from a couple of them. Of course, I only googled this the night before my procedure so there was no way of getting out of it. The dental hygienist had instructed me to take two triazolam for anxiety (which is a kind of benzodiazapine also known as Halcion, a powerful sleeping aid) and a benadryl. This was an hour before my appointment. I (thought) I knew my body pretty well and how I would react to the sleeping pills. But when it was time for me to sit in the operating chair, I was feeling somewhat normal. Not at all how I should be feeling after taking two powerful sleeping pills! So, they gave me another one. When I groggily brought up the fact that this was my third, the nurse looked at me with much surprise, like she had no idea that I had already taken TWO. Anyway, they put in the catheter in my arm, the Valium drip, and told me to try to fall asleep. I successfully put my body to sleep, but my mind was still somewhat lucid. A few minutes later, after drifting off to sleep, I feel an agonizing pain in my mouth. The method the oral surgeon used to perform surgery was a laser, instead of a scalpel and drill. I was told this is extremely less painful. Yeah, right. I begin to cry. I remember the surgeon saying, "I can't Fu***** believe she can feel this!" and shoving an anesthetic gas mask over my face. For some reason, I couldn't figure out what to do with it, and they had to take out the braces holding my mouth open so I could breathe in the gas. About an hour later, I awoke to much more agony! I somehow took off the heart rate monitor that was on my finger and thrust it across the room. I call the dentist a mother fu**** and begin to yell and cry. They scramble to stick the roof of my mouth with a long, very painful needle (local anesthetic..?) and give me more gas. And then I wake up AGAIN!! This time they don't bother putting me out, as they are just putting in the last of the stitches and I had already had triple (or more) the amount of anesthesia, sleeping pills, and local anesthetic normally used. After the surgery, I learned they ended up using a drill after all because one of my teeth was so badly impacted. They told my boyfriend and my mom to "play down my stories of agony" in hopes that I wouldn't have a fear of the dentist in the future. Yeah. OK. They even had to tell me that I was dreaming as I woke up the last time so I wouldn't try to sock the hygienist again. My mom later told me that she heard me scream and forced her way into the OR. SO they prop me up in the chair and give me a Disney movie to watch as I "recover" from the drugs, toss me into a wheelchair, and send me home. I did some research on the triazolam, and apparently, it is supposed to cause amnesia. It is banned in the UK because it causes psychosis, and the normal, "safe" dosage is .25 mg. I had .75 mg yesterday, and I still remember a LOT of what was happening to me, even though I was also on Valium and anesthesia gas and local anesthetic. Anyway, I am now happily on much pain medication and living off of mashed potatoes and strawberry smoothies. What is your horror story?

Answer: wow did you go to a chop shop or what! i'm 24 and i've had 9 surgeries including all four of my impacted wisdom teeth removed and honestly that was the easiest experience of them all. i went to an oral surgeon thats literally down the street and around the corner. i went in waited about 5 minutes and was taken back to the room. i had the monitors put on me and an oxygen mask on my nose and they put in the IV. they did have trouble with the IV cuz my veins are very bad and hard to see so that was a bit painful. after they gave me the drugs (a sedative and an amnesai drug so that if/when i did wake up during the procedure i wouldn't remember it). i don't wake up well from drugs so i was still half unconscious and they quickly helped me into an other room to take a little longer to wake up cuz they had another patient coming in and they didn't want her to see me like that and freak her out lol. i then went home and tried to have some chocolate milk but it kept falling back out of my mouth due to the gauze in my mouth. they only gave me one pain pill to take so i took it and since i didn't have food in my stomach it made me feel insainely drunk. i slept for about 5 hours and when i woke up i felt pretty much back to normal. and i started eating what ever i wanted that same day. when i went back for a check up the surgeon said it was a good thing that i choose to have the IV sedation cuz my wisdom teeth were in there really good and were really hard to get out. i did have a little bone fragment in my gum line as a result of the surgery but he filed it down so that was no longer a problem. overall my experience was perfectly fine.

