What an awful smell!

[DrBodacious]

Okay, I want to throw this out there to see if there are any solutions to this problem that I have not thought of.

I have a nice eletrocautery generator in my office (I just started my practice in July, and it came with the practice).

There is a pretty stark difference between a highly ventilated operating room with suction that evacuates the bovie smoke from the room, and my procedure room, with a "Gomco" type suction built in to an ENT exam room cart. The Gomco suction just seems to concentrate the smell within the cart, so the cart smells terrible. And, the smell fills the whole room from there.

Bad smelling exam room = bad for business, IMO.

I have yet to get a quote on a suction system that would evacuate the smoke from the room, but I suspect that would be pretty expensive. I do have an attic space directly overhead. but it is hard to access to change suction canisters, etc.

The obvious solutions are related to increasing the ventilation in the room. Maybe a vent from the ENT cart to the attic? Or just increasing the air turn over in the room (i.e. bathroom vent fan, and maybe something built in the the HVAC to blow fresh air in).

Are there any filters or smell masking products that you can put in the suction that I don't know about?

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[Fah-Q]

Get rid of the electrocautery. I do lots of in-office procedures and never needed one. You can get the disposable handheld heat cautery units for about $8 each if you like making stuff bleed.

And yes, have your staff change out your suction canisters twice a week. They will stank if left any longer.

 

[Pir8DeacDoc]

What sort of things are you doing? I do a decent amount of skin cancer including local flaps and FTSG. The idea of not having one bothered me at first but I just tie off any obvious pumper and hold pressure on any oozing. Good local injection with plenty of time for effect is key. I inject my office surgeries before I see my last clinic patient of the morning or afternoon.

 

[DrBodacious]

Yes, I think that I will not be using it very much. I used it for an older woman with a 1cm lesion in the tonsils fossa (turned out to be actinomycosis). She had very favorable anatomy and a good composure, so it will probably be a while time before I have another oropharynx case I choose to do in the office.

It might be nice for other oral cavity biopsies, if it didn't stink so bad.

I set it up for a guy on blood thinners who I did a FTSG on, but I also injected the heck out of him with local, and ended up not using the bovie.

It is nice to know the heat cauteries are not that $, I will look in to that. I suppose if I had a scalp excision, the electocautery would be nice, but I haven't come across that yet.

Fahq- I do need to make sure my staff are on it twice per week like they are supposed to.

Pir8Deacdoc- where do you get most of you skin cancer referrals from? Derm or PCP? I love that stuff.

 

[Pir8DeacDoc]

I have inherited a nice situation in my practice.

1. I had on older partner (now retired) who had a lot of interest in skin lesions. Once he retired the referrals kept coming. We have become the place that people think of for these sort of things. We get them in quickly and try and take them off without a huge delay. Patients appreciate that.

2. We have only one dermatologist in our town. She has little to no interest in these things, even the primary closure ones. Before I came we must have established a nice relationship with her because she sends some. But a majority come from the PCP's. Closest Moh's surgeon is about an hour away. Patients in my area aren't terribly savvy, generally speaking, and are happy to have it removed and not have to make a long drive and sit around with a bandage on their face all afternoon.

The cases aren't great in terms of reimbursement when you consider clinic time, supplies, and instruments. But we all enjoy doing them and make an effort to continue that part of our practice. Once you lose that part of your practice it's gone. Plus, they're a lot of fun to do and patients are generally very grateful.