That is fine, but you will have to move with your entier family to another location because the L and D nurse doesnt like your attitude at 2 am. They are very sensitive to that ****.. Its a social thing you have to be on you rbest behavior and cant tell a parturient she is being UNREASONABLE
Seriously, are there anesthesiology departments/employers who are dumb enough to believe the ob nurses complaints and/or take them seriously?
YES
Same experience re: nurses and timing of the epidural - so dumb... yet mistakes repeated over and over and over
your chairman is going to hear about it when they dont want you assigned to OB anymore or minimally
Can I ask a question about your last selling point? How often do you bolus up the epidural for a section? And do your patients ever feel like they had the bait and switch when you pull it for a spinal?
I very infrequently had this happen with an epidural. Can usually tell if the epidural was questionable, in that case I would pull it.
An attending had told me to never try and sell a procedure. If they are hesitant about a block, spinal, epidural and there really is no big medical reason, don't ever sell it.
I tend to agree with that sentiment too.
I dont think you will have problems selling an epidural on L and D. It sells itself.
? there is no chairman? even with partnership there is a hospital heirarchy . you are young in your career, it wont be a long one if you are constantly picking battles with nurses.. personally i like OB and would find it insulting to be banned from OB
in general i agree, but you are talking about using your expertise to lead people in the right direction on a subject they may not be correctly informed about. you want to be in control of the timing. dont leave it up to the nurses. do whatever it takes to do whats right for the patient...
until people starting saying epidural during child birth is a human right. not so elective anymore if they want it!
ive very rarely had to pull a labor epidural and do a spinal for a section..
Last I checked this is the anesthesia forum. If the OB says we need to section, then we need to section. I’m certainly not going to throw my 2 cents in.....
Besides the money, can I ask why you like OB? Honest question.
Some women already think that.
OB is a place where you can walk in and be a hero. You take someone and are a part of their beautiful moment. They stop you in the supermarket and say thanks, showing off their now 3 year old kid. Your wife tells you her friends thought you were awesome. Quite literally, the only thank you cards I have ever received have been from OB moms, and there are many of those every year.
Sheesh. Never, ever have I ever received a card from an OB patient. Ever. Many of these women are very entitled and think it’s their “right” to request an epidural whenever they want even when they push you away hours earlier. .
The epidural hematoma, persistent paresthesia and pdph is a human right too ..
Maybe you aren’t smiling enough when you are placing that epidural.
Let’s be realistic, once you have done a few hundred or thousand it is pretty rare to have a “tricky” one.
Infidelity, and a lot of drama.
You need more than a few hundred to encounter all of the diff scenarios.... Maybe a thousand.. But Still Im close to that number and I get ones that I struggle with 2- 3x redirect before finding the space and even then while its in a good place I cant believe I was so close to a wet tap and how extremely subtle the loss was... makes you humble for sure.
i like doing epidurals, i like interacting with the mom and OB team, yes they can both drive you nuts, but i think the people who DONT like OB are the ones who arent very personable and just want to keep quiet in the OR behind the drape. I have no problem interacting with mom and explaining what and why I am doing what I am doing, and what I think is best in a given situation. I like the little tricks that make things go smoother, like a neo drip after a spinal.. its just got a lot of anesthesia science and thought process. I managed it in downtown boston for 3 years every time I was on call, which was a lot.. now in my local community these cases are super easy for me and I enjoy them.. but just like many things with our field, its often relegated to CRNAs who are bad at it
In real life, I am personable. I am just not good at kissing ass in or outside the OR.
While I agree with this in theory, we all know L&D floor is full of ticking time bombs. 100% health patients can suddenly code for a handful of reasons including some that have nothing to do with performing an elective procedure.
This is just called "Normal Anesthesiologist". 99% of us didn't do this to keep people awake and small talk.
This I believe is true and I definitely have hot takes.
100%
You should never need to pull a working epidural to do a spinal for a c-section. 15-20cc of 2% lidocaine will last a good 2hrs. Even if she starts to " feel" just give 5 more ccs, see where they are in the case progress, and use the other drugs at your disposal (Prop, midaz, etc) Now you mentioned "residency" so I understand things are slower but when you get to "the real world" you dont need to make that part of your practice.
This is all 1000% true. I don't like covering OB but I also feel like I'm pretty good at it. A lot of factors come into play and quite honestly I think it affects a lot of patient outcomes. For the most part, as said above, when you make these patients go from a pain of 15 to a pain of zero, some would consider leaving their husbands at that very moment. Of course not everyone is grateful and those are the moments I really hate it. I also dislike C/S. People shouldn't be awake with laparotomy incisions, but that's just my opinion.
Even then....I may have to do it over Zoom
Then the epidural placed isn’t working the vast majority of the time.
Your first statement is just plain false. Your second paragraph is technically true, but like @Mman above said, it's an inferior block to a proper spinal. Having to use versed and ketamine more frequently than with a spinal to get them through should be evidence of that.
But you just proved my point. An inferior block needing a spinal is a bad block. Plain and simple. I’ve certainly placed spinals in ladies who have said “this block isn’t great” prior to me dosing the epidural only to turn them and see the catheter basically out.