Question: can anyone tell me which acute care record report these questions would be found & if inpatient or outpatient? 1. HEENT: Reveals the tympanic membranes, nares, and pharynx to be clear. No obvious head trauma. CHEST: Good bilateral chest sounds 2. Microscopic: Sections are of squamous mucosa with no atypia. 3. Admit to 3C. Diet: NPO Meds: Compazine 10mg IV Q 6 PRN 4. Following induction of an adequate general anesthesia, with the patient supine on the padded table, the left upper extremity was prepped and draped in the standard fashion. 5. CBC: WBC 12.0H, RBC 4.65, HGB 14.8, HCT 43.3, MCV 93 6. I authorize and direct William Smith, MD, my surgeon, and/or associates of his choice to perform the following operation upon me. 7. 38 weeks gestation, Apgar’s 8/9, 6# 9.8 oz., good cry, to room with mom. 8. Diagnoses: chronic atrial fibrillation, congestive heart failure, old myocardial infarction. She will be followed by me in the office. 9. Spoke to the attending re: my assessment. Provided adoption and counseling information. Spoke to CPS re: referral. Case manager to meet with patient and family. 10. I was asked to evaluate this Level I trauma patient with an open left humeral epicondylar fracture. Recommendations; Proceed with urgent surgery for debridement, irrigation, and treatment of open fracture. 11. c/o slight tingling in fingers, better when arm out of sling, fingers warm, color pink, wiggles fingers, will monitor. 12. PA and Lateral Chest: the lungs are clear. The heart and mediastinum are normal in size and configuration. There are minor degenerative changes of the lower thoracic spine. 13. Admit to 3C. Diet NPO Meds: Compazine 10mg IV Q 6 PRN 14. CBC: WBC 12.0H, RBC 4.65 HGB 14.8, HCT 43.3 MCV 93

Answer: Kennewick Irrigation District

Question: Is it strange that my hospital's Maternity Center pricing info sounds like a Fancy Hotel in the Bahamas? Personalized delivery packages are tailored to the individual needs of mother and baby. Packages include • External fetal monitoring • Local anesthetic • Maternal labs (CBC, type and screen) • Most maternal and newborn supplies • Non-prescription maternal medication • Well newborn medication and vaccines (vitamin K, erythromycin, Hep B) • Maternal labor care • Well newborn care and labs (metabolic screen, cord blood workup) • Epidural anesthesia supplies and medication • Newborn Algo hearing test One-night maternity package Hospital stay post-delivery includes one overnight stay. Cost: $5,216.67 Two-night maternity package Hospital stay post-delivery includes two overnight stays. Cost: $7,328.37 Three-night cesarean package Hospital stay post-delivery includes three overnight stays. Cost: $10,765.85 Four-night cesarean package Hospital stay post-delivery includes four overnight stays. Cost: $12,772.57 Shannon: I live right next door, in Alaska. =)

Answer: thats why i went to a BIRTHING CENTER with a midwife. it costs all of about 5k and is accepted by insurance. it is way less evasive than hospital care and is a much easier process (on you and the baby). It provides just as much care as a hospital and generally has a lower mortality rate for moms and babies. despite what many women think, active labor (the part that you feel) is about 4 hrs long, and it is more of a dull ache than the screaming pain you see on tv. the only part that actually hurts is the pushing because you stretch. rent Ricki Lakes business of Being Born video. its awesome and i think every mom should see it. Ashly www.mymerrymaternity.com Sexy lingerie for Pregnancy, Nursing, and after baby Curves!

Question: what do you think of my birth plan? did you write one out like this? 02/07/2009 Please follow ********'s birth plan unless a serious complication or emergency occurs in the birth of her daughter. **** **** *** is *****’s birth partner and has say in the labor & delivery. Sincerely, **** ******** LABOR I would like to be free to walk around during labor. I wish to be able to move around and change position at will throughout labor. I would like to be able to have fluids by mouth throughout the first stage of labor. I would like the environment to be kept as quiet as possible. I would like the lights in the room to be kept low during my labor. I would prefer to keep the number of vaginal exams to a minimum. I do not want an IV unless I become dehydrated. MONITORING I do not want an internal monitor unless the baby has shown some sign of distress. LABOR AUGMENTATION/INDUCTION I do not wish to have the amniotic membrane ruptured artificially unless signs of fetal distress require internal monitoring. If labor is not progressing, I would like to have the amniotic membrane ruptured before other methods are used to augment labor. I would prefer to be allowed to try changing position and other natural methods (walking, nipple stimulation) before pitocin is administered. Before pitocin is administered I must express consent. ANESTHESIA/PAIN MEDICATION I would like to have a standard epidural. CESAREAN Unless absolutely necessary, I would like to avoid a Cesarean. If my primary care provider determines that a Cesarean delivery is indicated, I would like to obtain a second opinion from another physician if time allows. If a Cesarean delivery is indicated, I would like to be fully informed and to participate in the decision-making process. I would like (coach) present at all times if the baby requires a Cesarean delivery. So I can view the birth, I would like the screen lowered just before delivery of the baby. If the baby is not in distress, the baby should be given to (coach) immediately after birth. EPISIOTOMY I would appreciate guidance in when to push and when to stop pushing so the perineum can stretch. If possible, I would like to use perineal massage to help avoid the need for an episiotomy. I would prefer an episiotomy rather than a tear. I would like a local anesthetic to repair a tear or an episiotomy. DELIVERY I would like to be allowed to choose the position in which I give birth, including squatting. I would like Rob and/or nurses to support me and my legs as necessary during the pushing stage. I would like a mirror available so I can see the baby's head when it crowns. I would like the chance to touch the baby's head when it crowns. Even if I am fully dilated, and assuming the baby is not in distress, I would like to try to wait until I feel the urge to push before beginning the pushing phase. I would appreciate having the room lights turned low for the actual delivery. I would appreciate having the room as quiet as possible when the baby is born. I would like to have the baby placed on my stomach/chest immediately after delivery. I would appreciate being able to use the birthing tub for pain relief until I receive an epidural. IMMEDIATELY AFTER DELIVERY I would like to have Rob cut the cord. I would prefer that the umbilical cord stop pulsating before it is cut. I would like to hold the baby while I deliver the placenta and any tissue repairs are made. I would like to hold the baby for at least fifteen minutes before (he/she) is photographed, examined, etc. I plan to keep the baby near me following birth and would appreciate if the evaluation of the baby can be done with the baby on my abdomen, with both of us covered by a warm blanket, unless there is an unusual situation. If the baby must be taken from me to receive medical treatment, Rob or some other person I designate will accompany the baby at all times. I would prefer to hold the baby rather than have (him/her) placed under heat lamps. I do not want a routine injection of pitocin after the delivery to aid in expelling the placenta unless I request it. I would like to delay the eye medication for the baby until a couple hours after birth. I would like to donate the umbilical cord blood if possible. I would like to see the placenta after it is delivered. I would like to bathe the baby with Rob first. ALL medications and medical procedures administered to the baby or myself are to be fully explained and my consent must be expressed I am to deliver the placenta, I do not want it ripped or pulled out, however I would welcome gentle assistance. POSTPARTUM I would like a private room, if available. Unless required for health reasons, I do not wish to be separated from my baby. I would like to have the baby "room in" and be with me at all times. BREASTFEEDING I plan to breastfeed th Sorry its so long you dont have to read it all! i used a birth plan generator to help word things, i wanted it to sound demanding because i want people to take it seriously because i meant every word i put in there you are in labor for a while before you have an epidural, thats when i want to be able to walk around.. i know it is not possible to walk while on an epidural im not stupid. also, no you dont need an IV. how do you think women in birth centers do it? i realize once the epidural is administered then i may need some extra fluids but until then i do not want an IV. i put the things about the positions in there because i am going to try and go without an epidural for as long as i can and use the birthing tub. there is one in every room where i am giving birth. i realize that i will most likely end up with an epidural and WHEN that happens i dont have an issue with an IV, but i dont want them to put an IV in right away, i want to wait until it is 100% necessary for the epidural

Answer: It sounds like you've thought everything through and are trying to achieve the best possible birth experience for both you and your baby. There's nothing wrong with that at all. Good for you! I don't think many women do this. The next step is to talk about your birth plan with your doctor, and visit the hospital where you plan to deliver to find out their policies. Mine absolutely required an IV, but was flexible about everything else. The only thing I would change if this were my own birth plan would be the epidural. Everything you see and hear makes the pain seem SO bad, but really, it's manageable. I wasn't against an epidural when I delivered my son, but I'm really glad I didn't have one. Think about trying it without for awhile, and only having one if you really need it. The hot tub helps. Overall, great job, Mom!

Question: Update on wisdom tooth removal! 4 bony impacted wisdom teeth removal? Okay folks I have had the worst and best time with these 4 impacted wisdom teeth. Lets start off with the appointment on 8/13/2010, I was told not to eat or drink anything for 8 hours before the surgery and was given Triazolam ( 2 pills to take an hour before going in) well I did as requested, I remember getting to the drs office, I remember them giving me 2 more of those same pills and then I remember them sticking needles in my gums, and I must have went to sleep again because I woke up screaming with this oral surgeon trying to pull my top impacted wisdom tooth out and my blood pressure was through the roof, so he stopped and stitched me up and referred me to another oral surgeon that does general anesthesia, so My husband and best friend drive me to the referred dentist office and they advised “ now I should stop here and tell you that with triazolam will cause you to have memory problems” so I am telling you all of this information that has been provided to me by my husband and best friend because I don’t even remember leaving the first dentist office. The second dentist advised that I couldn’t have it done that day because of the triazolam that they gave me and he was not going to risk my life putting me under with those drugs in my systems. So I get home at around 11:30 am and I did not snap back until 6PM, when I asked my husband for something to eat and that I needed to make a phone call, I started to realize that something wasn’t right, my phone was broken, I had a hole in my wall, my lap top was dinged up pretty bad, so that’s when I started to ask questions, apparently I was extremely angry and threw my phone and lap top several times and broke the phone, and screamed cursed and yelled even at the referred doctor. So after laughing and apologizing to everyone, ( not really sure what for because I don’t remember anything but I was told I said some pretty mean things to my husband and caused him to cry so I don’t care if I don’t remember I was going to apologize for that regardless) . So I get a new appointment with the new dr for 8/20 to be put to sleep and have the teeth removed. So I don’t eat anything or drink anything for 10 hours and the appointment is at 2pm on the 8/20 so I decieded to go into work to get some things done, and I put a piece of freaking gum in my mouth and chewed it and it was SO good, so off to my appointment, I get there and they call me to the back and I ask for a trash can to spit the gum out and they all look at me like I have LOST my mind, catcher… you cant chew GUM either which I didn’t think was a big deal but they did because if you threw up while under it could get in your lungs and you could die, SO I had to reschedule! BLAH at this point I am truly over it and if it wasn’t for the pain in my mouth I would have said F you all and ran out of the drs office. So 8/24/2010 at 2 once again was the date, I didn’t eat or drink or even brush my teeth because I was not going to reschedule this surgery once again, so I get there in the waiting room and sit and wait and they call me back, I sit in the chair, they hook me up to some monitors on my chest and finger and the blood pressure machine and then he puts the needle in and I swear it didn’t hurt a bit, he pushes some medicine in and I asked was I about to go out and he said not yet that was just something to relax me, and then I got really cold, they gave me a nice fluffy blanket and the next thing I know they said count backwards from 100, I got to 99 and the next thing I know they were telling me to wake up, I kept asking if it was done and they told me yes like 10 times, I had a breathing tube and everything and I did not notice at all, I wasn’t in any pain when I left, it just felt really numb and my face was swollen. So if anyone is thinking of trying “ oral conscious sedation” I would not recommend it from my experience, it does nothing for pain. General anesthesia is the way to go and I would not do anything different. I am on day 3 after removal and I am doing great, swelling is a yes, pain is some what but not too bad with all the meds I have and ice cream is like heaven. The only bummer was the price different, which oral sedation it was 535.00 and that was with my insurance. With general it was 1650.00 and that was with my insurance paying 1k of the amount.

Answer: Wow I feel really bad for you! I also had conscious sedation and it was through an IV and it was the best thing I did. I remember going in and them putting the IV in and asking me pointless questions and the next thing I remember is waking up in my bed 4 hours after the surgery!!!!! I am just like you when it comes to stuff like that, when I first heard it was conscious sedation I flipped out and almost canceled. They then told me all the risks of general and told me that there were different levels of conscious sedation and that they would make sure they "snowed me out". It is actually kind of funny seeing how I was after it, my little sister took a video of me after the surgery and I continually slept and asked for water. I was as innocent as a 5 year old and believed everything. I still don't remember what happened after but I have that to give me a good laugh. I'm glad that yours finally worked out in the end.

Question: In October of '08 I went into the hospital for same day surgery? to have nasal polyps removed. They gave me too much anesthesia, and too many fluids, causing me to go into Congestive Heart Failure. Not only did they conceal this info from me, they are also refusing to take care of the extra added on expenses I incurred as a result of their error. No attorney will take this case because I did not die. (seriously). I feel my only alternative at this point is to start at the bottom with the Bureau of Consumer Affairs, and go up from there. All I really want is to be compensated for the care I needed as a result of their error. They had to keep me in the hospital to run cardiac tests and monitor me. What do you think I should do?

Answer: there are a great many variables involved here, and that is why no attorney will take your case, you cannot prove that the fluids caused your chf, as there may have been a pre-existing factor that caused your body to have troubles dealing with the fluid, and the hospital lawyers would certainly point that out. suggest that you just have to learn from this experience and move on with your life

Question: Want to read the beginning of a story I've started? I don't know what I'm going to do with this...should it be developed into a novel or just a short story? It's just a scene that popped into my head. Opinions? “Hey, Diezel! Remember me?” I typed the words into my cell phone slowly, deliberately. The Oxycodone was just starting to kick in and I could barely keep my eyes open. As I finally managed to hit the send button, my head lulled back against my pillow that was elevated against the arm of the couch I was laying across. I didn’t remember much about the procedure. I could remember the slightly heavy and jolly nurse mentioning my miss-matched sunshine yellow and vibrant pink flip-flops as I climbed into the dentist’s chair. “Couldn’t find a matching pare?” she asked with a smile. “No, I was just indecisive this morning,” I smiled back as I tried to make myself comfortable. It wasn’t that hard for me to do, thankfully due to the easy going atmosphere of the nurse and the oral surgeon and anesthesiologist as the two men came to join us while the nurse began to hook me up to the heart monitor. I remember watching my heartbeat being put into a visual of a steady green wave as the kindly middle-aged anesthesiologist asked if being put under anesthesia was traumatic for me. “Not traumatic,” I answered truthfully. “I’m a little nervous but that’s just because I’ve never gone under before…I’ve never even had an IV or anything.” He smiled and reassured me that I had nothing to worry about as he inspected my right arm to see if I had a good vein to use. Seemingly pleased with his findings, he wrapped a blue band around my bicep as I saw the number 89 in big green bold letters near the top of the heart monitor screen. “So where are you going to school next year, Revelle?” the jolly man with half-moon spectacles and mostly gray short hair asked me – to distract me, I was sure – as he waited for my vein to be ready to use. “Washington State,” I said. “Oh, Wazzu!” he said cheerily. “And what do you plan on studying there?” “I’m aiming to go into Zoology.” “Cool,” he said with the same enthusiasm as he sanitized the inside of my elbow. “Is there anything specific you want to do with that degree?” The oral surgeon asked me. I diverted my gaze to him, “I want to work in non-profit,” I answered as I felt something extremely cold on the arm the anesthesiologist was working on. “Hopefully the World Wildlife Fund,” I specified as I ignored the strange sensation. “Wow! A kid that actually cares about a cause!” the nurse said. “It’s not often we see an eighteen year old that isn’t all about the ‘me, me, me,’ is it, doc?” “Nope, it’s not,” the two men both said in unison. “Now, this will be a slight bit of discomfort,” the anesthesiologist warned as he began to insert the IV. I cringed slightly as I felt the needle go in, but it wasn’t that bad. “I’m going to lay you back, hon,” the nurse advised me just as I felt the chair automatically begin to recline. “You have beautiful hair,” she added as she pulled it from over my shoulders so that it lay down my back and out of the way. “There’s Happy Drug Number One,” the anesthesiologist said as I saw a clear liquid being drained into my arm. I concentrated on trying to feel the “Happy” that he had promised but I couldn’t feel anything. The nurse began to move my arms onto my lap. She turned my arm so she could read the text on my SocialVibe wristband. “Get Sponsored. Give Back,” she read aloud. “And…there’s Happy Drug Number Two.” The nurse began to wrap the thin blue sheets over my torso. “I’m gonna cover you up because it gets a little messy,” she explained. I don’t remember if I vocalized how much I wished she didn’t say that or not… The next thing I remembered was being wheeled out to the car, minus four wisdom teeth. I don’t remember getting into the car, but I remember my mom mentioning dropping my prescription off at Walgreen’s before taking me home since it took fifteen minutes for the pharmacy to get the meds ready. She dropped me off at home and left again to get the Oxycodone and Hydrocodone. My dad lead me to the couch where he propped pillows behind my head and covered me with a blanket before I quickly dozed off again, the anesthesia still not faded completely from my bloodstream. My mother arrived shortly after I feel asleep to give me my Oxycodone. I didn’t really know what had encouraged me to text Diezel for the first time in months. I remember figuring it was the drugs, but I didn’t really care. I wanted to talk to him. I missed him. I'm currently working on the second draft of a novel that is completely unrelated to this, so I think - that is, if my novel is as good as I hope it is - that I can write novels. This story is kind of a way for me to give myself a break from the novel and it's plot that I've been stuck with for a year, but I've never done a short story, so we'll see... And yeah, I kind of just threw the first names that came into my head in there. Like I said, the scene just popped into my head so I wasn't in the mood to research the perfect names. I'm sure I'll change 'em later on if I continue with this story.

Answer: It sounds really good. I write also. If you ever come across a book called 'When Enemies Collide' you'll know I finally got published. anyway I really liked it. You seem very talented. I don't know whether to make it a short story or not though. If you think you can keep up the good writing all the way through a novel then that's what you should write. Some people can write short stories very well but can't write novels. Some can write novels and not short stories. Some can write both. It just depends on the person. Me, I write novels. Short stories hate me.

Question: What do you think of this beginning of a story? I don't know what I'm going to do with this...should it be developed into a novel or just a short story? It's just a scene that popped into my head. Opinions? “Hey, Diezel! Remember me?” I typed the words into my cell phone slowly, deliberately. The Oxycodone was just starting to kick in and I could barely keep my eyes open. As I finally managed to hit the send button, my head lulled back against my pillow that was elevated against the arm of the couch I was laying across. I didn’t remember much about the procedure. I could remember the slightly heavy and jolly nurse mentioning my miss-matched sunshine yellow and vibrant pink flip-flops as I climbed into the dentist’s chair. “Couldn’t find a matching pare?” she asked with a smile. “No, I was just indecisive this morning,” I smiled back as I tried to make myself comfortable. It wasn’t that hard for me to do, thankfully due to the easy going atmosphere of the nurse and the oral surgeon and anesthesiologist as the two men came to join us while the nurse began to hook me up to the heart monitor. I remember watching my heartbeat being put into a visual of a steady green wave as the kindly middle-aged anesthesiologist asked if being put under anesthesia was traumatic for me. “Not traumatic,” I answered truthfully. “I’m a little nervous but that’s just because I’ve never gone under before…I’ve never even had an IV or anything.” He smiled and reassured me that I had nothing to worry about as he inspected my right arm to see if I had a good vein to use. Seemingly pleased with his findings, he wrapped a blue band around my bicep as I saw the number 89 in big green bold letters near the top of the heart monitor screen. “So where are you going to school next year, Revelle?” the jolly man with half-moon spectacles and mostly gray short hair asked me – to distract me, I was sure – as he waited for my vein to be ready to use. “Washington State,” I said. “Oh, Wazzu!” he said cheerily. “And what do you plan on studying there?” “I’m aiming to go into Zoology.” “Cool,” he said with the same enthusiasm as he sanitized the inside of my elbow. “Is there anything specific you want to do with that degree?” The oral surgeon asked me. I diverted my gaze to him, “I want to work in non-profit,” I answered as I felt something extremely cold on the arm the anesthesiologist was working on. “Hopefully the World Wildlife Fund,” I specified as I ignored the strange sensation. “Wow! A kid that actually cares about a cause!” the nurse said. “It’s not often we see an eighteen year old that isn’t all about the ‘me, me, me,’ is it, doc?” “Nope, it’s not,” the two men both said in unison. “Now, this will be a slight bit of discomfort,” the anesthesiologist warned as he began to insert the IV. I cringed slightly as I felt the needle go in, but it wasn’t that bad. “I’m going to lay you back, hon,” the nurse advised me just as I felt the chair automatically begin to recline. “You have beautiful hair,” she added as she pulled it from over my shoulders so that it lay down my back and out of the way. “There’s Happy Drug Number One,” the anesthesiologist said as I saw a clear liquid being drained into my arm. I concentrated on trying to feel the “Happy” that he had promised but I couldn’t feel anything. The nurse began to move my arms onto my lap. She turned my arm so she could read the text on my SocialVibe wristband. “Get Sponsored. Give Back,” she read aloud. “And…there’s Happy Drug Number Two.” The nurse began to wrap the thin blue sheets over my torso. “I’m gonna cover you up because it gets a little messy,” she explained. I don’t remember if I vocalized how much I wished she didn’t say that or not… The next thing I remembered was being wheeled out to the car, minus four wisdom teeth. I don’t remember getting into the car, but I remember my mom mentioning dropping my prescription off at Walgreen’s before taking me home since it took fifteen minutes for the pharmacy to get the meds ready. She dropped me off at home and left again to get the Oxycodone and Hydrocodone. My dad lead me to the couch where he propped pillows behind my head and covered me with a blanket before I quickly dozed off again, the anesthesia still not faded completely from my bloodstream. My mother arrived shortly after I feel asleep to give me my Oxycodone. I didn’t really know what had encouraged me to text Diezel for the first time in months. I remember figuring it was the drugs, but I didn’t really care. I wanted to talk to him. I missed him.

Answer: Great...waiting to hear the rest of the SHORT STORY !!!

Question: Is MAC (Monitored Anesthesia Care) considered only as a Level II or III type surgery? I am trying to define whether a surgery is Level I, II or III. If MAC is provided to the patient, would that necessarily make it a Level II or III type surgery? Do you know of any document, report, paper, regulation and/or statement that defines MAC for Level II or III type surgeries?

Answer: yes, it is

Question: Canine Dog Vasectomy? I recently questioned why we neuter aka castrate our dogs as opposed to having them vasectomized. I found out that castrations are not done in Europe, but vasectomies are very common. It turns out we are behind (yet again). After a lot of research, I was able to find a vet nearby who was both experienced and willing to give my puppy beagle a vasectomy instead! I live in CT. The cost for the procedure, monitoring, anesthesia, post-op care, and anti-inflamitories to go home is $378. Required pre-op blood-work is $50. Is anyone else in CT interested in this, and what have you paid for neutering if you've already gone that route?

Answer: umm, what difference does it make if you neuter your dog or have a vasectomy done? it is the same thing only thing different is the dog gets to keep its scrotum which is of no use anyhow after a vasectomy other then cosmetic reasons and do you think the dog is vain to where it cares one way or another about that? also neuturing removes some agression and the feeling of the need to make babies where as a vasectomy allows the body to continue to produce semen and leaves the sex drive intact and the semen is just reabsorbed into the body so is letting the dog keep his scrotum and his sex drive worth the mental stress i feel it causes since you dont allow the dog to have sex with another dog anyhow may as well remove the testicles and ease the feelings of needing to do that from the dog

Question: can anyone tell me which acute care record report these questions would be found & if inpatient or outpatient? 1. HEENT: Reveals the tympanic membranes, nares, and pharynx to be clear. No obvious head trauma. CHEST: Good bilateral chest sounds 2. Microscopic: Sections are of squamous mucosa with no atypia. 3. Admit to 3C. Diet: NPO Meds: Compazine 10mg IV Q 6 PRN 4. Following induction of an adequate general anesthesia, with the patient supine on the padded table, the left upper extremity was prepped and draped in the standard fashion. 5. CBC: WBC 12.0H, RBC 4.65, HGB 14.8, HCT 43.3, MCV 93 6. I authorize and direct William Smith, MD, my surgeon, and/or associates of his choice to perform the following operation upon me. 7. 38 weeks gestation, Apgar’s 8/9, 6# 9.8 oz., good cry, to room with mom. 8. Diagnoses: chronic atrial fibrillation, congestive heart failure, old myocardial infarction. She will be followed by me in the office. 9. Spoke to the attending re: my assessment. Provided adoption and counseling information. Spoke to CPS re: referral. Case manager to meet with patient and family. 10. I was asked to evaluate this Level I trauma patient with an open left humeral epicondylar fracture. Recommendations; Proceed with urgent surgery for debridement, irrigation, and treatment of open fracture. 11. c/o slight tingling in fingers, better when arm out of sling, fingers warm, color pink, wiggles fingers, will monitor. 12. PA and Lateral Chest: the lungs are clear. The heart and mediastinum are normal in size and configuration. There are minor degenerative changes of the lower thoracic spine. 13. Admit to 3C. Diet NPO Meds: Compazine 10mg IV Q 6 PRN 14. CBC: WBC 12.0H, RBC 4.65 HGB 14.8, HCT 43.3 MCV 93

Answer: 1. H&P 2. Path report 3. Orders 4. Operative report 5. Lab report 6. Informed consent 7. Delivery note 8. Discharge report 9. Social work note? 10. Orthopedic consult 11. Progress note 12. Radiology report 13. Orders 14. Lab report

Question: Where can you surrender cats in the Buffalo NY area (No-kill)? I have a friend who is not the wealthiest of people that has a whole bunch of cats in his house (around 20 or so) that he just cannot afford. None of them are spayed/neutered or have vaccines, because his family cant afford that. I have been trying to help him find a place for these animals to go but it is proving to be easier said than done. He wants them to go to a no-kill shelter so some place like the SPCA wouldn't work. We have looked into HEART Animal Rescue, but they only take in strays and overflow from the SPCA not personal surrenders. We have also looked at Ten Lives Club, but they are full. We are going to try to give Second Chance a call to see what they can do for us. But we are running out of options and ideas. We've tried everything from trying to work something out with my school (I am studying to become a vet tech and my school spays and neuters outside animals for free in exchange for using them in our classes to learn how to monitor them while they are under anesthesia and assist during surgery, but the animals have to be vaccinated before they can come on campus which just isn't possible for him) to looking into low cost spaying and neutering ($80 for a spay/neuter plus a rabies and distemper vaccines), but they cant afford that either. They are basically stuck between a rock and hard place and I'm trying to help get them out not only because i care about him as a friend but, obviously because I want to help the animals. So any ideas about what we could do or where we could take them would be great, thank you ******PLEASE READ THIS. The cats are NOT in horrible living conditions like you see on Animal Planet, the house is kept clean, the animals are feed, and their litter boxes are kept clean. It is just hard for them to get ends to meet while having so many cats on a small income******

Answer: There are not enough homes, I am so sorry. If they are outdoors contact a feral cat rescue, allie cat allies ect for assistance. call vets to ask for help on cost. Do a media stint. :) Seperate all the females and males asap. Good luck even if not feral contact the orgs for help http://www.feralcat.com/ http://www.alleycat.org/NetCommunity/Pag…

Question: Surgical Technologist Competency Test Help, Please? Surgical Staff, Inc. Surgical Technologist Competency Test Instructions:____Circle the correct answer 4. The minimum exposure time for unwrapped instruments in a flash sterilizer set at 270oF (132oC) and 27 lbs. per square inch is: a. 2 minutes. c. 4 minutes. b. 3 minutes. 5. Malignant hyperthermia is characterized by: a. Slow verbal sounds during anesthesia. c. A gradual cooling of body temperature. b. Rapid increase in body temperature. 6. Which article MUST be kept functioning until the patient leaves the room? a. Suction b. Electrosurgical unit c. Surgical lights 7. If a pack of sponges contains an incorrect number of sponges, the scrub person should a. Retain the pack on a back table. c. Include the pack in the sponge count. b. Pass the pack off to the circulator to remove from the room. 8. When a patient is positioned in the reverse Trendelenburg position, what additional table accessory will be needed? a. Foot board b. Shoulder braces c. Stirrups 9. The goal of aseptic technique is to: a. Optimize primary wound healing. c. Minimize the length of recovery. b. Prevent surgical infection d. All of the above 11. The complications of endoscopy procedures include: a. Infection. c. Hemorrhage. b. Perforation. d. All of the above 13. The complete destruction of all living organisms is known as: a. Disinfection. b. Sterilization. c. Bactericidal. 14. What quality control device ensures the absence of all living organisms? a. Process monitors (indicators) b. Biological monitors c. Chemical indicator 17. For aseptic purposes, covering a sterile table for later use a. Is permissible for up to 1 hour before the procedure. c. Is not recommended by AORN. b. Is permissible for up to 2 hours before the procedure. 18. To be effective in killing microorganisms, steam sterilization requires specific a. Temperatures and pressures. b. Temperatures and times. c. Times and pressures. 20. The acronym MAC stands for: a. Mixed anesthesia b. Manipulated anesthesia comfort. c. Monitored anesthesia care.

Answer: 4 b 5 c 6 b 7 a 8 b 9 b 11 b 13 b 14a 17 c 18 a 20 c